Abstract:

Objective　To assess the effects of different nursing programs, namely traditional pressure ulcer prevention interventions and ultrasound-guided nursing program combined with traditional pressure ulcer prevention interventions, on observed indicators in children during the extracorporeal membrane oxygenation (ECMO) operation period. Methods　Sixty children during the ECMO operation period admitted to Children's Hospital Affiliated to Zhengzhou University from June 2020 to June 2022 were randomly divided into a control group and an observation group, with 30 cases in each group. In the control group, there were 18 boys and 12 girls; the age was 5-14 (10.74±1.63) years old; there were 7 cases of cardiovascular diseases, 5 cases of respiratory diseases, 4 cases of gastrointestinal diseases, 8 cases of surgical diseases, and 6 cases of other diseases. In the observation group, there were 16 boys and 14 girls; the age was 5-13 (10.72±1.55) years old; there were 8 cases of cardiovascular diseases, 6 cases of respiratory diseases, 3 cases of gastrointestinal diseases, 9 cases of surgical diseases, and 4 cases of other diseases. After enrollment, the control group received traditional pressure ulcer prevention interventions, while the observation group received ultrasound-guided nursing program combined with traditional pressure ulcer prevention interventions. Nursing till discharge, the nursing effects of different nursing intervention schemes were compared by observing the data of indicators. t test and χ² test were used. Results　The incidence of pressure ulcers in the observation group [6.67% (2/30)] was lower than that in the control group [26.67% (8/30)], and the length of hospital stay [(14.71±2.59) d], the use time of vasoactive drugs [(15.34±2.38) h], and the ECMO support time [(8.91±2.51) d] were shorter than those in the control group [(20.38±3.39) d, (23.55±2.45) h, and (12.05±3.54) d], with statistically significant differences between the two groups (χ²=4.320, t=7.280, 13.165, and 3.963; all P<0.05). Nursing till discharge, the Short Form 36 (SF-36) scores (social function, physical function, psychological function, and role function) of the observation group were (86.64±5.48) points, (82.28±5.41) points, (82.54±5.51) points, and (84.17±5.48) points, which were higher than those of the control group [(74.35±5.61) points, (73.59±5.37) points, (71.41±5.48) points, and (70.21±5.53) points], with statistically significant differences between the two groups (t=5.584, 5.584, 7.845, and 9.821, all P<0.05). Nursing till discharge, the Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) scores of the control group and the observation group [(48.27±4.64) and (41.28±3.51) points, (42.10±4.79) and (33.59±3.57) points] were decreased compared with those before nursing [(52.49±4.33) and (49.35±2.61) points, (51.67±4.29) and (48.64±2.48) points], and those of the observation group were lower than those of the control group (all P<0.05). Nursing till discharge, the satisfaction scores (health education, environmental comfort, nurses' attitude, nursing operation, and treatment effect) of family members of the observation group were (16.22±2.47) points, (17.28±2.45) points, (16.48±2.72) points, (18.36±1.12) points, and (18.01±1.51) points, which were higher than those of the control group [(14.18±2.58) points, (15.66±2.51) points, (13.56±2.59) points, (12.28±2.33) points, and (13.40±2.61) points], with statistically significant differences between the two groups (t=3.128, 2.530, 4.258, 12.882, and 8.374, all P<0.05). The treatment compliance of the observation group was higher than that of the control group [90.00% (27/30) vs. 73.33% (22/30)], with a statistically significant difference (χ²=4.320, P=0.038). Conclusion　The use of ultrasound-guided nursing program in children during the ECMO operation period can shorten the recovery time, improve the psychological status, enhance the quality of life, increase the treatment compliance and family satisfaction, and prevent the pressure ulcers.

Key words:

Extracorporeal membrane oxygenation, Pressure ulcers, Prevention, Ultrasound, Nursing intervention, Quality of life

摘要：

目的　评估将不同护理方案，即传统防压疮护理干预、超声指导下的护理方案联合传统防压疮护理干预，分别予以体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）运转期患儿后，对其各观察指标的影响。方法　郑州大学附属儿童医院2020年6月至2022年6月收治的ECMO运转期患儿60例，通过随机分组得到对照组、观察组，每组均包含30例患儿。对照组中，男、女患儿例数分别为18、12；年龄5～14岁（10.74±1.63）岁；心血管疾病7例，呼吸系统疾病5例，胃肠系统疾病4例，外科疾病8例，其他病症6例。观察组中，男、女患儿例数分别为16、14；年龄5～13（10.72±1.55）岁；心血管疾病8例，呼吸系统疾病6例，胃肠系统疾病3例，外科疾病9例，其他病症4例。入组后，对照组予以传统防压疮护理干预，观察组予以超声指导下的护理方案联合传统防压疮护理干预。护理至出院，通过观察指标的数据评估对比不同护理干预方案的护理效果。采用t检验、χ²检验。结果　观察组压疮发生率6.67%（2/30）低于对照组26.67%（8/30），住院时间［（14.71±2.59）d］、血管活性药物使用时间［（15.34±2.38）h］、ECMO支持时间［（8.91±2.51）d］均短于对照组［（20.38±3.39）d、（23.55±2.45）h，（12.05±3.54）d］，组间比较差异均有统计学意义（χ²=4.320，t=7.280、13.165、3.963，均P<0.05）。护理至出院，观察组生活质量调查表（Short Form 36，SF-36）评分（社会功能、躯体功能、心理功能、角色功能）分别为（86.64±5.48）分、（82.28±5.41）分、（82.54±5.51）分、（84.17±5.48）分，均高于对照组［（74.35±5.61）分、（73.59±5.37）分、（71.41±5.48）分、（70.21±5.53）分］，组间比较差异均有统计学意义（t=5.584、5.584、7.845、9.821，均P<0.05）。护理至出院，对照组、观察组抑郁自评量表（Self-Rating Depression Scale，SDS）、焦虑自评量表（Self-Rating Anxiety Scale，SAS）评分［（48.27±4.64）分和（41.28±3.51）分，（42.10±4.79）分和（33.59±3.57）分］相比于护理前［（52.49±4.33）分和（49.35±2.61）分，（51.67±4.29）分和（48.64±2.48）分］均降低，且观察组低于对照组（均P<0.05）。护理至出院，观察组患儿家属满意度评分（健康宣教、环境舒适、护士态度、护理操作及治疗效果）分别为（16.22±2.47）分、（17.28±2.45）分、（16.48±2.72）分、（18.36±1.12）分、（18.01±1.51）分，高于对照组［（14.18±2.58）分、（15.66±2.51）分、（13.56±2.59）分、（12.28±2.33）分、（13.40±2.61）分］，组间比较差异均有统计学意义（t=3.128、2.530、4.258、12.882、8.374，均P<0.05）。观察组治疗依从性高于对照组［90.00%（27/30）比73.33%（22/30）］，差异有统计学意义（χ²=4.320，P=0.038）。结论　ECMO运转期患儿采用超声指导下的护理方案能够缩短恢复时间，改善心理状态，提高生活质量，增加治疗依从性及家属满意度，避免压疮发生。

关键词:

体外膜肺氧合, 压疮, 预防, 超声, 护理干预, 生活质量