| Objective:1. Explor the most suitable strength of tracheal pressure stimulation adult effective cough.2. Construct effectiveness evaluation system of manual vibration pressure method assisting adult cardiothoracic postoperative patients sputum expectoration.3. By clinical empirical study comparing the effect of manual vibration pressure and manual vibration method to assist the sputum is effective.,and explore its influential factors.Methods:1. Recruited2011in Fujian Province Hospital practice nursing interns, and draw voluntarily participated in this study40subjects, using strip box dynamometer to measure the strength of tracheal pressure,find the optimal tracheal pressure strength in stimulate healthy adults effectively cough.2. Construct the effectiveness assessment system of manual vibration pressure method assisting adult cardiothoracic postoperative patients of sputum expectoration:Based on ADC effectiveness assessment theory famewok,effectiveness evaluation system was developed from three dimensions including availability (A), Dependability (D), Capacity (C). Content validity was estimated by25experts for two rounds of the consultation,then though the content validity test,the Effectiveness Assessment Protocol was developed. Internal consistency was calculated through Cronbach’s alpha, select30patients tnterval24h to evaluation test-retest reliability and inter-rater reliability.3. A convenience sample of184cardiothoracic postoperative patients come from Fujian Provincial Hospital and Fujian Pulmonary Hospital was in intervention study from November2011to February2012. Divided the184patients into the control group and the experimental group, the test group using manual vibration pressing method (manual vibration+trachea pressing method), and control group only with manual vibration method for assisting expectoration, compared in the two groups results validity. Using t test,rank sum test method analysis the difference with different demographic characteristics (gender,age,education, smoking), characteristics of disease (disease type, disease severity of APACHE II score), operation management(endotracheal intubation time, operation time, the number of sputum suction), basic functional status (pulmonary function, sputum culture),fluid intake and output, chest fluid amount and other variables in adult cardiothoracic postoperative patients of sputum expectoration.Results:1. The optimal strength of tracheal press to stimulate healthy adults effectively cough is1.59N～3.45N. Pressing area changes, subjects comfort is also changed.2. The effectiveness assessment system of manual vibration pressure method assisting adult cardiothoracic postoperative patients of sputum expectoration included3dimensions,11indicators and42items,the index system administrative levels clear, reflected the manual vibration pressure method assisting sputum expectoration’s general process of operation.The content validity index(CVI) was0.882-0.891,the Cronbach’s a Coefficient of internal consistency reliability for overall assessment form was0.902, each dimensions were0.877,0.815and0.826. The Kappa value for test-retest reliability of the overall assessment form was0.923, each dimension are0.892,0.875,0.813;Intra-class correlation coefficient for overall assessment form was0.899, each dimension are0.856,0.817,0.829.3. Manual vibration pressure method is efficiency better than manual vibration method in assisting adult cardiothoracic postoperative patients of sputum expectoration, the days of expectoration auxiliary measures, leukocyte improvement, radiological improvement,sputum volume, sputum viscosity, patients with autonomic effective cough, lung auscultation, breathing improvement were less than manual vibration method,and improve the prognosis of patients, reduce complication rate (P< 0.05).4. Single factor analysis showed:different demographic characteristics, disease characteristics, operation management, basic function, fluid intake and output, thoracic fluid amount improving expectoration in patients, the difference was statistically significant (P<0.05).Conclusions:1. Tracheal press to stimulate healthy adults effectively cough should focus on comfort, the strength of trachea press should be evidence-based approach and appropriate training, thus making the ues of trachea press standardized and scientific.2. The manual vibration pressure method assisting adult cardiothoracic postoperative patients sputum expectoration effectiveness assessment form had comprehensive content, correlation with the theme, good internal consistency,fully reflects the full nursing quality control of the manual vibration pressure method,and can be used for clinical nursing staff work practice guidelines, suitable for adult postoperative cardiothoracic patients sputum expectoration efficiency assessment.3. The Manual vibration press method to assist adult cardiothoracic postoperative patients sputum expectoration effectiveness was superior to manual vibration method, we should promote beneficial factors for sputum expectoration, improve patient’s comfort, establish and implement clinical situable humanistic care measures, advocate evidence based on sputum drainage nursing measures can effectively improve the sputum expectoration efficiency of adult cardiothoracic postoperative patients. |
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