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基于目标管理的呼吸集束护理在胃肠手术呼吸风险患者中的应用

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目的 探究基于目标管理的呼吸集束护理对胃肠手术呼吸风险患者术后肺功能、肺部并发症和术后恢复质量的影响.方法 选取 2021 年 4 月—11 月在广州市某三级甲等综合医院胃肠外科病房进行择期手术的 80 例呼吸风险评估为中、高风险的患者作为研究对象,以手术时间的先后顺序,4 月—7 月手术的 48 例患者为对照组,进行常规呼吸道护理,8 月—11 月手术的 32 例患者为观察组,进行基于目标管理的呼吸集束护理.比较两组患者术后第 5d肺功能、术后肺部并发症和15 项恢复质量(quality of recovery-15,QoR-15)评分.结果 观察组患者术后第 5d,FVC(t=3.173,P=0.002)和FEV1(t=2.883,P=0.005)下降的程度小于对照组,差异有统计学意义.观察组患者术后第 5d经皮血氧饱和度高于对照组(Z=-2.454,P=0.014),差异有统计学意义.两组患者术后肺部并发症发生率的差异无统计学意义(P>0.05).术后第 5d QoR-15 评分,两组患者总分比较,差异无统计学意义(P>0.05);"中度疼痛"(Z=-2.738,P=0.006)、"感到紧张或焦虑"(Z=-2.593,P=0.010)和"感到伤心沮丧"(Z=-2.945,P=0.003)3 个条目,观察组患者的评分高于对照组,差异有统计学意义;两组患者其他各条目评分的比较,差异无统计学意义(P>0.05).结论 基于目标管理的呼吸集束护理有利于胃肠手术呼吸风险患者术后肺功能的恢复,能够提高胃肠手术呼吸风险患者术后恢复质量.
Application of respiratory care bundle combined with management by objectives on the gastrointestinal surgical patients with respiratory risk
Objective To explore the effect of respiratory care bundle combined with management by objectives(MBO)on postoperative pulmonary function,pulmonary complications and postoperative quality of recovery of respiratory risky patients undergone gastrointestinal surgeries.Methods A total of 80 patients with respiratory risk underwent elective surgery in a ward of gastrointestinal surgery from April to November 2021 were selected.Based on the order of the surgery,48 patients with surgeries between April to July were selected into control group and received routine respiratory care,while 32 patients with surgeries between August to November were selected into trial group and received the respiratory care bundle combined with MBO.The pulmonary function,postoperative pulmonary complications and postoperative quality of recovery were analyzed and compared on the 7th postoperative day.Results There was no significant difference between two groups in preoperative general data,preoperative lung function,preoperative quality of recovery(QoR-15)and other baseline data,as well as the surgery data.On the 7th postoperative day,the decrease of pulmonary function indexes,FVC(t=3.173,P=0.002)and FEV1(t=2.883,P=0.005)in the trial group was less than that in the control group,and the degree of percutaneous oxygen saturation in the trial group was higher than that in the control group(Z=-2.454,P=0.014).There was no significant difference in the incidence of postoperative pulmonary complications.As with the QoR-15,the score of trial group was higher than that in the control group in 3 items including"moderate pain"(Z=-2.738,P=0.006),"feeling nervous or anxious"(Z=-2.593,P=0.010)and"feeling sad and depressed"(Z=-2.945,P=0.003).There was no significant difference in other items between the two groups.Conclusion The respiratory care bundle combined with MBO is beneficial to the recovery of postoperative pulmonary function and postoperative quality of recovery of gastrointestinal surgical patients with respiratory risk.

respiratory care bundlemanagement by objectivespulmonary functionrespiratory riskpostoperative pulmonary complicationspostoperative quality of recovery

乔金方、熊伟昕、成守珍

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中山大学附属第一医院胃肠外科三区,广东广州,510080

中山大学附属第一医院护理部,广东广州,510080

呼吸集束护理 目标管理 肺功能 呼吸风险 术后肺部并发症 术后恢复质量

2024

现代临床护理
中山大学

现代临床护理

CSTPCD
影响因子:1.317
ISSN:1671-8283
年,卷(期):2024.23(10)