The Contrast Study Of The Prophylactic Effects Of Different Nursing Interventions On Complications After Thoracic Surgery

Background and Purpose: The main cause of high incidence rate of pulmonary complication for patients after thoracic operation is: operation wound is big, time is long, pulmonary lobe is squeezed to expand operation scope, hilum of lung and bronch are often wounded or excretion of respiratory tract is stimulated to increase, effective breath area fall because of swelling stomach and injury of diaphragm after operation; Respiratory center is inhibited and total lung compliance and ventilation function come down becaused of application of junk and paregoric. The activity of thoracal is restricted and effective ventilation of lung obviously decreased because wound of entry ached and thoracic girdle wrapped tightly; Pulmonary alveoli and small airway collapse and ratio of ventilation and blood flow is abnormal because the activity diaphragmatic was limited, interstitial edema after operation and pulmonary elastic recoil increased; Patient would not like cough to discharge sputum because of Culture differences and patients' dependent psychological. A lot of factors inevitably bring about the breath function coming down and respiratory system complication happened. Helping patient that accepted thoracotomy to discharge sputum effectively is one of that main prevention and cure of lung complication Arranging the sputum nursing is according to effect of conveyer belt of cilium- mucus system of cellula columnoepithelialis and strengthen eliminating efficiency of the mucous membrane cilium thereby by wielding the body place drainage, fighting and vibrating and making the secretes upward, eliminate secretes ultimately by coughing At present doctors adopt the therapy of knocking the back and coughing, at the same time to keep air smooth, clinically adopt the therapy of inhale the sputum and the diffusion suck by atomization. In recent years, studies were made on the discharge sputum nursing without wound, the aim at seeking intervention study on effect, economy and feasible discharge sputum nursing, including two-step expectoration, knocking the back, vibrating the bony thorax, forced expiration and application of arranging sputum machine and there being no wound air flue expectoration machine. The aim of the Study is to discuss the prevention against lung complication after application of sputum machine, the effect of discharging sputum and improving the breath function.Methods :A total of 120 patients who had been thoracically operated were randomized into the observed group (60 cases) and the control group (60 cases). In the observed group, patients were conducted sputum excretion by the vibratory spum-excretion apparatus on the bases of routine therapy consisting of oxygen-atomizated inhalation and anti-infection therapy. Vibration was produced by the interaction of the slippery surface of a size-230 knocking ram with the patient's body surface. Thresh was produced by the edge of the knocking ram pounding on the patients. Vibratory sputum excretion was undertaken by pounding the patient's chest down-above and ecto-entad. The patients were posed at lateral position and the frequency was set at 15-30 Hz adjusted by the patients' age, constitution and conditions. Thresh was conducted by a specifically well-trained primary nurse. Held by the professional, the knocking ram was leniter ambulated sequentially from the right side to the left side and from back to the vertebral column and then the breast bone during pounding. Each episode of thresh lasted 15-20 min. In the control group, patients were conducted sputum-excretion by a routine maneuver rhythmically and repeatedly knocking at the corresponding chest wall of sputum-retention pulmonary segment at a frequency of 3-6 Hz with the hand fixed to a tumblerful shape of capylus & koilometacarpus in order to fall the glutinous secretion off. Pounding was only positioned on the areas of pulmonary lobe in necessity of drainage, excluding the areas of the vertebral column, breast, or inferior to the ribs to prevent a soft tissue injury. Pain was carefully avoided without directly hitting the naked skin. Comparison was made between the two groups by the endpoints including postoperational hypoxemia, pulmonary atelectasis, interventional therapy with BFS, intratracheal sputum excretion by tracheal incision, hospitalized duration, medical cost, 48 h postoperational heart rate, and the patients' gratification grade. Arterial blood gas analysis was carried out in the two groups at 6 h and 48 h postoperation. Efficacy of assisted sputum excretion measures on the precaution of pulmonary complications, subjective feeling about sputum excretion, and the opportunity of sputum excretion were recorded and compared between the two groups.Results: 1. Occurrence of hypoxemia: of the total 60 cases, 16 patients were complicated by hypoxemia in the control group compared to 5 patients in the observed group (x²=8.64 , P＜0.01). 2 There were significant differences between observed and control groups regarding to the occurrence of pulmonary atelectasis (x²=7.62, P＜0.01) and the necessity of sputum-sucking by fiberoptic bronchoscopy (x²=7.50, P＜0.01). No case with the necessity of sputum-sucking by tracheal incision was found in the observed group (x²=1.37, P＞0.05), without significant difference compared with the control group. 3 Medical expenditure: 11.4±2.4 thousand yuans to the observed group, significantly lower than 15.7±3.1 thousand yuans to the control group (P＜0.01). Hospitalized duration: 7.07±0.71 days in the observed group, significantly shorter than 8.73±2.51 days in the control group (P＜0.01). 4. Heart rate alteration: 94.98±8.92 beats/min in the observed group, significantly lower than 108.67±10.80 beats/min in the control group (P＜0.01). 5. Patients' gratification grade: 93.65±1.93 (%) in the observed group, significantly higher than 88.30±1.60(%) in the control group (P＜0.01). 6. There were significant differences in PaO₂, PaCO₂ but not PH between 48 h post-operation and 6 h post-operation (e. g. before sputum ejection, P＜0.01) by using a vibratory spum-ejection apparatus in the observed group and a traditional method in the control group. When comparison was made between the two groups by the difference of PaO₂ and PaCO₂ from 6 h post-operation to 48 h post-operation, a significant discrepancy was found (P＜0.01). 7. There were 47 patients who felt comfortable in the observed group compared to 12 patients in the control group (x²=40.85, P＜0.01). In the control group, there were 22 cases who felt too sore to accept sputum excretion (x²=11.93, P＜0.01), 26 cases who felt a bearable pain to assisted sputum excretion (x²=15.542, P＜0.01), and 13 cases who felt nausea (x²=9.219, P＜0.01), showing a significant difference compared with the observed group.Conclusion: Chest wall vibration approach with the vibratory spum-ejection apparatus is positive and beneficial to the precaution of post-thoracotomic pulmonary complications. This method allows to alleviate ventilation dysfunction, remove mucus retention in the airway, effectively promote coughing to excrete sputum, compromise PaCO₂ in the arterial blood, raise PaO₂, thus to prevent the pulmonary complications and ensure the patients' smooth rehabilitation. Besides, it also efficiently eliminates the airway excretion, not only avoids hypoxemia and pulmonary atelectasis, shortens the patients' hospitalization period, reduces the usage of antibiotics, lowers the medical expenditure, but also renders a comfortable feeling in sputum excretion, relieves labor intensity of medical professionals from turning patient' body and pounding patient' back, eventually improves the efficiency of the nursing staffs.