| Purpose:This topic aims to explain the effect of noninvasive mechanical ventilation on nasal hygiene and respiratory flora in patients with COPD combined with type ? respiratory failure,and to clarify the important role of nasal care in patients with COPD combined with type ? respiratory failure with noninvasive mechanical ventilation.This article analyzes the effects of nasal care on nasal secretions,nasal comfort,nasal mucosal bleeding,clinical outcomes,and upper and lower respiratory tract flora in patients with noninvasive mechanical ventilation to provide a basis for nasal care in patients with noninvasive mechanical ventilation.Methods:This study collected 52 patients diagnosed with COPD combined with type ? respiratory failure and required non-invasive mechanical ventilation at a third-level hospital in Zhejiang Province from March 2019 to December 2019.According to the method of randomization was divided into trial group and control group,each group of 26 patients.The control group received conventional nursing with non-invasive mechanical ventilation,and the trial group received nasal spray and nasal wipe on the basis of conventional nursing with non-invasive mechanical ventilation.Before the intervention,the general data of the two groups of patients were collected and analyzed to ensure the comparability between the two groups.The changes of nasal comfort score,nasal secretion score,occurrence of nasal mucosal bleeding,ventilator-associated pneumonia,sputum culture positive results and C-reactive protein recovery time before and after intervention were followed and collected;nasal and deep sputum samples from the two groups of patients were collected before and after the intervention,and the changes in the abundance,diversity,and quantity of the nasal and lower respiratory tract flora between the two groups of patients were identified by 16 SrDNA gene sequencing.Comprehensive evaluation of the nursing effect of nasal cavity nursing on patients with non-invasive mechanical ventilation to provide a basis for clinical nursing.Results:1.This study included 52 subjects,among which 9 patients were lost after the study,and 43 subjects completed this study(22 in the trial group and 21 in the control group).There were 25 males(58.1%)and 18 females(41.9%).The age ranged from 58 to 89 years old,with an average age of 75.30±8.47 years.There was no statistical difference between the two groups in terms of age,gender,smoking history and other general data(P> 0.05).2.There was no statistical difference in nasal comfort scores between the two groups of patients before enrollment(P> 0.05),but after the intervention,it was found that there was a statistical difference in the nasal comfort scores of the two groups of patients(P <0.001).The nasal comfort score of the test group decreased from 2.41 ± 1.53 to 0.73 ± 0.93(P <0.001),while the nasal comfort score of the control group increased from 2.00 ± 0.83 to 4.24 ± 1.86(P <0.001);There was no statistical difference in nasal secretion scores between the two groups of patients before enrollment(P> 0.05),but after the intervention,it was found that the nasal secretion scores of the two groups were statistically different(P <0.001),of which the nasal secretion score of the test group decreased from 1.36 ± 0.49 to 1.09 ± 0.29(P <0.05),while the nasal secretion score of the control group increased from 1.14 ± 0.35 to 2.05 ± 0.74(P <0.001);Although there was no statistical difference in the occurrence of nasal mucosal hemorrhage between the two groups(P> 0.05),but the nasal mucosal bleeding in the experimental group(13.6%)was less than that in the control group(33.3%).3.By comparing the nasal cavity and lower respiratory tract flora species abundance at the phylum level,there was no significant difference in the dominant nasal flora before and after nasal care in the experimental group,while there was an increase in the Firmicutes in the nasal cavity of the control group,and in the nasal cavity and lower respiratory tract of the control group,there were rare flora,such as Candidatus-Marinimicrobia,Nitrospirae and Chloroflexi.In the comparison of nasal cavity and lower respiratory tract flora species abundance at the class level,there was no significant difference between Bacilli and Actinobacteria in the nasal flora of the experimental group before and after the nasal care,with a slight decrease in Gammaproteobacteria,and an increase in both Bacilli and Gammaproteobacteria in the control group.In addition,rare bacteria such as Gemmatimonadetes and Acidobacteria-Gp6 appeared in the flora of the lower respiratory tract of the control group.In the comparison of nasal cavity and lower respiratory tract flora species abundance at the genus level,the increased proportion of Staphylococcus in the control group was more obvious than that in the experimental group,but the species of the lower respiratory tract did not change significantly.4.There was no statistically significant difference in positive sputum culture results between the two groups before and after the intervention(P > 0.05).including 11 cases(50%)in the experimental group and 13 cases(61.9%)in the control group before the intervention.After the intervention,there were 8 cases(36.4%)in the experimental group and 10 cases(47.6%)in the control group.There was no statistically significant difference in the recovery time of c-reactive protein between the two groups(P >0.05),but the comparison of c-reactive protein recovery time between the two groups after intervention showed that the experimental group(3.71±0.91)was less than the control group(3.82±0.85).There was no statistically significant difference in the incidence of VAP between the two groups(P >0.05),including 1 case in the test group(4.5%)and 3 cases in the control group(14.5%).5.No serious adverse nursing events occurred during the nasal care.Conclusion:1.Nasal care based on routine nursing can reduce nasal secretions of patients with non-invasive mechanical ventilation,improve patient comfort,and reduce the incidence of nasal mucosal bleeding.2.During the treatment of noninvasive mechanical ventilation,the changes of nasal flora were most significantly increased by Staphylococcus,and rare flora appeared in both nasal cavity and lower respiratory tract,which may be one of the causes of ventilator-associated pneumonia in patients with noninvasive mechanical ventilation.3.Under the premise of routine nursing in the hospital,the nasal care of patients with noninvasive mechanical ventilation found no significant change in the abundance of dominant nasal flora,and no rare flora was found in the distribution of bacteria in the lower respiratory tract.4.The nasal care of patients with non-invasive mechanical ventilation cannot be ignored,and effective nasal care is imperative. |
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