气道分级管理在老年重症肺炎病人中的应用及对依从性的影响

doi:10.3969/j.issn.1003-9198.2021.08.006

摘要/Abstract

摘要： 目的探讨气道分级管理在老年重症肺炎病人治疗中的应用效果及对依从性的影响。方法选择2018～2019年我院收治的老年重症肺炎病人184例,按照治疗模式分为对照组和观察组,每组92例。对照组采用常规的胸部物理治疗,观察组则采用在气道分级管理的基础上实施胸部物理治疗,观察并比较2组干预后循环功能、肾功能、血气分析指标及相关并发症和治疗依从性情况。结果干预后,观察组SBP、DBP、LVEF、舒张早期充盈峰速度/舒张晚期充盈峰速度(E/A)、PaO₂、氧合指数、治疗依从率高于对照组,血肌酐、BUN、PaCO₂水平及相关并发症的发生率低于对照组(P<0.05)。结论气道分级管理在老年重症肺炎病人治疗中的应用效果显著,有助于改善病人的循环功能、肾功能和呼吸功能,提高病人的依从性,降低并发症发生的风险,促进病人恢复。

关键词: 气道分级管理, 老年人, 重症肺炎, 依从性

Abstract: Objective To explore the application of airway classification management in the elderly patients with severe pneumonia and its effect on compliance. Methods A total of 184 elderly patients with severe pneumonia admitted to our hospital from January 2018 to December 2019 were selected and divided into control group and observation group, with 92 cases in each group. The control group was treated with conventional chest physical therapy, while the observation group was treated with chest physical therapy on the basis of airway classification management. The indexes of circulatory function, renal function, blood gas analysis, and the related complications and compliance of the two groups were observed and compared. Results After the intervention,the systolic blood pressure(SBP), diastolic blood pressure(DBP), left ventricular ejection fraction(LVEF),E/A ratio, arterial partial pressure of oxygen(PaO₂),oxygenation index and the compliance rate were significantly higher, and the levels of serum creatinine, blood urea nitrogen, partial pressure of carbon dioxide(PaCO₂) and the incidence of related complications were significantly lower in the observation group than those in the control group (P<0.05). Conclusions The efficacy of airway classification management in the treatment of elderly patients with severe pneumonia is significant, which is helpful to improve the circulatory function, renal function and respiratory function, improve the compliance of patients, reduce the risk of complications, and promote the recovery of patients.

Key words: airway classification management, aged, severe pneumonia, compliance

中图分类号:

R 563.1

阮筝, 张玉勤, 金晔, 薛艳丽. 气道分级管理在老年重症肺炎病人中的应用及对依从性的影响[J]. 实用老年医学, 2021, 35(8): 812-815.

RUAN Zheng, ZHANG Yu-qin, JIN Ye, XUE Yan-li. Airway classification management in elderly patients with severe pneumonia and its effect on compliance[J]. Practical Geriatrics, 2021, 35(8): 812-815.

参考文献

[1] 冯敏, 潘岁月. 基于气道分级管理策略的胸部物理治疗在老年重症肺炎机械通气病人中的应用[J]. 护士进修杂志, 2019, 34(19):1810-1813.
[2] 陈浩. 老年重症肺炎患者适应性支持通气模式机械通气治疗的临床分析[J]. 内科急危重症杂志, 2018, 24(5):364-366.
[3] 陈显静, 涂婷婷, 赵仁国, 等. 基于CPIS评分用药指导对细菌感染所致老年重症肺炎患者用药时间及用药频度的影响[J]. 中国中西医结合急救杂志, 2020, 27(1):72-76.
[4] ZHANG X Y, YU R H, DONG J Z. Clinical characteristics and efficacy of radiofrequency catheter ablation in the treatment of elderly patients with atrial fibrillation[J]. Am J Med Sci, 2018, 355(4):357.
[5] 张晓雨. 机械振动排痰机在重症肺炎患儿机械通气气道护理中的应用[J]. 中国医科大学学报, 2018, 47(2):95-97.
[6] 施琳, 周伟芬. 护理风险管理在重症肺炎患儿呼吸道感染及治疗效果中的应用研究[J]. 山西医药杂志, 2019, 48(12):1517-1519.
[7] KYODO R, KUDO T, HORIUCHI A, et al. Pureed diets containing a gelling agent to reduce the risk of aspiration in elderly patients with moderate to severe dysphagia: a randomized, crossover trial[J]. Medicine, 2020, 99(31):e21165.
[8] 杜春雨, 王佳贺. 老年重症肺炎临床特点及诊治进展[J]. 实用老年医学, 2018, 32(10):13-16.
[9] 郝菲, 姚晨, 韩俊婷, 等. 降阶梯治疗策略结合血清PCT动态监测在老年重症肺炎患者中的应用[J]. 河北医药, 2019, 41(21):3219-3223.
[10] 李京, 田慧超, 王美芹. 不同卧位角度对重症肺炎患者呼吸指标的影响[J]. 上海护理, 2019, 19(7):37-39.
[11] 龚敬, 陆伟, 史刚, 等. 比阿培南联合莫西沙星对老年重症肺炎患者炎性指标及不良反应的影响[J]. 河北医学, 2020, 26(5):721-727.
[12] ALEKSEEVA I V, SEMIGLAZOVA T, TKACHENKO E, et al. The role of continuity of systematic treatment and rehabilitation in patients with metastatic colorectal cancer in elderly and senile age[J]. J Clin Oncol, 2020, 38(15 Suppl):e16041-e16041.
[13] 何强. 老年重症肺炎患者凝血指标变化及抗凝治疗的临床效果观察[J]. 临床肺科杂志, 2018, 23(7):1282-1285.
[14] 黄种杰, 洪丽月, 洪原城, 等. 烟雾弹致吸入性肺损伤60例的分级管理与救治[J]. 临床肺科杂志, 2018, 23(2):278-281.
[15] 中华医学会小儿外科学分会心胸外科学组. 基于快速康复的小儿外科围手术期气道管理专家共识[J]. 中华小儿外科杂志, 2019, 40(7):577-582.
[16] BRENNAN J M, BRYANT A, BPERO I, et al. Race and sex-based disparities persist in the treatment of patients with severe, symptomatic aortic valve stenosis[J]. J Am Coll Card, 2019, 73(9):1207.
[17] 肖婷, 裴冬杰, 颜璐璐, 等. Arndt支气管阻塞器用于患儿单肺通气时气道管理效果的初步评价[J]. 中华麻醉学杂志, 2018, 38(11):1366-1368.
[18] 赵立群, 李雅莉, 徐灵彬, 等. 谷氨酰胺联合比阿培南对老年重症肺炎患者的疗效及血清肺表面活性蛋白的影响[J]. 药物评价研究, 2018, 41(10):1859-1862.
[19] 吴水英. 不同剂量比阿培南对重症肺炎的疗效及安全性影响[J]. 中国药物与临床, 2019, 19(12):2028-2029.