快速时效管理模式对危重症患者床边经气管镜吸痰的时效及预后的影响

doi:10.19983/j.issn.2096-8493.20260157

摘要/Abstract

摘要：

目的: 探究危重症患者床边经气管镜吸痰应用快速时效管理模式的效果。方法: 选取2024年11月至2025年10月于汕头大学医学院第二附属医院呼吸与危重症医学科(PCCM)诊治的100例床边经气管镜吸痰危重症患者进行研究,采用随机数字表法并通过密封信封法进行分配隐藏,分为观察组及对照组,每组50例;对照组实施常规护理干预,观察组实施快速时效管理模式干预。对比两组患者的临床观察指标、并发症发生率、呼吸功能指标、血气分析指标、心理状态、自我效能感与舒适度的差异。结果: 干预后观察组操作时间、气喘恢复时间、咳嗽恢复时间、住院时间分别为(20.66±2.84)min、(12.34±1.66)d、(12.38±1.63)d、(23.22±1.96)d,均低于对照组[(41.48±2.44)min、(20.36±3.34)d、(21.32±3.43)d、(30.94±1.97)d],差异均有统计学意义(t值分别为-39.586、-15.193、-16.646、-19.618,P值均<0.01)。干预后观察组呼吸频率(RR)、气道压(AP)、潮气量(TV)分别为(18.34±1.70)次/min、(10.54±0.50)mmHg、(8.44±0.50)ml/kg,均优于对照组[(22.70±1.17)次/min、(8.44±0.50)mmHg、(7.52±0.51)ml/kg],差异均有统计学意义(t值分别为-15.305、20.898、9.144,P值均<0.01)。干预后观察组pH值、动脉血氧分压(PaO₂)、动脉血氧饱和度(SaO₂)、动脉血二氧化碳分压(PaCO₂)分别为(7.41±0.04)、(78.38±2.19)mmHg、(96.16±1.18)%、(42.44±1.51)mmHg,均优于对照组[(7.33±0.05)、(64.06±2.65)mmHg、(89.84±1.42)%、(51.28±1.94)mmHg],差异均有统计学意义(t值分别为8.828、29.467、24.175、-25.415,P值均<0.01)。干预后观察组焦虑自评量表(SAS)、抑郁自评量表(SDS)、一般自我效能感量表(GSES)、舒适状况量表(GCQ)评分分别为(36.32±2.64)分、(36.08±2.36)分、(33.44±1.09)分、(94.86±3.15)分,均优于对照组[(47.50±1.74)分、(47.22±1.50)分、(22.92±1.81)分、(75.08±2.16)分],差异均有统计学意义(t值分别为-25.015、-28.129、35.267、36.648,P值均<0.01)。干预后观察组并发症总发生率为4.00%(2/50),低于对照组的20.00%(10/50),差异有统计学意义(χ²=4.640,P=0.031)。结论: PCCM床旁纤维支气管镜患者应用快速时效管理模式可以明显改善呼吸功能、血流动力学以及心理状态并提升自我效能感、护理舒适度,有助于缩短临床治疗周期,并且可以降低并发症发生风险,值得临床推广应用。

关键词: 危重病人医疗, 重症监护病房, 支气管镜检查, 病人医疗护理

Abstract:

Objective: To explore the effect of rapid time-effect management mode on bedside bronchoscope sputum suction in critically ill patients. Methods: A total of 100 critically ill patients who received bedside bronchoscopic sputum aspiration in the Department of Pulmonary and Critical Care Medicine (PCCM) of The Second Affiliated Hospital of Shantou University Medical College from November 2024 to October 2025 were enrolled in this study. Allocation concealment was implemented using the sealed envelope method, and patients were assigned to an observation group and a control group via the random number table method, with 50 cases in each group. The control group received routine nursing intervention, while the observation group received intervention based on the rapid time-effect management mode. The two groups were compared in terms of clinical observation indicators, complication incidence, respiratory function indicators, blood gas analysis indicators, psychological status, self-efficacy and comfort level. Results: After intervention, the operation time, dyspnea recovery time, cough recovery time and hospital stay in the observation group were (20.66±2.84) min, (12.34±1.66) d, (12.38±1.63) d and (23.22±1.96) d respectively, all shorter than those in the control group ((41.48±2.44) min, (20.36±3.34) d, (21.32±3.43) d, (30.94±1.97) d), with statistically significant differences (t=-39.586, -15.193, -16.646, -19.618; all P<0.01).After intervention, the respiratory rate (RR), airway pressure (AP) and tidal volume (TV) in the observation group were (18.34±1.70) breaths/min, (10.54±0.50) mmHg and (8.44±0.50) ml/kg respectively, all better than those in the control group ((22.70±1.17) breaths/min, (8.44±0.50) mmHg, (7.52±0.51) ml/kg), with statistically significant differences (t=-15.305, 20.898, 9.144; all P<0.01).After intervention, the pH value, partial pressure of arterial oxygen (PaO₂), arterial oxygen saturation (SaO₂) and partial pressure of arterial carbon dioxide (PaCO₂) in the observation group were 7.41±0.04, (78.38±2.19) mmHg, (96.16±1.18) % and (42.44±1.51) mmHg respectively, all better than those in the control group (7.33±0.05, (64.06±2.65) mmHg, (89.84±1.42) %, (51.28±1.94) mmHg), with statistically significant differences (t=8.828, 29.467, 24.175, -25.415; all P<0.01).After intervention, the scores of the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), General Self-Efficacy Scale (GSES) and General Comfort Questionnaire (GCQ) in the observation group were (36.32±2.64), (36.08±2.36), (33.44±1.09) and (94.86±3.15) points respectively, all better than those in the control group ((47.50±1.74), (47.22±1.50), (22.92±1.81), (75.08±2.16) points), with statistically significant differences (t=-25.015, -28.129, 35.267, 36.648; all P<0.01).The total incidence of complications in the observation group after intervention was 4.00% (2/50), which was lower than 20.00% (10/50) in the control group, with a statistically significant difference (χ²=4.640, P=0.031). Conclusion: The application of the rapid time-effect management mode in patients undergoing bedside flexible bronchoscopy in PCCM can significantly improve respiratory function, hemodynamics and psychological status, enhance self-efficacy and nursing comfort, help shorten the clinical treatment cycle, and reduce the risk of complications, which is worthy of clinical promotion and application.

