程序化急救护理在肺结核大咯血患者中的实施效果

doi:10.19982/j.issn.1000-6621.20230053

摘要/Abstract

摘要：

目的: 探讨程序化急救护理在肺结核大咯血患者中的应用效果。方法: 选择浙江大学医学院附属杭州市胸科医院结核病诊疗中心2019年1月1日至2020年12月31日住院治疗的肺结核大咯血患者163例。将2019年1月1日至2019年12月31日收治的81例患者纳入常规组,2020年1月1日至2020年12月31日收治的82例患者纳入程序化组。常规组采用常规护理方法,程序化组采用程序化急救护理流程。比较两组患者的支气管动脉栓塞术前准备时间、住院时间、住院费用、疾病相关危重并发症及支气管动脉栓塞术后相关并发症发生率和患者满意度。结果: 常规组的支气管动脉栓塞术前准备时间、住院时间、住院费用分别为(43.28±11.54)min、(15.22±3.58)d、(6.44±1.01)万元,程序化组分别为(25.90±6.21)min、(10.11±2.58)d、(4.78±0.87)万元,程序化组均明显低于常规组,差异均有统计学意义(t=-11.993、-10.464、-11.247,P值均<0.001);常规组支气管动脉栓塞术术后并发症发生率(25.93%,21/81)高于程序化组(12.20%, 10/82),差异有统计学意义(χ²=4.988,P=0.026);常规组危重并发症(窒息、休克)发生率(13.58%,11/81)高于程序化组(3.66%,3/82),差异有统计学意义(χ²=5.109,P=0.024);程序化组患者满意度(98.78%,81/82)高于常规组(91.36%,74/81),但差异无统计学意义(χ²=3.351,P=0.067)。结论: 程序化急救护理能缩短肺结核大咯血患者的救治时间和住院时间,减少住院费用,还能降低并发症发生率,提高肺结核大咯血患者的满意度。

关键词: 结核, 咯血, 手术后并发症, 急救医疗服务, 护理

Abstract:

Objective: To explore the effect of programmed emergency nursing in patients with pulmonary tuberculosis massive hemoptysis. Methods: From January 1, 2019 to December 31, 2020, 163 patients with pulmonary tuberculosis and massive hemoptysis were selected from the Tuberculosis Treatment Center, Affiliated Hangzhou Chest Hospital, Zhejiang University School of Medicine. Eighty-one patients admitted between January 1, 2019 and December 31, 2019 were included in the conventional group and 82 patients admitted between January 1, 2020 and December 31, 2020 were included in the programmed group. Regular nursing care methods were used in the conventional group, and programmed emergency nursing procedures were applied in the programmed group. The preparation time for bronchial artery embolization, hospital stay, hospital cost, disease-related critical complications, incidence of complications after bronchial artery embolization and patient satisfaction were compared between two groups. Results: The preparation time of bronchial artery embolization, hospital stay, and hospital cost were (43.28±11.54) min, (15.22±3.58) d, and (64.4±10.1) RMB thousand yuan in the conventional group and (25.90±6.21) min, (10.11±2.58) d, and (47.8±8.7) RMB thousand yuan in the programmed group, respectively. All of them were significantly lower in the programmed group than in the conventional group, and the differences were statistically significant (t=-11.993, -10.464, -11.247, all P<0.001); the postoperative complication rate of bronchial artery embolization was higher in the conventional group (25.93%, 21/81) than in the programmed group (12.20%, 10/82), and the difference was statistically significant (χ²=4.988,P=0.026); the incidence of severe complications including apnea and shock was higher in the conventional group (13.58%, 11/81) than in the programmed group (3.66%, 3/82), with a statistically significant difference (χ²=5.109,P=0.024); patient satisfaction was higher in the programmed group (98.78%, 81/82) than in the conventional group (91.36%, 74/81), but the difference was not statistically significant (χ²=3.351,P=0.067). Conclusion: Programmed emergency nursing could shorten the rescue time and the hospitalization time of patients with pulmonary tuberculosis massive hemoptysis, reduce the hospitalization cost and the incidence of complications, and improve the satisfaction of patients with pulmonary tuberculosis massive hemoptysis.

