物联网联合多学科诊疗康复护理模式对慢性阻塞性肺疾病康复效果的影响

doi:10.19983/j.issn.2096-8493.20220046

摘要/Abstract

摘要：

目的:探讨物联网联合多学科诊疗(multi-disciplinary diagnosis and treatment,MDT)康复护理模式对慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者康复效果的影响。方法:采用前瞻性研究方法,搜集河北省胸科医院2019年5—12月确诊并住院治疗的83例COPD患者作为对照组;2020年6—11月确诊并住院治疗的83例COPD患者作为观察组。对照组采用常规肺康复护理措施,观察组在常规护理基础上接受物联网联合MDT康复护理模式进行肺康复管理。比较两组患者入院时、出院随访6个月后的血气分析指标、肺功能指标、焦虑情绪评分、抑郁情绪评分、Barthel评分、健康知识评分以及住院时间及出院时护理满意度的情况。结果:观察组患者住院时间明显短于对照组[(10.28±2.44)d vs. (19.67±1.27)d],差异有统计学意义(t=6.054,P=0.011);出院时两组护理满意度相当[观察组为59.04%(49/83),对照组为53.01%(44/83),χ²=3.254,P=0.434)。出院随访6个月后,观察组氧分压[(9.41±0.11)kPa]、第1秒用力呼气容积[1.90(1.72,2.21)L]、一秒率[(66.86±4.52)%]、最大呼气流量[3.95(3.70,4.02)L/s]、Barthel评分[(73.59±10.49)分]均明显高于对照组[分别为(8.84±0.32)kPa、1.43(1.17,1.62)L、(61.74±3.59)%、3.27(2.85,3.64)L/s、(68.73±12.37)分],差异均有统计学意义(t=12.235,P=0.032;U=-7.654,P=0.000;t=-8.081,P=0.000;U=15.327,P=0.003;t=2.730,P=0.007);观察组二氧化碳分压水平[(5.13±0.57)kPa)、焦虑评分[(10.28±2.13)分]及抑郁评分[(10.27±0.44)分]均明显低于对照组[分别为(5.64±0.81)kPa、(19.45±5.11)分、(16.27±2.11)分],差异均有统计学意义(t=11.251,P=0.041;t=15.090,P=0.000;t=25.361,P=0.000)。结论:物联网联合MDT康复护理模式制定规范化的肺康复策略对COPD患者进行康复干预,能明显改善患者焦虑和抑郁情绪,提高生活质量,改善呼吸困难症状,降低疾病对患者的影响程度,缩短患者住院时间。

关键词: 肺疾病,慢性阻塞性, 护理, 康复护理, 评价研究

Abstract:

Objective: To investigate Internet of Things (IoT) combined with multi-disciplinary diagnosis, treatment (MDT) and rehabilitation nursing model for recovery of chronic obstructive pulmonary disease (COPD). Methods: From May to December 2019,a prospective study was conducted in 83 COPD patients who were diagnosed and hospitalized in Hebei Chest Hospital (control group); and 83 COPD patients diagnosed and hospitalized from June to November 2020 were included as observation group. The control group received conventional lung rehabilitation nursing measures, and the observation group received IoT combined with MDT rehabilitation nursing mode for lung rehabilitation management on the basis of conventional nursing. Blood gas analysis indexes, lung function indexes, anxiety score, depression score, Barthel score, health knowledge score, length of stay and nursing satisfaction at discharge were compared between the two groups at admission and 6 months after discharge follow-up. Results: The length of hospitalization in the observation group was significantly shorter than that in the control group ((10.28±2.44) d vs. (19.67±1.27) d; t=6.054, P=0.011). Nursing satisfaction at discharge was similar between the two groups (59.04% (49/83) vs. 53.01% (44/83), χ²=3.254, P=0.434). Six months after discharge, oxygen partial pressure ((9.41±0.11) kPa), forced expiratory volume in the first second (1.90 (1.72, 2.21) L), FEV₁/FVC ((66.86±4.52) %), maximum expiratory flow (3.95 (3.70, 4.02) L/s) and Barthel score (73.59±10.49) in the observation group were significantly higher than those in the control group ((8.84±0.32) kPa, 1.43 (1.17, 1.62) L, (61.74±3.59) %, 3.27 (2.85, 3.64) L/s, 68.73±12.37), the differences were statistically significant (t=12.235, P=0.032; U=-7.654, P=0.000; t=-8.081, P=0.000; U=15.327, P=0.003; t=2.730, P=0.007), the PaCO₂ ((5.13±0.57) kPa), anxiety score (10.28±2.13) and depression score (10.27±0.44) of the observation group were significantly lower than those of the control group ((5.64±0.81) kPa, 19.45±5.11, and 16.27±2.11, respectively), the differences were statistically significant (t=11.251, P=0.041; t=15.090, P=0.000; t=25.361, P=0.000). Conclusion: For COPD patients, developing standardized pulmonary rehabilitation strategy for recovery intervention through combining IoT with MDT rehabilitation nursing mode, could significantly improve emotion, quality of life, the symptoms of dyspnea, reduce the impact of the disease on patients, and shorten the length of hospital stay.

