ICU过渡期多学科协作心肺...在重症肺炎患者中的应用效果_梁进丽.pdf

第 41 卷第 1 期2023 年 2 月广东医科大学学报JOURNAL OF GUANGDONG MEDICAL UNIVERSITYVol.41 No.1Feb.2023672017,1541:303-309.8 GARDNER D K,LANE M,STEVENS J,et al.Blastocyst score affects implantation and pregnancy outcome:Towards a single blastocyst transfer J.Fertil Steril,2000,73(6):1155-1158.9 ZHANG H G,ZHANG X Y,ZHANG H Y,et al.Balanced reciprocal translocation at amniocentesis:Cytogenetic detection and implications for genetic counselingJ.Genet Mol Res,2016,15(3):15038556.10 WILCH E S,MORTON C C.Historical and clinical perspectives on chromosomal translocationsJ.Adv Exp Med Biology,2018,1044:1-14.11 VASILEVSKA M,IVANOVSKA E,KUBELKA SABIT K,et al.The incidence and type of chromosomal translocations from prenatal diagnosis of 3800 patients in the republic of macedonia J.Balkan J Med Genet,2013,16(2):23-28.12 PEK A J R,PANCZAK A,MIHALOV R,et al.Pericentric inversion of human chromosome 9 epidemiology study in czech males and females J.Folia Biol,2015,61(4):140-146.13 CHEN Y,XU Y,CAO X,et al.Three patients with 46,X,inv(Y)(p11.2q11.2)pat/45,X and their pedigree analysis J.Ann Hum Genet,2020,84(4):331-338.14 WANG Y,LI G,ZUO M Z,et al.Y chromosome polymorphisms may contribute to an increased risk of male-induced unexplained recurrent miscarriage J.Biosci REP,2017,37(2):BSR20160528.15 XIE P,HU L,TAN Y,et al.Retrospective analysis of meiotic segregation pattern and interchromosomal effects in blastocysts from inversion preimplantation genetic testing cycles J.Fertil Steril,2019,112(2):336-342.16 ASKARI S G,KHATBASREH M,EHRAMPOUSH M H,et al.The relationship between environmental exposures and hormonal abnormalities in pregnant women:An epidemiological study in Yazd,Iran J.Women Birth,2018,31(3):e204-e209.17 李鸿.孕妇发生胎儿染色体非整倍体疾病妊娠的风险因素及处置 J.中国优生与遗传杂志,2020,28(12):1450-1452.18 谢建渝,谢家宁,余海花,等.孕妇发生胎儿染色体非整倍体疾病妊娠的风险因素研究 J.国际检验医学杂志,2018,39(23):2911-2915.19 IRVING C,BASU A,RICHMOND S,et al.Twenty-year trends in prevalence and survival of Down syndrome J.Eur J Hum Genet,2008,16(11):1336-1340.20 张敬旭.环境优生学的发展与展望J.中国优生与遗传杂志,2019,27(9):1025-1027.ICU 过渡期多学科协作心肺康复在重症肺炎患者中的应用效果梁进丽1，徐二喜2，李冬芬1，陆志英1（广东省佛山市南海区第四人民医院 1.ICU；2.心内消化科，广东佛山 528211）摘要：目的了解ICU 过渡期重症肺炎患者应用多学科协作心肺康复的效果。方法86 例ICU 监护的重症肺炎患者为研究对象，随机分为常规干预组和多学科协作组，每组 43 例。常规干预组进行常规干预，多学科协作组进行多学科协作心肺康复干预，比较两组的APACHE 评分、肺功能指标、舒适度、48 h 重返ICU 率、风险事件发生率及护理投诉情况。结果干预后，两组患者的APACHE 评分均降低，且多学科协作组降低更显著（P0.01）；多学科协作组患者的第 1 秒最大呼气量、用力肺活量、第 1 秒最大呼气量/用力肺活量均高于常规干预组，48 h 重返ICU 率、风险事件发生率及护理投诉率均低于常规干预组（P0.05 或 0.01）。结论在ICU 过渡期应用多学科协作心肺康复能够缓解患者病情，改善肺功能，提高舒适度。