多频震荡排痰机在重症肺炎患者的护理研究

  目的  探讨多频震荡排痰机在ICU重症肺炎患者的护理效果，为其应用提供参考。  方法  按随机数字法将衢州市人民医院2018年1月—2019年12月收治的122例ICU重症肺炎患者分为2组，每组61例，2组患者均给予常规治疗，在此基础上对照组应用传统手工扣背排痰，观察组应用多频震荡排痰机排痰。治疗后，比较2组日均排痰量、体温(T)、降钙素原(PCT)、C反应蛋白(CRP)、白细胞计数(WBC)、动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、临床肺部感染评分(CPIS)、血管活性药物使用时间、机械通气时间、ICU住院时间、总住院时间、急性生理和慢性健康状况评分(APACHE Ⅱ)及28 d病死率。  结果  治疗后观察组总有效率(95.08%)显著高于对照组(77.05%，χ2=8.296，P=0.016)。治疗后，2组PCT、CRP、WBC、PaCO₂、T、CPIS水平均明显降低(均P < 0.05)，且观察组低于对照组(均P < 0.05)；2组PaO₂水平升高(均P < 0.05)，且观察组高于对照组(P < 0.05)；观察组日均排痰量明显高于对照组(P < 0.05)，观察组血管活性药物使用时间、机械通气时间、ICU住院时间、总住院时间明显短于对照组(均P < 0.05)；2组APACHE Ⅱ评分显著降低(均P < 0.05)，且观察组低于对照组(P < 0.05)。治疗后观察组28 d病死率(1.64%)低于对照组(8.20%)，但差异无统计学意义(χ2=1.578，P=0.209)。  结论  应用多频震荡排痰机治疗ICU重症肺炎，可明显缩短患者血管活性药物使用时间、机械通气时间、ICU住院时间，促进患者排痰，减轻患者炎症反应，改善患者血气水平，治疗效果较佳。 

Study on Nursing Care of Patients with Severe Pneumonia with Multi-frequency Vibrating Sputum Extractor

Objective To explore the nursing effect of multi-frequency concussion sputum extractor in ICU patients with severe pneumonia. Methods According to the random number method, 122 patients with severe pneumonia in ICU admitted by Quzhou City People’s hospital, from January 2018 to December 2019, were divided into two groups, with 61 patients in each group. Both groups were given conventional treatment. On this basis, the control group was treated with traditional manual back button sputum drainage, and the observation group was treated with multi-frequency shock sputum drainage machine. After treatment, the average daily sputum volume, temperature(T), calcitonin(PCT) and c-reactive protein(CRP) and white blood cell count(WBC), arterial blood oxygen partial pressure, arterial blood(PaO2), CO2 partial pressure(PaCO2) and clinical pulmonary infection score(CPIS), vascular active drug use time, mechanical ventilation, ICU length of hospital stay, the total length of hospital stay, acute physiology and chronic health evaluation(APACHE Ⅱ) and 28 d case fatality rate of change were compared between two groups. Results The total effective rate of the observation group(95.08%) was significantly higher than that of the control group(77.05%, χ²=8.296, P=0.016). After treatment, the levels of PCT, CRP, WBC, PaCO2, T and CPIS in both groups were significantly reduced(all P<0.05), and the observation group was lower than the control group(all P<0.05). PaO2 level increased in the two groups(all P<0.05), and was higher in the observation group than in the control group(P<0.05). The average daily sputum output of the observation group was significantly higher than that of the control group(P<0.05). After treatment, the use time, mechanical ventilation time, length of stay in ICU and total length of stay in the observation group were significantly shorter than those in the control group(all P<0.05). APACHE Ⅱ scores of the two groups were significantly reduced(all P<0.05), and the observation group was lower than the control group(P<0.05).The case fatality rate of the observation group on day 28(1.64%) was lower than that of the control group(8.20%), but the difference was not statistically significant(χ2=1.578, P=0.209). Conclusion The application of multi-frequency oscillatory sputum ejector in the treatment of severe pneumonia in ICU can significantly shorten the use time of vasoactive drugs, mechanical ventilation time and ICU hospitalization time, promote the sputum ejector, reduce the inflammatory response of patients, improve the blood gas level of patients, and the treatment effect is better.