关键词: 结核,肺, 呼吸功能不全, 麻醉后护理, 表格和记录管理, 对比研究, 结果与过程评价(卫生保健)

Abstract:

Objective To explore the clinical effect of daily awaking execution scale in patients with pulmonary tuberculosis mechanical ventilation sedation,and to provide clinical basis for standardizing clinical nursing pathway.Methods The data of 127 patients with pulmonary tuberculosis admitted to the Tubercular Intensive Care Unit (ICU) of Zhejiang Provincial Integrated Chinese and Western Medicine Hosipital from January to June 2017 (before the scale was implemented) were collected, and 92 patients with type Ⅱ respiratory failure were selected, and 30 cases were randomly selected as control group by using digital table method in 49 patients who were included in the inclusion and exclusion criteria. Routine implementation of daily wake-up measures. From the collection of 142 patients with tuberculosis admitted to the Tubercular ICU from July to December 2017 (after the scale was implemented), 110 patients with type Ⅱ respiratory failure were selected, and 30 cases were randomly selected as observation group in 52 patients who were included in the inclusion and exclusion criteria. The daily wake-up execution scale was used on the basis of routine implementation of daily wake-up measures, and the incidence of adverse events such as sedative dosage, complete sobriety time after withdrawal, duration of mechanical ventilation, duration of sedation, ICU hospitalization time, emotional abnormalities and so on were observed in the two groups.Results Both groups of patients completed full observation in the Tubercular ICU. The observation group duration of sedation (100.50 (72.50,112.75)h), the total amount of sedative (110.00 (89.00,143.00)mg), the total waking time after withdrawa (29.50 (21.00,37.75)min), duration of mechanical ventilation (119.50 (99.25,138.0)h), Tubercular ICU hospitalization time (115.00 (103.75,170.25)h) were better than the control group for each of items respectivly (126.50 (85.70,172.25)h,152.00 (123.00,219.00)mg,35.50 (30.75,48.00)min,145.50 (123.00,227.00)h,182.00 (145.25,253.75)h)(Z=2.795,3.408,2.717,2.994,4.081; P=0.005, 0.001, 0.007, 0.003, 0.000). During wake-up, the observation group and the control group carried out 349 wake-up sands and 273 cases respectively, and no serious adverse events such as accidental tube extraction and fall occurred. The incidence of mood abnormalities, the incidence of heart rate abnormalities, the incidence of abnormal blood pressure, the incidence of human-machine confrontation in the control and observation groups, respectively ((67.77% (185/273) and 67.34% (235/349), 50.18% (137/273) and 47.56% (166/349), 35.90%(98/273) and 32.09% (112/349), 25.27% (69/273) and 26.36% (92/349)), and the success rate of spontaneous breath tests (56.82% (50/88) and 68.42% (78/114)) were not statistically significant (χ ²=0.013, 0.420, 0.992, 0.094, 2.880; P=0.909, 0.517, 0.319, 0.759, 0.090,respectively). Conclusion Through the organization and implementation of the daily wake-up scale, the clinical path of nursing in patients with mechanical ventilation sedative tuberculosis can be effectively standardized, the operability is strong, safe and practical, and it is worth the clinical application.

Key words: Tuberculosis,pulmonary, Respiratory insufficiency, Postanesthesia nursing, Forms and records control, Comparative study, Outcome and process assessment (health care)