关键词：重症肺炎；多学科协作心肺康复；ICU 过渡期；舒适度中图分类号：R 47 文献标志码：A 文章编号：2096-3610（2023）01-0067-04Application effect of multidisciplinary collaborative cardiopulmonary rehabilitation in patients with severe pneumonia during the ICU transitionLIANG Jin-li1,XU Er-xi2,LI Dong-fen1,LU Zhi-ying1(1.ICU;2.Department of Cardiac Gastroenterology,Nanhai Fourth People s Hospital,Foshan 528211,China)收稿日期：2022-07-19基金项目：佛山市医学类科技攻关项目（2020001005550）作者简介：梁进丽（1986-），女，本科，主管护师，E-mail：广东医科大学学报682023年 第41卷Abstract:ObjectiveTo understand the application effect of multidisciplinary collaborative cardiopulmonary rehabilitation in patients with severe pneumonia in the transition period of intensive care unit(ICU).MethodsA total of 86 patients with severe pneumonia who were monitored in ICU were selected as the research objects and randomly divided into the Routine Intervention Group and Multidisciplinary Collaboration Group,43 cases in each group.The Routine Intervention Group was given routine intervention while the Multidisciplinary Collaboration Group was given multidisciplinary collaborative cardiopulmonary rehabilitation.The APACHE II score,pulmonary function indexes,comfort level,48 h return to ICU,incidence of risk events and nursing complaints were compared between the two groups.ResultsAfter intervention,both groups had the APACHE II score significantly decreased,and the Multidisciplinary Collaboration Group showed a more significant decrease(P0.01).The Multidisciplinary Collaboration Group had the FEV1,FVC and FEV1/FVC higher than the Routine Intervention Group,and had the 48 h return to ICU,incidence of risk events and nursing complaints lower than the Routine Intervention Group(P0.05）。纳入标准：（1）首发为重症肺炎；（2）从ICU 转普通病房住院时间少于 1 周。排除标准：（1）重大器官损伤者；（2）资料不齐全者；（3）合并血液系统疾病者；（4）具有精神意识障碍者；（5）严重肝肾功能障碍。本实验已得患者及家属的同意，且获本院伦理委会审批。1.2方法常规干预组对重症肺炎患者进行常规护理，包括：（1）监测患者体温、血压、脉搏等基本情况；（2）定期对病房进行消毒，开窗通风，保持病房环境干净卫生；（3）指导患者日常饮食；（4）对患者及时进行心理疏导；（5）指导患者进行康复训练。多学科协作组在常规护理的基础上对患者进行多学科协作心肺康复干预，具体如下：（1）组建多学科协作小组，选 2 名ICU过渡期联络护士为护理组长，主要负责日常沟通；组员分别为营养科、心理科、康复科医师各 1 名，负责整合各自科室的临床专业优势对患者进行干预，通过分析病患的实际情况对其进行转科治疗，并将转入科室的责任医生、护士任命为临时护理团队成员，对患者实施过渡期干预；（2）转科前干预：医护工作者需对患者介绍转入科室的基本情况及转出目的，对患者进行相应评估并将其结果及临床资料转给临时护理组成员，以便确定后续的治疗方案；（3）转科时干预：ICU主治护士与联络护士为患者办理转科手续，做好交接工作，同时创建重症肺炎护理工作群以方便ICU 医护工作者对患者提供持续性支持；（4）转科后干预：根据ICU 提供的评估及临床资料，同时结合本科室的护理优势，进行心肺康复训练，包括对患者进行呼吸训练（每日 2 次呼吸操及持续 1015 min 腹式呼吸、缩唇呼吸，同时进行有效咳嗽排痰训练）、运动训练、生活方式第1 期梁进丽，等.ICU 过渡期多学科协作心肺康复在重症肺炎患者中的应用效果69干预、日常饮食干预、心理护理，同时给予患者相应的医护支持，加强药物管理，鼓励患者结合自身实际情况进行自主调整。患者转出ICU 的第 1、2、3、5 天，多学科协作小组固定成员需进行