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目的评价对多发肋骨骨折合并血气胸患者接受胸腔闭式引流术(CTD)治疗期间进行全面综合护理干预的护理质量。方法回顾性分析2014年1月至2015年10月日照市五莲县人民医院住院接受CTD治疗的42例多发肋骨骨折合并血气胸患者其中男性27例,女性15例;年龄18~68岁,平均(45.32±5.43)岁。对比观察在常规护理的基础上,规范引流管护理操作并加强对患者的呼吸道管理、疼痛护理、心理护理、饮食护理和并发症预防等全面综合性护理干预后,患者排痰难易程度、疼痛程度、心理状态、术后并发症发生率和患者满意度的变化。结果护理干预后患者的排痰难度较干预前显著降低,差异有统计学意义(P<0.05)。干预后患者视觉模拟评分(VAS)及严重程度分级、汉密尔顿焦虑量表(HAMA)评分和汉密尔顿抑郁量表(HAMD)评分均显著降低[VAS评分:(3.12±0.41)分vs(8.65±0.64)分;HAMA评分:(22.34±4.69)分vs(46.32±5.68)分;HAMA评分:(29.31±4.42)分vs(47.43±6.82)分]差异有统计学意义(P均<0.05)。42例患者的引流管留置时间为(66.78±1.59)h,住院期间均未发生胸腔感染、皮下气肿以及引流管脱管等并发症。患者对护理总满意度为100%(42/42)。结论在多发肋骨骨折拌血气胸患者的CTD中开展精心的护理干预能够减轻疼痛,降低并发症感染率等。
Objective To evaluate the quality of care for patients with multiple rib fractures complicated with hemopneumothorax undergoing total comprehensive nursing intervention during thoracic closure drainage (CTD). Methods A retrospective analysis of 42 cases of multiple rib fractures with hemopneumothorax admitted to Wulian County People’s Hospital of Rizhao from January 2014 to October 2015 were 27 males and 15 females aged 18-68 years (45.32 ± 5.43) years old. Contrast observation On the basis of routine nursing, standardize drainage tube nursing operation and strengthen patient’s comprehensive nursing intervention such as respiratory tract management, pain nursing, psychological nursing, diet nursing and complication prevention, the patient’s ease of expectoration, pain Degree, psychological status, incidence of postoperative complications and patient satisfaction. Results Nursing intervention patients sputum aspiration difficulty significantly lower than before intervention, the difference was statistically significant (P <0.05). After intervention, VAS scores, severity scores, HAMA scores and Hamilton Depression Rating Scale (HAMD) scores were significantly decreased [VAS score: (3.12 ± 0.41) vs (8.65 ± 0.64) The scores of HAMA score: (22.34 ± 4.69) vs (46.32 ± 5.68); HAMA score: (29.31 ± 4.42) vs (47.43 ± 6.82), the difference was statistically significant (all P <0.05). In 42 patients, drainage catheter retention time was (66.78 ± 1.59) h. No complications such as thoracic cavity infection, subcutaneous emphysema and drainage tube were found during hospitalization. Total patient satisfaction with care was 100% (42/42). Conclusions Careful nursing intervention in CTD with hemifacial multiple thoracic fractures can reduce the pain and reduce the infection rate of complications.