Key words: Pulmonary disease,chronic obstructive, Nursing care, Rehabilitation nursing, Evaluation studies

中图分类号:

R563

赵虹, 高小丽, 郭贝贝, 吕莎. 物联网联合多学科诊疗康复护理模式对慢性阻塞性肺疾病康复效果的影响[J]. 结核与肺部疾病杂志, 2022, 3(3): 187-192. doi: 10.19983/j.issn.2096-8493.20220046

ZHAO Hong, GAO Xiao-li, GUO Bei-bei, LYU Sha. Influence of Internet of Things combined with multidisciplinary diagnosis, treatment and rehabilitation nursing model for recovery of chronic obstructive pulmonary disease[J]. Journal of Tuberculosis and Lung Disease, 2022, 3(3): 187-192. doi: 10.19983/j.issn.2096-8493.20220046

图/表 2

表1

两组患者入院时基线资料的比较

基线资料	观察组(83例)	对照组(83例)	统计检验值	P值
年龄(岁, $x ¯$ ±s)	67.0±17.0	65.5±17.5	t=0.560	0.576
性别[例,构成比(%)]			χ²=2.375	0.755
男性	38(45.78)	36(43.37)
女性	45(54.22)	47(56.63)
病程[年,M(Q₁,Q₃)]	10.69(5.54,15.32)	11.84(5.97,14.53)	U=-8.674	0.841
HAMD评分(分, $x ¯$ ±s)	31.53±5.94	29.85±6.03	t=1.808	0.072
HAMA评分(分, $x ¯$ ±s)	32.37±6.73	33.65±6.07	t=-1.287	0.200
Barthel评分(分, $x ¯$ ±s)	55.97±5.94	54.72±6.02	t=1.347	0.180

表1

表2

观察组和对照组患者入院时及出院随访6个月时肺功能指标的比较

肺功能指标	观察组(83例)	对照组(83例)	统计检验值	P值
FEV₁[L,M(Q₁,Q₃)]
入院时	0.99(0.69,1.51)	0.98(0.72,1.37)	U=-10.377	0.312
随访6个月	1.90(1.71,2.21)	1.43(1.17,1.62)	U=-7.654	0.000
U值	-7.294	-8.543
P值	0.001	0.022
FEV₁/FVC(%, $x ¯$ ±s)
入院时	54.12±3.82	54.55±2.87	t=0.820	0.414
随访6个月	66.86±4.52	54.55±2.87	t=-8.081	0.000
t值	-19.613	-14.252
P值	0.000	0.000
PEF[L/s,M(Q₁,Q₃)])
入院时	2.66(2.11,2.99)	2.57(2.06,3.01)	U=-11.594	0.785
随访6个月	3.95(3.70,4.02)	3.27(2.85,3.64)	U=15.327	0.003
U值	-9.032	-5.675
P值	0.000	0.044

表2

参考文献 9

[1]	World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization, 2011.
[2]	Zhong N, Wang C, Yao W, et al. Prevalence of chronic obstructive pulmonary disease in China: a large, population-based survey. Am J Respir Crit Care Med, 2007, 176(8): 753-760. doi: 10.1164/rccm.200612-1749OC. doi: 10.1164/rccm.200612-1749OC URL
[3]	俞磊, 陆阳, 朱晓玲,等. 物联网技术在医疗领域的研究进展. 计算机应用研究, 2012, 29(1):1-7. doi: 10.3969/j.issn.1001-3695.2012.01.001. doi: 10.3969/j.issn.1001-3695.2012.01.001
[4]	朱俞彤, 刘祚燕. 物联网云平台的肺康复护理对老年慢性阻塞性肺疾病稳定期患者肺功能的影响. 中国医药导报, 2021, 18(1): 184-188.
[5]	中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 慢性阻塞性肺疾病基层诊疗指南(2018年).中华全科医师杂志, 2018, 17(11): 856-870. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002. doi: 10.3760/cma.j.issn.1671-7368.2018.11.002
[6]	谢欲晓, 卢茜, 段亚景,等. 肺康复的发展现状与展望. 华西医学, 2019, 34(5): 498-502. doi: 10.7507/1002-0179.201903245. doi: 10.7507/1002-0179.201903245
[7]	Clini EM, Crisafulli E, Costi S, et al. Effects of early inpatient rehabilitation after acute exacerbation of COPD. Respir Med, 2009, 103(10): 1526-1531. doi: 10.1016/j.rmed.2009.04.011. doi: 10.1016/j.rmed.2009.04.011 URL
[8]	刘洁, 张静, 白春学. 物联网医学在肺功能随访与监测中的应用. 中华结核和呼吸杂志, 2014, 37(4):316-317. doi: 10.3760/cma.j.issn.1001-0939.2014.04.026. doi: 10.3760/cma.j.issn.1001-0939.2014.04.026
[9]	吴玉婷, 王建宁, 詹梦梅. 慢性阻塞性肺疾病延续性护理的研究进展. 实用临床医学, 2020, 21(7):103-107. doi: 10.13764/j.cnki.lcsy.2020.07.033. doi: 10.13764/j.cnki.lcsy.2020.07.033

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