进阶式肺康复在经鼻高流量氧疗患者中的应用研究

doi:10.3761/j.issn.0254-1769.2024.17.001

摘要/Abstract

摘要：

目的探讨进阶式肺康复在经鼻高流量氧疗（high-flow nasal cannula oxygen therapy，HFNC）患者中的应用效果。方法采用便利抽样法，选取天津市某三级甲等综合医院呼吸科、ICU、冠心病监护室等在2023年1月—6月收治的40例HFNC患者为试验组，2022年6月—12月收治的40例HFNC患者为对照组，试验组以信息-动机-行为技巧（informa-tion-motivation-behavioral skills，IMB）模型为理论基础，实施包括病情稳定期、出院准备期、居家康复期的进阶式肺康复，且通过随访平台进行居家肺康复的依从性管理；对照组实施常规肺康复及居家随访。比较干预前、出院后第2个月、出院后第6个月两组呼吸困难程度、6 min步行距离、运动自我效能、生活质量，以及出院后6个月内两组居家肺康复依从性。结果重复测量方差分析显示，两组呼吸困难程度、6 min步行距离、运动自我效能、生活质量比较，时间与组间均存在交互效应（P<0.05）；简单效应分析显示，出院后第2、6个月，试验组呼吸困难程度、6 min步行距离、运动自我效能、生活质量均优于对照组（P<0.05）。出院后6个月内，试验组居家肺康复依从性优于对照组，差异有统计学意义（P<0.05）。结论基于IMB模型的进阶式肺康复能改善HFNC患者的呼吸系统症状，提高其运动自我效能和居家肺康复依从性，增强运动耐力和提高生活质量。

关键词: 经鼻高流量氧疗, 肺康复, 智随访, 信息-动机-行为技巧模型, 康复护理

Abstract:

Objective To explore the application effect of advanced lung rehabilitation programs in patients undergoing high flow nasal cannula oxygen therapy（HFNC）. Methods Convenience sampling method was used to select 40 HFNC patients admitted to the respiratory department，ICU，coronary heart disease monitoring unit，and other departments of a tertiary A comprehensive hospital in Tianjin from January to June 2023 as the experimental group，and 40 HFNC patients admitted from June to December 2022 as the control group. Both groups of patients received HFNC treatment during hospitalization and continued at home，while the experimental group adopts the information-motivation-behavioral skills（IMB） model as the theoretical basis，implements advanced pulmonary rehabilitation during the stable condition period，discharge preparation period，and home rehabilitation period，and implements compliance management of home pulmonary rehabilitation through cloud follow-up，and the control group received routine lung rehabilitation and home follow-up. The degree of respiratory distress，6-minute walking distance，exercise self-efficacy，quality of life were compared between the 2 groups before intervention，2 months and 6 months after intervention，and compliance with home pulmonary rehabilitation was compared between the 2 groups 6 months after intervention. Results The repeated measures analysis of variance showed that there was an interaction effect between time and the 2 groups in terms of difficulty in breathing，6-minute walking distance，exercise self-efficacy，and quality of life（P<0.05）. Simple effect analysis showed that after 2 and 6 months of intervention，the experimental group performed better than the control group in the respiratory distress，6-minute walking distance，exercise self-efficacy，and quality of life（P<0.05）. Within 6 months of intervention，the compliance of home pulmonary rehabilitation in the experimental group was better than that in the control group，and the difference was statistically significant （P<0.05）. Conclusion The application of advanced pulmonary rehabilitation programme based on IMB can improve respiratory symptoms and improve exercise self-efficacy and adherence to pulmonary rehabilitation，enhance activity endurance and improve quality of life.

Key words: High-Flow Nasal Cannula Oxygen Therapy, Pulmonary Rehabilitation, Smart Follow-Up, Information-Motivation-Behavioral Skills Model, Rehabilitation Nursing

吕丹, 赵莹, 贺艳, 刘青, 宋福娟, 李萌, 张馨月, 王晓萍. 进阶式肺康复在经鼻高流量氧疗患者中的应用研究[J]. 中华护理杂志, 2024, 59(17): 2053-2061.

LÜ Dan, ZHAO Ying, HE Yan, LIU Qing, SONG Fujuan, LI Meng, ZHANG Xinyue, WANG Xiaoping. Construction and application of an advanced pulmonary rehabilitation programme for patients undergoing high-flow nasal cannula oxygen therapy[J]. Chinese Journal of Nursing, 2024, 59(17): 2053-2061.

图/表 7

表1 经鼻高流量氧疗患者进阶式肺康复方案

Table 1 Pulmonary rehabilitation programme for patients undergoing high-flow nasal cannula oxygen therapy

表2 两组一般资料的比较（例）

Table 2 Comparisons of general data between the 2 groups（case）

表3 两组改良英国医学研究委员会呼吸困难量表评分的比较（分，$\bar{x}\pm s$）

Table 3 Comparison of modified Medical British Research Council between the 2 groups（scores，$\bar{x}\pm s$）

表4 两组运动自我效能量表得分的比较（分，$\bar{x}\pm s$）

Table 4 Comparison of Self-Efficacy for Exercise between the 2 groups（scores，$\bar{x}\pm s$）

表5 两组6 min步行距离的比较（m，$\bar{x}\pm s$）

Table 5 Comparison of 6-minutes walk test between the 2 groups（m，$\bar{x}\pm s$）

表6 两组简明健康状况调查表得分的比较（分，$\bar{x}\pm s$）

Table 6 Comparison of 36-Item Short From Suyvey between the 2 groups（scores，$\bar{x}\pm s$）

表7 两组居家肺康复训练依从性比较（例）

Table 7 Comparison of family pulmonary rehabilitation training compliance between the 2 groups（n）

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