| ObjectiveOn the basis of evidence-based medicine,review the progress of research about Pulmonary Rehabilitation Program of Mechanical Ventilation of Cervical Spinal Cord Injury at home and abroad.Collect all the information about pulmonary rehabilitation nursing in patients with CSCI mechanical ventilation to understand the status of lung rehabilitation training in patients.Based on current research and through the clinical observation,literature review,expert meetings,expert advice and other methods to build a scientific program of lung rehabilitation training in patients with mechanical ventilation of CSCI,apply the program to clinical research,in order to provide strong guidance for clinical applications,reduce the pulmonary infection rate,reduce the time of using ventilator and hospital stay of patients with cervical spinal cord injury,save medical expenses and improve the quality of life of patients until fully recovered.Methods1.Retrospective study on nursing care of patients with CSCI mechanical ventilation: Applied electronic medical record information system to collect 42 cases of CSCI patients with mechanical ventilation from a grade III,class A comprehensive hospital's ICU of Chongqing from January 2015 to December 2015,make the information collected,sorted,summarized and descriptive analysis of the obtained data,for understanding the current status of lung rehabilitation training in patients with CSCI mechanical ventilation.2.The application of literature review and expert meeting method in the construction of pulmonary rehabilitation program:(1)The clinical data of CSCI patients with mechanical ventilation were analyzed,point out the deficiency in rehabilitation nursing measures.(2)Used the high level of research evidence to establish the basic content of lung rehabilitation training measures for patients with CSCI mechanical ventilation through the guide and literature review,combined with the review of the case to form a draft of the program.(3)Convened an expert meeting to discuss the basic content of CSCI lung function rehabilitation training program for CSCI patients with mechanical ventilation,combined with experts' opinion to collate and revise,the official text of the lung rehabilitation training program for patients with CSCI mechanical ventilation was eventually obtained.3.Using the method of experimental study to verify the clinical effect of pulmonary rehabilitation program: Selected January~December 2015 cervical spinal injury patients as control group,control group using conventional nursing measures,Selected Selected January~December 2016 patients with cervical spinal injury as treatment group,early stage lung rehabilitation measures,compared two groups of patients in the use of breathing machine using time,the differences between the total length of hospital stay and pulmonary infection rate.Results1.A retrospective survey and analysis of 42 patients showed that the average age of CSCI patients was 51.14±12.71 years old,and the peak age of the injury was 42 to 59 years old.Among them,32 patients were male which account for 76.19% and 10 patients were female which account for 23.81%,the ratio between male and female patients was 3.2: 1.The way of payment for treatment cost : one case from state medicine,4 cases at their own expense,23 cases from health insurance,12 cases from commercial insurance,and 2 cases from the others.Traffic injury caused the highest rate of cervical spinal cord injury among them,the majority spinal cord nerve segment were C3~C6,and the degree of injury in the A,B level accounted for 55%.On the rehabilitation of patients with CSCI mechanical ventilation,there were several weaknesses:(1)there was no rehabilitation time,which may allow patients to lose the best time to recover.(2)lacking of profe ssional team to do the guidance.(3)The goals of rehabilitation were not clear.(4)lacking of assessment mechanism.(5)the contents of rehabilitation measures was single,(6)Participants of CSCI patients with mechanical ventilation were single.A series of clinical problems would occur:the patient's infection rate of lung reached 76.19% in this group.The occurrence of pulmonary infection would extend the patient's time of using ventilator,staying in the hospital and reduce the survival rate and quality of life of patients.2.Based on evidence-based medicine as guidance,combined with clinical experience and expert opinion,we developed the official text of lung rehabilitation training for patients with CSCI mechanical ventilation.It mainly includes the basic data of pulmonary rehabilitation program,assessment and classification of information,training content,airway management and respiratory muscle training,other nursing measures,and remarks.All the 6 parts are very systematic,normative and practical.3.In the validation,we applied the measures to clinical empirical studies.Results display,The duration of mechanical ventilation and hospitalization time values in the control group were 13.98 ± 11.11,25.10 ± 17.95,which was higher than those of estrogen-treated group(7.23±4.94,16.70±7.21),The number of pulmonary infection was 31 cases,infection rate was 76.19% in control group.The number of pulmonary infection was 26 cases,infection rate was 52.38% in treatment group,compared two groups of mechanical ventilation time,the total hospitalization days,pulmonary infection rate were statistically difference(P < 0.01).ConclusionBased on evidence-based medicine as guidance,combined with clinical experience and expert opinion,we developed the official text of lung rehabilitation training for patients with CSCI mechanical ventilation,which could reduce the patient's lung infection rate,short the time of using ventilator and total length of hospital stay.It has good effectiveness and clinical value. |
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