心脏外科患者术后有创机械通气撤机锻炼体验的质性研究

doi:10.3761/j.issn.0254-1769.2023.16.009

摘要/Abstract

摘要：

目的探讨心脏外科患者术后有创机械通气撤机锻炼期间的体验。目的采用描述性质性研究方法，通过目的抽样，于2022年4月—9月对浙江省某三级甲等医院符合标准的心脏外科患者及与其进行撤机锻炼密切相关的医护人员进行面对面半结构式深入访谈。资料分析采用传统内容分析法。结果最终访谈患者11例、护士11名、医生4名，共提炼出4个主题及13个亚主题，包括消极的生理不适感（身体层面的不适感、自我表达受限、迫切渴望拔除气管插管），双向的感知安全与尊重（护患之间的尊重关怀、患者心理关怀与护理安全冲突、护患有效借助家属力量），获得控制感（保持信息的同步交流、知晓自身撤机状态、医护协作帮助患者树立信心），期待完善撤机锻炼支持系统（渴望针对性术前宣教、建立有效沟通、给予舒适支持、提供专业流程管理）。结论心脏外科患者术后有创机械通气撤机锻炼期间存在多方面问题，护士应密切关注此类患者的身心状态，调节其撤机锻炼的情绪，重视术前宣教，改进非语言沟通形式，帮助患者尽早拔管，并适当联合家属力量促进撤机锻炼进程，从而优化撤机锻炼策略。

关键词: 心脏外科手术, 呼吸，人工, 撤机锻炼, 康复护理, 体验, 质性研究

Abstract:

Objective To explore the psychological experience of patients undergoing invasive mechanical ventilation weaning exercise after cardiac surgery. Methods The descriptive qualitative research method in qualitative research was used to conduct semi-structured in-depth interviews. From April to September 2022，by purposive sampling，face-to-face interviews were conducted with cardiac surgery patients who met the criteria and their medical staff who were closely related to their weaning exercise in a tertiary hospital in Zhejiang Province. Traditional content analysis was used for data analysis. Results Finally，11 patients，11 nurses and 4 doctors were interviewed. A total of 4 core themes and 13 sub-themes were extracted. These included negative physiological discomfort（physical discomfort，limited self-expression，and urgent desire for extubation），two-way perceived safety and respect（respect and care between nurses and patients，conflicts between patients’ psychological care and nursing safety，and effective assistance of family members by nurses and patients），and gaining a sense of control（maintaining synchronous communication of information，knowing their own weaning status，and establishing patient trust through medical cooperation），looking forward to improving the weaning exercise support system（desire targeted preoperative education，establish effective communication，provide comfortable support，and provide professional process management）. Conclusion There are many problems during the weaning exercise of invasive mechanical ventilation in patients after cardiac surgery. Nurses should pay close attention to the physical and mental state of such patients，regulate their emotions for weaning exercise，pay attention to preoperative education，improve non-verbal communication forms，meet patients’ early extubation，and appropriately combine family forces to promote the weaning exercise process，so as to optimize the weaning exercise strategy.

Key words: Cardiac Surgical Procedures, Respiration，Artificial, Weaning Exercise, Rehabilitation Nursing, Experience, Qualitative Research

桑明, 卫建华, 张萍, 翁峰霞, 盛贵箫, 冷雅楠, 沈怡, 冯艳霞. 心脏外科患者术后有创机械通气撤机锻炼体验的质性研究[J]. 中华护理杂志, 2023, 58(16): 1970-1976.

SANG Ming, WEI Jianhua, ZHANG Ping, WENG Fengxia, SHENG Guixiao, LENG Yanan, SHEN Yi, FENG Yanxia. A qualitative study on the experience of weaning from invasive mechanical ventilation in patients after cardiac surgery[J]. Chinese Journal of Nursing, 2023, 58(16): 1970-1976.

