关键词: 脓胸,结核性, 胸腔镜, 康复护理, 临床方案, 方案评价

Abstract:

Objective: To explore the application effect of integrated traditional Chinese medicine (TCM) and Western medicine pulmonary rehabilitation nursing program in patients with tuberculous empyema undergoing thoracoscopic clearance. Methods: Using a prospective research method, 66 newly admitted patients with tuberculous empyema who met surgical indications in Hangzhou Chest Hospital Affiliated with Zhejiang University School of Medicine from October 2021 to December 2022 were enrolled. They were randomly divided into observation group (33 cases) and control group (33 cases) using a random number table method. The control group received routine care, while the observation group received the Pulmonary rehabilitation nursing program of integrated traditional Chinese and Western medicine for patients with tuberculous empyema under thoracoscopic clearance in addition to the routine care. Lung function, daily living ability, anxiety level and postoperative chest tube indwelling time of the two groups on the day of admission, the second day after surgery, the day of discharge, and one month after discharge were compared, and the pain level on the second day after surgery were also compared. Results: One month after discharge after treatment, of the study subjects, 28 cases in the control group completed the intervention, with a completion rate of 84.8% (28/33), and 31 cases in the observation group completed the intervention, with a completion rate of 93.9% (31/33). The median (quartile) levels of forced expiratory volume in one second in the observation group before discharge and one month after discharge were 1.83 (1.60, 2.29) L and 2.20 (2.00, 2.32) L, respectively, which were significantly higher than those in the control group (1.58 (1.43,1.83) L and 1.91 (1.88, 2.04) L), with statistical significance (Wald χ²=8.947, P=0.003; and Wald χ²=7.285, P=0.007, respectively); the forced vital capacity levels in the observation group were 2.50 (2.30,2.64) L and 2.65 (2.45,2.79) L, respectively, significantly higher than those in the control group (2.21 (2.20,2.49) L, Wald χ²=10.072, P=0.002; 2.55 (2.35,2.69) L, Wald χ²=5.708, P=0.017, respectively). On the second day after surgery, the median (quartile) Barthel index in the observation group was 55.0 (55.0, 70.0), which was significantly higher than that in the control group (50.0 (40.0, 53.8), Wald χ²=14.009, P<0.001). The anxiety scores of the observation group before discharge and one month after discharge were 54.52±4.89 and 49.58±3.91, respectively, which were significantly lower than those of the control group (57.43±4.77, t=5.338, P=0.025; 54.61±3.98, t=23.907, P<0.001, respectively). The postoperative thoracic tube retention time in the observation group was 9 (7, 9) d, significantly shorter than that in the control group (9 (8, 10) d, Z=-2.076, P=0.038). Conclusion: The intervention of the integrated TCM and Western medicine pulmonary rehabilitation nursing program can improve the lung function of patients undergoing thoracoscopic clearance surgery for tuberculous empyema, reduce anxiety levels, enhance postoperative daily living ability, and shorten postoperative chest tube retention time, which is worth promoting.

Key words: Empyema, tuberculous, Thoracoscopes, Rehabilitation nursing, Clinical protocols, Program Evaluation