Key words: Critical care, Intensive care units, Bronchoscopy, Patient care

中图分类号:

陈佳丽, 柯贤丽, 林燕环, 林静君. 快速时效管理模式对危重症患者床边经气管镜吸痰的时效及预后的影响[J]. 结核与肺部疾病杂志,2026, 7(5): 635-642. doi: 10.19983/j.issn.2096-8493.20260157

Chen Jiali, Ke Xianli, Lin Yanhuan, Lin Jingjun. The effect of rapid time-effect management mode on the time-effect and prognosis of bedside endotracheal suctioning in critically ill patients[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(5): 635-642. doi: 10.19983/j.issn.2096-8493.20260157

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参考文献 20

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特征	观察组(50例)	对照组(50例)	统计检验值	P值
年龄(岁,$\bar{x}±s$)	69.45±4.54	69.49±4.35	t=-0.045	0.964
性别[例(构成比,%)]			χ²=0.160	0.689
男性	22(44.00)	20(40.00)
女性	28(56.00)	30(60.00)
住院病程(d,$\bar{x}±s$)	6.72±1.85	6.86±1.72	t=-0.394	0.695
临床诊断			χ²=0.045	0.832
重症肺炎	24(48.00)	22(44.00)
慢性阻塞性肺疾病急性加重	18(36.00)	19(38.00)
重症支气管哮喘	6(12.00)	7(14.00)
其他危重型肺部疾病	2(4.00)	2(4.00)
合并症[例(构成比,%)]
有高血压	17(34.00)	16(32.00)	χ²=0.045	0.832
无高血压	33(66.00)	34(68.00)
有糖尿病	17(34.00)	14(28.00)	χ²=0.421	0.517
无糖尿病	33(66.00)	36(72.00)

组别	观察组(50例)	对照组(50例)	t值	P值
RR(次/min)
干预前	28.82±1.98	28.94±2.09	-0.295	0.769
干预后	18.34±1.70^a	22.70±1.17^a	-15.305	<0.001
TV(ml/kg)
干预前	6.44±0.50	6.54±0.50	-0.995	0.322
干预后	8.44±0.50^a	7.52±0.51^a	9.144	<0.001
AP(mmHg)
干预前	7.50±0.51	7.58±0.50	-0.797	0.427
干预后	10.54±0.50^a	8.44±0.50^a	20.898	<0.001

组别	观察组(50例)	对照组(50例)	t值	P值
pH值
干预前	7.25±0.05	7.24±0.06	0.905	0.368
干预后	7.41±0.04^a	7.33±0.05^a	8.828	<0.001
PaO₂(mmHg)
干预前	44.28±2.77	45.34±3.22	-1.763	0.081
干预后	78.38±2.19^a	64.06±2.65^a	29.467	<0.001
PaCO₂(mmHg)
干预前	68.20±2.52	68.50±2.16	-0.640	0.524
干预后	42.44±1.51^a	51.28±1.94^a	-25.415	<0.001
SaO₂(%)
干预前	82.36±1.71	82.80±1.76	-1.267	0.208
干预后	96.16±1.18^a	89.84±1.42^a	24.175	<0.001

组别	SAS		SDS
组别	干预前	干预后	干预前	干预后
观察组(50例)	67.50±1.54	36.32±2.64^a	67.80±1.78	36.08±2.36^a
对照组(50例)	67.52±1.81	47.50±1.74^a	67.44±1.61	47.22±1.50^a
t值	-0.059	-25.015	1.061	-28.129
P值	0.953	<0.001	0.292	<0.001

组别	GSES		GCQ
组别	干预前	干预后	干预前	干预后
观察组(50例)	12.40±1.80	33.44±1.09^a	51.88±4.53	94.86±3.15^a
对照组(50例)	12.56±1.74	22.92±1.81^a	53.62±4.86	75.08±2.16^a
t值	-10.452	35.267	-1.852	36.648
P值	0.652	<0.001	0.067	<0.001