Key words: Tuberculosis, Hemoptysis, Postoperative complications, Emergency medical services, Nursing care

中图分类号:

R521

黄金鹏, 陈园园, 高丹, 毛潇潇, 张玥, 高晶. 程序化急救护理在肺结核大咯血患者中的实施效果[J]. 中国防痨杂志, 2023, 45(8): 768-774. doi: 10.19982/j.issn.1000-6621.20230053

Huang Jinpeng, Chen Yuanyuan, Gao Dan, Mao Xiaoxiao, Zhang Yue, Gao Jing. The effect of programmed emergency nursing in patients of pulmonary tuberculosis with massive hemoptysis[J]. Chinese Journal of Antituberculosis, 2023, 45(8): 768-774. doi: 10.19982/j.issn.1000-6621.20230053

图/表 6

表1

两组患者基本资料的比较

指标	常规组(81例)	程序化组(82例)	统计检验值	P值
性别[例,构成比(%)]			χ²=0.149	0.699
男性	52(64.20)	55(67.07)
女性	29(35.80)	27(32.93)
年龄(岁, $x ˉ$ ±s)	49.30±5.50	48.00±4.50	t=1.652	0.100
BMI[M(Q₁,Q₃)]	19.82(17.53,23.00)	21.63(18.51,23.94)	Z=-1.848	0.065
收缩压[mmHg,M(Q₁,Q₃)]	123.00(118.50,129.50)	123.00(120.00,128.00)	Z=-0.928	0.353
舒张压[mmHg,M(Q₁,Q₃)]	73.00(66.00,84.50)	75.00(70.00,82.00)	Z=-0.668	0.504
心率[次/min,M(Q₁,Q₃)]	85.00(79.00,89.00)	83.00(79.00,89.00)	Z=-0.574	0.566
休克指数[M(Q₁,Q₃)]	70.83(63.66,70.83)	65.96(62.94,71.02)	Z=-1.712	0.087
血小板[×10⁹/L,M(Q₁,Q₃)]	198.00(154.00,249.50)	203.00(163.00,241.00)	Z=-0.516	0.606
WBC[×10⁹/L,M(Q₁,Q₃)]	6.50(5.30,8.15)	6.40(5.00,8.35)	Z=-0.174	0.862
Hb[g/L,M(Q₁,Q₃)]	118.00(107.00,129.00)	122.00(111.00,141.00)	Z=-1.585	0.113
白蛋白[g/L,M(Q₁,Q₃)]	36.20(33.40,39.50)	37.20(33.20,40.00)	Z=-0.640	0.522
CRP[mg/L,M(Q₁,Q₃)]	14.54(3.26,37.98)	12.00(2.22,31.55)	Z=-1.129	0.259
D-二聚体[g/L,M(Q₁,Q₃)]	500.00(270.00,1065.00)	470.00(260.00,920.00)	Z=-0.387	0.699
红细胞压积[%,M(Q₁,Q₃)]	35.70(31.50,39.65)	36.30(32.35,41.65)	Z=-0.982	0.326
并发症[例,发生率(%)]			χ²=0.894	0.925
肺曲霉菌	10(12.35)	8(9.76)
空洞	31(38.27)	32(39.02)
毁损肺	4(4.94)	6(7.32)
糖尿病	26(32.10)	24(29.27)
高血压	10(12.35)	12(14.63)
痰菌[例,构成比(%)]			χ²=0.050	0.822
阴性	47(58.02)	49(59.76)
阳性	34(41.98)	33(40.24)

表1

图1

表2

两组患者支气管动脉栓塞术前准备时间、住院时间和住院费用比较

指标	常规组(81例)	程序化组(82例)	t值	P值
支气管动脉栓塞术前准备时间(min, $x ˉ$ ±s)	43.28±11.54	25.90±6.21	-11.993	<0.001
住院时间(d, $x ˉ$ ±s)	15.22±3.58	10.11±2.58	-10.464	<0.001
住院费用(万元, $x ˉ$ ±s)	6.44±1.01	4.78±0.87	-11.247	<0.001

表2

表3

表4

表5

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并发症	常规组(81例)	程序化组(82例)	χ²值	P值
发热	15(18.52)	10(12.20)	1.255	0.263
胸部疼痛	12(14.81)	6(7.32)	2.332	0.127
穿刺处血肿	7(8.64)	3(3.66)	0.998	0.318
尿潴留	10(12.35)	5(6.10)	1.904	0.168
合计	21(25.93)	10(12.20)	4.988	0.026

危重并发症	常规组(81例)	程序化组(82例)	χ²值	P值
窒息	7(8.64)	2(2.44)	1.934	0.164
休克	4(4.94)	1(1.22)	0.851	0.356
合计	11(13.58)	3(3.66)	5.109	0.024

满意度	常规组(81例)	程序化组(82例)	χ²值	P值
非常满意	60(74.07)	70(85.37)	3.218	0.073
一般满意	14(17.28)	11(13.41)	0.470	0.493
不满意	7(8.64)	1(1.22)	3.351	0.067
总满意度	74(91.36)	81(98.78)	3.351	0.067