摘要
目的探讨不同的胸部物理治疗措施在预防老年下肢骨折患者肺部感染中的应用效果。方法陆军军医大学新桥医院骨科2016年1月-2018年4月收治105例老年术前无肺部感染下肢骨折患者,按随机数字表法分为A、B、C三组,各35例。每组在常规措施基础上给予不同的胸部物理治疗:A组为手法叩击,B组为机械排痰,C组为叩击+机械排痰。观察三组术后1~3d治疗前与治疗后10min心率(HR)、呼吸频率(RR)及脉搏血氧饱和度(SpO2);同时比较三组间术后第3天C-反应蛋白(CRP)、红细胞沉降率(ESR)和术后1个月内的肺部感染发生率。结果最终纳入并完成观察研究的患者94例。术后第3天治疗后组间HR差异有统计学意义,ABC三组分别是[(79.3±6.81)、(75.4±8.22)、(78.1±7.76)次/min(F=3.418,P=0.037)];术后第2、3天治疗后组间RR差异有统计学意义,其中术后第2天三组分别是[(16.8±1.53)、(16.2±1.26)、(16.8±1.63)次/min(F=5.649,P=0.005)];术后第3天三组分别是[(15.9±1.41)、(15.3±1.10)、(15.4±1.15)次/min(F=4.817,P=0.010)];术后第2、3天治疗后组间SpO2差异有统计学意义,术后第2天三组分别是[(96.1±2.15)、(97.0±1.84)、(96.9±2.08)%(F=5.659,P=0.005)];术后第3天分别是[(97.8±1.70)、(97.9±1.78)、(98.2±1.64)%(F=4.247,P=0.017)]。术后1个月内肺部感染各组发生率比较差异无统计学意义,但A组发生率最高(9.4%),其余各指标差异均无统计学意义(P>0.05)。结论三种治疗方式均能很好地改善呼吸功能和预防术后肺部感染,临床上可结合科室自身条件选择性开展相应措施。
Objective To explore the effects of different methods of chest physiotherapy in preventing pulmonary infection in elderly patients with lower extremity fracture.Methods Totally 105 elderly patients with lower extremity fracture were enrolled in this study from our orthopedics department from Jan.2016 to Apr.2018.The patients were divided into 3 groups,group A,B and C,according to the random number table method.On the basis of routine oxygen atomization inhalation,deep breathing and cough training,Group A was treated with manual percussion,group B was treated with mechanical expectoration,and the method in group C was manual percussion combined with mechanical expectoration.The heart rate(HR),respiratory rate(RR) and pulse oxygen saturation(SpO2) were observed before and 10 mins after physical therapy during the 1-3 days after surgery.At the same time point,pairwise comparisons were carried out(adjusted α=0.017).C-reactive protein(CRP),erythrocyte sedimentation rate(ESR) on the 3 rd day postoperatively and the incidence of pulmonary infection within 1 month after surgery were determined and compared.Results Data from 94 patients were valid in the study.There were significant differences in HR on the 3 rd day after treatment(F=3.418,P=0.037),which was(79.3±6.81)times/min,(75.4±8.22)times/min,(78.1±7.76)times/min,respectively in the three groups.There were significant differences in RR and SpO2 among 3 groups on the 2 nd,3 rd day postoperatively.On the 2 nd day after treatment,the RR of the three groups was(16.8±1.53) times/min,(16.2±1.26) times/min,(16.8±1.63) times/min,respectively(F=5.649,P=0.005);on the third day after treatment,the RR of the three groups was(16.9±1.41) times/min,(15.3±1.10) times/min,(15.4±1.15) times/min,respectively(F=4.817,P=0.010).The SpO 2 in the three groups on the 2 nd day after treatment was(96.1±2.15)%,(97.0± 1.84)%,(96.9±2.08)%,respectively,on the third day after treatment was(97.8±1.70)%,(97.9±1.78)%,(98.2±1.64)%,respectively(F=5.659,P=0.005),and the differences among the three groups were statistically significant on the second and third day after treatment.There was no statistically significant difference in the incidence of pulmonary infection among the groups within 1 month after surgery,but the highest incidence was found in group A(9.4%),and no statistically significant difference was found in other indicators(P>0.05).Conclusion All the three methods could effectively improve respiratory function and prevent pulmonary infection with certain advantages.Different methods can be chosen according to the condition of the department in clinical practice.
作者
易德坤
何洁
李玉
张玉梅
YI De-kun;HE Jie;LI Yu;ZHANG Yu-mei(Department of Orthopaedics,Xinqiao Hospital,Army Medical University,Chongqing 400037,China)
出处
《创伤外科杂志》
2019年第6期405-409,413,共6页
Journal of Traumatic Surgery
关键词
下肢骨折
肺部感染
物理治疗
老年
lower limb fracture
pulmonary infection
physiotherapy
elderly
