Abstract:

Objective　To explore the effect of refined nursing based on the three-dimensional space model for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and respiratory failure. Methods　Ninety-eight patients with AECOPD and respiratory failure admitted to Wuxi Second People's Hospital from August 2020 to March 2022 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 49 cases in each group. There were 31 males and 18 females in the control group; they were 51-79 (64.56±8.15) years old. There were 29 males and 20 females in the observation group; they were 53-80 (66.23±7.36) years old. The control group took routine care; in addition, the observation group took refined nursing based on the three-dimensional space model. The self-care abilities, arterial blood gas indicators, pulmonary function indicators, quality of life before and after the nursing and the incidences of complications were compared between the two groups. t and χ² tests were applied. Results　After the nursing, the scores of self-nursing skills, health knowledge, self-concept, and self-care responsibility were higher than those before the control group; the scores in the observation group were higher than those in the control group [(40.92±10.23) vs. (33.56±8.39), (49.83±12.21) vs. (39.62±9.91), (32.96±8.24) vs. (23.49±5.87), and (28.76±7.19) vs. (22.26±5.57)], with statistical differences (t=3.89, 4.55, 6.55, and 5.00; all P<0.05). After the nursing, the oxygen saturation (SaO₂), arterial oxygen partial pressure (PaO₂), percentage of forced vital capacity (FVC%), percentage of forced expiratory volume in the first second to the expected value (FEV₁%), and the percentage of forced expiratory volume in the first second to the forced vital capacity (FEV₁/FVC%) were higher than those before the nursing in both groups (all P < 0.05); the SaO₂, PaO₂, FVC%, FEV₁%, FEV₁/FVC%, and partial pressure of carbon dioxide (PaCO₂) in the observation group were better than those in the control group [(96.86±24.22)% vs. (84.12±21.03)%, (88.79±22.19) mmHg (1 mmHg=0.133 kPa) vs. (73.21±18.30) mmHg, (2.63±0.66)% vs. (2.29±0.57)%, (1.46±0.37)% vs. (1.28±0.32)%, (0.67±0.17)% vs. (0.58±0.15)%, and (46.58±11.65) mmHg vs. (58.67±4.67) mmHg], with statistical differences (t=2.78, 3.78, 2.73, 2.58, 2.78, and 4.52; all P<0.05). After the nursing, the scores of disease effect and symptom and the total score of St. George's Respiratory Questionnaire (SGRQ) were lower and the score of activity ability was higher than those before the nursing in both groups; the scores in the observation group were better than those in the control group [(20.74±4.15) vs. (29.46±5.89), (37.86±7.57) vs. (49.58±9.92), (29.56±7.39) vs. (38.76±9.69), and (62.85±12.57) vs. (52.32±10.46)], with statistical differences (t=8.47, 6.58, 6.61, and 4.51; all P<0.05). The total incidence of complications in the observation group was lower than that in the control group [6.12%(3/49) vs. 24.49%(12/49)], with a statistical difference (χ²=5.04; P<0.05). Conclusion　Refined nursing based on the three-dimensional space model for patients with AECOPD and respiratory failure is conducive to improving their lung ventilation function, self-care ability, and quality of life and reducing the incidence of complications, so it is worthy of clinical promotion.

Key words:

Acute exacerbation of chronic obstructive pulmonary disease, Respiratory failure, Three dimensional space model, Refined nursing

摘要：

目的　探讨基于三度空间模型的精细化护理在慢性阻塞性肺疾病急性加重期（AECOPD）并呼吸衰竭患者中的应用效果。方法　选取无锡市第二人民医院2020年8月至2022年3月收治的98例AECOPD并呼吸衰竭患者进行随机对照试验，利用随机数字表法分为观察组（49例）与对照组（49例）。对照组男性31例，女性18例，年龄51～79（64.56±8.15）岁，给予常规护理；观察组男性29例，女性20例，年龄53～80（66.23±7.36）岁，在对照组的基础上给予三度空间模型的精细化护理。比较两组患者护理前后自护能力、动脉血气指标、肺功能指标、生活质量以及并发症发生情况。统计学方法采用t检验、χ²检验。结果　护理后，两组患者自我护理技能、健康知识水平、自我概念、自护责任感评分均较护理前升高，且观察组均高于对照组［（40.92±10.23）分比（33.56±8.39）分、（49.83±12.21）分比（39.62±9.91）分、（32.96±8.24）分比（23.49±5.87）分、（28.76±7.19）分比（22.26±5.57）分］，差异均有统计学意义（t=3.89、4.55、6.55、5.00，均P<0.05）。护理后，两组患者氧饱和度（SaO₂）、动脉血氧分压（PaO₂）、用力肺活量占正常预计值百分比（FVC%）、第一秒用力呼气量占正常预计值百分比（FEV₁%）、第一秒用力呼气量占用力肺活量百分率（FEV₁/FVC%）均较护理前升高，且观察组均高于对照组，二氧化碳分压（PaCO₂）低于对照组［（96.86±24.22）%比（84.12±21.03）%、（88.79±22.19）mmHg（1 mmHg=0.133 kPa）比（73.21±18.30）mmHg、（2.63±0.66）%比（2.29±0.57）%、（1.46±0.37）%比（1.28±0.32）%、（0.67±0.17）%比（0.58±0.15）%、（46.58±11.65）mmHg比（58.67±4.67）mmHg］，差异均有统计学意义（t=2.78、3.78、2.73、2.58、2.78、4.52，均P<0.05）；护理后，两组患者疾病影响、症状评分、圣乔治呼吸问卷（SGRQ）总分均较护理前降低，且观察组均低于对照组，活动能力评分高于对照组［（20.74±4.15）分比（29.46±5.89）分、（37.86±7.57）分比（49.58±9.92）分、（29.56±7.39）分比（38.76±9.69）分、（62.85±12.57）分比（52.32±10.46）分］，差异均有统计学意义（t=8.47、6.58、6.61、4.51，均P<0.05）；观察组患者并发症总发生率低于对照组［6.12%（3/49）比24.49%（12/49）］，差异有统计学意义（χ²=5.04，P<0.05）。结论　基于三度空间模型的精细化护理应用于AECOPD并呼吸衰竭患者，有利于改善患者的肺通气、换气功能，提高患者自护能力和生活质量，降低并发症发生率，值得临床推广。

关键词:

慢性阻塞性肺疾病急性加重期, 呼吸衰竭, 三度空间模型, 精细化护理