| BackgroundTracheotomy and mechanical ventilation are important treatment measures in the acute phase of cervical spinal cord injury patients.After the condition was stable,the course of the disease entered the subacute stage from the 6 to 12 weeks.However,respiratory muscle fatigue caused by nerve damage,cough is ineffective,reduced lung function,atelectasis,pneumonia and other trachea still need to be retained for a long time.Many studies have confirmed the effectiveness of pulmonary rehabilitation,but more attention is paid to the pulmonary rehabilitation of patients with SCI tracheotomy in the period of mechanical ventilation and the rehabilitation period,the lack of pulmonary rehabilitation intervention in the subacute phase,and the rehabilitation process of patients is slow.Therefore,in this context,this study aims to construct a pulmonary rehabilitation program for patients in the subacute phase.Objective Aset of scientific,standardized and systematic pulmonary rehabilitation nursing programs for patients withcervical spinal cord injury in the subacute stage was constructed to provide a theoretical basis for clinical nurses to implement pulmonary rehabilitation measures.Methods1.Evidence-based nursing methods:retrieve,screen and evaluate relevant guidelines,expert consensus and systematic evaluation of lung rehabilitation of patients with cervical spinal cord injury;summarize and evaluate the evidence,and summarize the best evidence on pulmonary recovery of cervical spinal cord injury as the content basis of the program.2.Expert meeting method:Organize experts in relevant fields to demonstrate the preliminary construction of cervical SCI tracheotomy patients in the subacute phase.3.Clinical experimental methods:Patients with cervical spinal cord injury with subacute tracheotomy were selected as research subjects,patients from September 2020 to February 2021 were used as the control group,and patients from March 2021 to October 2021 were selected as the intervention group.The control group used conventional pulmonary rehabilitation methods,and the intervention group used the newly constructed pulmonary rehabilitation program.Comparing the sputum volume,vital capacity,forced expiratory volume at the first second,maximum expiratory volume,and the incidence of pulmonary aspiration and pneumonia during the intervention period.Results1.Best evidence summary:54 best evidence for lung recovery in patients with cervical spinal cord injury are summarized.2.Construction of pulmonary rehabilitation program:Through discussion and in-depth analysis at expert meetings,a pulmonary rehabilitation program including pulmonary rehabilitation team establishment,pulmonary rehabilitation timing,evaluation content,pulmonary rehabilitation intervention measures,health education,29 secondary indicators and follow-up management was finally formed.The expert authority coefficient of the participating experts in this study was 0.881.3.Clinical trial results:①the single sputum discharge(5.54 ± 1.5765)ml was better than the control(2.94 ± 1.398)ml,and the average daily sputum(26.39 ±11.508)ml was less than the control(49.73± 14.955)ml(p<0.05).The②test group,first second forced breath capacity and maximum breath volume were(4.17± 0.70)L,(3.86 ± 0.94)L,(266.67 ± 36.70)L were all higher than the control group(3.06 ±0.73)L,(2.91± 0.72)L,(221.73 ± 19.53)L,which were statistically significant(p<0.05).③The incidence of pulmonary dylectasis(3.03%)and pneumonia(6.06%)were all lower than the control group(24.24%)and(27.27%),which were statistically significant(p<0.05).Conclusion1.The subacute pulmonary rehabilitation care program constructed in this study is reasonable,comprehensive and practical.2.This pulmonary rehabilitation program can improve patients’ pulmonary function,prevent respiratory complications such as pneumonia and atelectasis,and has certain reference value for the development of pulmonary rehabilitation in spinal cord injury patients. |
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