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参考文献 21

[1]	Maisat W, Siriratwarangkul S, Charoensri A, et al. Perioperative risk factors for delayed extubation after acute type A aortic dissection surgery[J]. J Thorac Dis, 2020, 12(9):4796-4804. DOI PMID
[2]	王哲芸, 杨燕, 王岩, 等. 心脏外科患者加速康复气道管理方案的制订与应用研究[J]. 中华护理杂志, 2020, 55(11):1605-1611. DOI
	Wang ZY, Yang Y, Wang Y, et al. Construction and application of airway nursing in cardiac enhanced recovery after surgery[J]. Chin J Nurs, 2020, 55(11):1605-1611. DOI
[3]	Epstein SK, Walkey L. Initial weaning strategy in mechanically ventilated adults[EB/OL].[2022-11-14]. https://www.uptodate.cn/contents/initial-weaning-strategy-in-mechanically-ventilated-adults.
[4]	Albanesi B, Nania T, Barello S, et al. Lived experience of patients in ICU after cardiac surgery:a phenomenological study[J]. Nurs Crit Care, 2022, 27(2):204-213. DOI URL
[5]	刘庆华, 李文玉, 郑静, 等. 心脏术后机械通气撤机流程再造的临床研究[J]. 浙江创伤外科, 2021, 26(6):1050-1051.
	Liu QH, Li WY, Zheng J, et al. Clinical study on process reengineering of mechanical ventilation after cardiac surgery[J]. Zhejiang J Trauma Surg, 2021, 26(6):1050-1051.
[6]	刘湉, 李庆印. 护士主导机械通气患者程序化撤机的研究进展[J]. 中华现代护理杂志, 2021, 27(24):3352-3357.
	Liu T, Li QY. Research progress of nurse-led programmed weaning in mechanical ventilation patients[J]. Chin J Mod Nurs, 2021, 27(24):3352-3357.
[7]	Hester M, Ingalls NK, Hatzfeld JJ. Perceptions of ICU diary utility and feasibility in a combat ICU[J]. Mil Med, 2016, 181(8):895-899. DOI PMID
[8]	Hsieh HF, Shannon SE. Three approaches to qualitative content analysis[J]. Qual Health Res, 2005, 15(9):1277-1288. DOI URL
[9]	Lin R, Chen HY, Chen LL, et al. Effects of a spray-based oropharyngeal moisturising programme for patients following endotracheal extubation after cardiac surgery:a randomised,controlled three-arm trial[J]. Int J Nurs Stud, 2022, 130:104214. DOI URL
[10]	Gjeilo KH, Stenseth R, Klepstad P. Risk factors and early pharmacological interventions to prevent chronic postsurgical pain following cardiac surgery[J]. Am J Cardiovasc Drugs, 2014, 14(5):335-342. DOI URL
[11]	Leung CCH, Pun J, Lock G, et al. Exploring the scope of communication content of mechanically ventilated patients[J]. J Crit Care, 2018, 44:136-141. DOI PMID
[12]	Nyhagen R, Egerod I, Rustøen T, et al. Unidentified communication challenges in the intensive care unit:a qualitative study using multiple triangulations[J]. Aust Crit Care, 2023, 36(2):215-222. DOI URL
[13]	赵旭, 王伟, 赵小静, 等. 慢性心力衰竭患者出入量管理的最佳证据总结[J]. 中华护理杂志, 2020, 55(3):456-461. DOI
	Zhao X, Wang W, Zhao XJ, et al. Best evidence summary for management of output and input in chronic heart failure patients[J]. Chin J Nurs, 2020, 55(3):456-461. DOI
[14]	李营阳, 乔亚欣, 候琳琳, 等. ICU经口气管插管患者口渴管理的证据总结[J]. 中华护理杂志, 2023, 58(14):1750-1757. DOI
	Li YY, Qiao YX, Hou LL, et al. Evidence summary of thirst management in patients with oral tracheal intubation in ICU[J]. Chin J Nurs, 2023, 58(14):1750-1757. DOI
[15]	Laerkner E, Egerod I, Olesen F, et al. Negotiated mobilisation:an ethnographic exploration of nurse-patient interactions in an intensive care unit[J]. J Clin Nurs, 2019, 28(11/12):2329-2339. DOI URL
[16]	Newell S, Jordan Z. The patient experience of patient-centered communication with nurses in the hospital setting:a qualitative systematic review protocol[J]. JBI Database System Rev Implement Rep, 2015, 13(1):76-87. DOI URL
[17]	Danielis M, Chiaruttini S, Palese A. Unplanned extubations in an intensive care unit:findings from a critical incident technique[J]. Intensive Crit Care Nurs, 2018, 47:69-77. DOI URL
[18]	韩遵海, 刘雪娇, 何茵, 等. ICU以患者家庭为中心探视模式的研究进展[J]. 中华护理杂志, 2019, 54(2):235-238. DOI
	Han ZH, Liu XJ, He Y, et al. Research progress of ICU patient-and family-centered care[J]. Chin J Nurs, 2019, 54(2):235-238.
[19]	Tingsvik C, Hammarskjöld F, Mårtensson J, et al. Patients’ lived experience of intensive care when being on mechanical ventilation during the weaning process:a hermeneutic phenomenological study[J]. Intensive Crit Care Nurs, 2018, 47:46-53. DOI URL
[20]	Cuzco C, Delgado-Hito P, Marín Pérez R, et al. Patients’ experience while transitioning from the intensive care unit to a ward[J]. Nurs Crit Care, 2022, 27(3):419-428. DOI URL
[21]	Everhart KK, Khorsand S, Khandelwal N, et al. Nighttime extubation does not increase risk of reintubation,length of stay,or mortality:experience of a large,urban,teaching hospital[J]. Anesth Analg, 2019, 128(5):918-923. DOI PMID