Fundamental Experiment And Clinical Application Of Cooling Method Based On Symptomatic Management Theory For Fever Patients

Objective:1.Through the basic experiment of high-temperature cooling,explored the effect of different cooling methods and different ice pad used time on high fever rat model.2.To establish the management model of fever symptom on the basis of experimental research,and then evaluate the effect of the model on the cooling effect and comfortableness of high fever in-patients.Method:1.Fundamental experiment:(1)Using random block design,50 SD rats were randomly divided into control group,drug group,20-minute group,30-minute group and 60-minute group.The high fever rats model was built by subcutaneous injection with 20% dry yeast solution.The group was treated with the following measures.The control group has not cooling treatment;drug group was dealt with antipyretic;20min group with 20 min ice pack cooling;30min group with 30 min ice pack cooling;60min group with 60 min ice pack cooling.The rats rectal temperature was measured at different time points after cooling and the reaction of rats was observed.(2)Using random block design 64 SD rats were randomly divided into control group,drug group,ice bag group and combined group.The following interventions were taken after successful replication of the fever model.The control group has not cooling treatment;drug group was dealt with antipyretic;ice pack group with 30 min ice pack cooling;combined group with 30 min ice pack cooling and antipyretic.At the end of the intervention,10 rats were subjected to rectal temperature monitoring at each time point,and serum CK and LDH were measured in 6 rats.The effect of cooling in the two groups was evaluated by repeated measurement of variance analysis,single factor analysis of variance and nonparametric test.Using Origin9.0 trace out the body temperature curve,and calculate the body temperature reaction index.2.Clinical study: Convenient select 120 fever patients in the tertiary hospital respiratory department from May to November 2016 in Fuzhou,who were all in line with the inclusion and exclusion criteria.Randomly divided them into experimental group and Control group,60 patients in each group.The experimental group was treated with fever syndrome management mode,the control group received conventional clinical cooling care intervention.Body temperature were measured at 30,60,and 90 minutes after the intervention and the time required for the body temperature drop to 38?were recorded.Patients' blood pressure,pulse,oxygen saturation,comfort value were also recorded before and after intervention.Statistical analysis were performed by descriptive statistical analysis,t test,chi-square test,Mann-Whitney U test and Wilcoxon rank sum test.Evaluated the effect of fever management model on the cooling effect and comfort level.Results:1.Fundamental experiment(1)Experiment 1: There was no statistically significant difference in groups by repeated measurements of variance(F=1.844,P=0.163).Compared the temperature of same time point,except 300 and 360 min,the other time point all have significant difference between groups(P<0.05).Further comparison with control group found that the significant point of 20/30/60 min group were respectively within 0/15/45 min.There was no significant difference in TRI6 between cooling group and control group(P> 0.05).(2)Experiment 2: There was statistically significant difference in groups by repeated measurements of variance(F=20.372,P=0.000).Compared the temperature of same time point,except 300 and 360 min,the other time point all have significant difference between groups(P < 0.05).Further comparison with control group found that ice pack group's only effective in 15 min and the other two group has impact for 240 min.There was significant difference in TRI6 between drug group/combined group and control group(P> 0.05).There was no significant difference in serum CK and LDH between all groups(P> 0.05).2.Clinical study(1)Cooling effect: There was statistically significant difference in groups by repeated measurements of variance(F=0.909,P=0.343).In the aspect of cooling effect,there were significant differences in the curative effect of the two groups at 30min(Z=-2.019,P=0.044).The time required for the body temperature drop to 38?have no significant differences between groups(P>0.05).(2)Comfort degree: VAS score has no significant difference between the two group after intervention(P> 0.05).VAS score difference of the two group has a significant difference(Z =-3.138,P = 0.002).(3)Physiological indicators: SBP and SPO2 of the two group has a significant difference(P<0.05),DBP and HR of the two group has no significant difference(P>0.05).Conclusion:1.Fundamental experiment(1)Ice pack cooling has quick onset and short validity characteristic.Within 60 min,it showed a certain time-effect relationship.The choice of cooling time should be based on the state of the body,considering the cooling effect and economic benefits,30 minutes cooling is appropriate;(2)Drug cooling can effectively reduce the body temperature of the rats and lasting effect.Ice packs can apply to high fever which require rapid cooling,auxiliary to the drug cooling can extend the cooling effect.2.Clinical study: Fever symptoms management can effectively reduce the patient's body temperature,improve patient comfort experience.From the perspective of symptom management theory to fever symptoms,the enthusiasm and initiative of nursing work can be improve and nurse-patient communication can be promoted.