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基於噴霧的口咽保溼程式對心臟手術後患者拔管的影響:隨機對照三臂試驗|Int J Nurs Stud

作者:由 九派健康 發表于 繪畫日期:2022-05-16

術後口渴怎麼緩解

基於噴霧的口咽保溼程式對心臟手術後患者拔管的影響:隨機對照三臂試驗|Int J Nurs Stud

Abstract

Background

When a patient emerges from cardiac surgery, they may experience intense thirst and discomfort or even impaired swallowing after endotracheal extubation。 This may lead to feelings of suffocation, desperation, fear, and anxiety。 Although thirst relief and dysphagia prevention share similar mechanisms, there is limited evidence for a combined intervention to alleviate thirst and prevent dysphagia。 Furthermore, no studies to date have targeted postoperative cardiac patients。

Objective

To evaluate the safety, feasibility, and effects of a spray-based oropharyngeal moisturising programme for cardiac surgery patients following endotracheal extubation。

Design

A randomised, controlled three-arm trial was conducted from October 2017 to December 2019。

Setting

Tertiary medical centre cardiac care unit。

Participants

Participants (N=145) were patients who underwent cardiac surgery and received mechanical ventilation。

Methods

Participants were randomly assigned to one of three groups: a four-part programme offering spray-based therapy with either a constant low-temperature cold spray (programme A; n=47) or low-to-normal temperature spray (programme B; n=49), or those that received usual care (control group; n=49)。 Control group patients who complained of thirst were given wet cotton swabs to moisten their mouths。 The primary outcomes included discomfort and various levels of thirst intensity; secondary outcomes included dysphagia and adverse events。 Outcomes were evaluated at Time 0 (baseline), Time 1 (3 hours), Time 2 (6 hours) and Time 3 (96 hours) post intervention。 Repeated-measures analyses was performed using generalised estimating equations。

Results

The baseline evaluation indicated no significant differences between the groups。 Participants (average age: 55 years; 53。8% men) underwent cardiac surgery for; valvular heart disease (64。8%), coronary atherosclerotic heart disease (25。5%), or aortic dissection (9。7%)。 Baseline scores indicated moderately severe thirst (6。24±1。57) and discomfort (9。88±2。23)。 Post intervention, the thirst intensity in the intervention groups was significantly lower than that of the control group (p<0。001)。 The generalised estimating equation analysis showed no significant difference in reduced thirst intensity between programmes A and B (adjusted β=0。08, 95% CI: 0。59–0。76, p=0。810) when controlling for intervention condition and time。 Comparable results were found for reduced thirst discomfort (adjusted β=0。36, 95% CI: 0。66–1。38, p=0。493)。 The three groups showed no significant differences for dysphagia frequency。 No observable adverse events were reported during the intervention period。

Conclusions

A spray-based oropharyngeal moisturising programme is a practical and effective intervention to alleviate patient thirst after cardiac surgery and tracheal intubation that could be integrated into comfort care for post-surgical patients’ critical care management。

Tweetable abstract: A spray-based oropharyngeal moisturising programme for cardiac surgery recipients following endotracheal extubation may alleviate thirst。

摘要翻譯(僅供參考)

背景

當患者從心臟手術中出來時,他們可能會在氣管內拔管後出現強烈的口渴和不適,甚至吞嚥障礙。這可能會導致窒息、絕望、恐懼和焦慮的感覺。儘管口渴緩解和吞嚥困難預防具有相似的機制,但聯合干預以緩解口渴和預防吞嚥困難的證據有限。此外,迄今為止還沒有針對術後心臟病患者的研究。

目標

評估基於噴霧的口咽部保溼程式對氣管內拔管後心髒手術患者的安全性、可行性和效果。

設計

2017 年 10 月至 2019 年 12 月進行了一項隨機、對照的三臂試驗。

環境

三級醫療中心心臟監護室。

參與者

參與者(N=145)是接受心臟手術並接受機械通氣的患者。

方法

參與者被隨機分配到三組之一:一個由四部分組成的計劃,提供基於噴霧的治療,採用恆定低溫冷噴霧(計劃 A;n=47)或低溫至常溫噴霧(計劃 B;n =49),或那些接受常規護理的人(對照組;n = 49)。抱怨口渴的對照組患者被給予溼棉籤來潤溼他們的嘴。主要結果包括不適和不同程度的口渴強度;次要結局包括吞嚥困難和不良事件。在干預後的時間 0(基線)、時間 1(3 小時)、時間 2(6 小時)和時間 3(96 小時)評估結果。使用廣義估計方程進行重複測量分析。

結果

基線評估表明各組之間沒有顯著差異。參與者(平均年齡:55 歲;53。8% 為男性)接受了心臟手術:瓣膜性心臟病(64。8%)、冠狀動脈粥樣硬化性心臟病(25。5%)或主動脈夾層(9。7%)。基線評分表明中度嚴重口渴(6。24±1。57)和不適(9。88±2。23)。干預後,干預組的口渴強度顯著低於對照組(p<0。001)。廣義估計方程分析顯示,在控制干預條件和時間時,程式 A 和 B 之間的口渴強度降低沒有顯著差異(調整後的 β = 0。08,95% CI:-0。59-0。76,p = 0。810)。在減少口渴不適方面發現了類似的結果(調整後的 β=0。36,95% CI:-0。66-1。38,p=0。493)。三組吞嚥困難頻率無顯著差異。在干預期間沒有報告可觀察到的不良事件。

結論

基於噴霧的口咽保溼程式是一種實用且有效的干預措施,可緩解心臟手術和氣管插管後患者的口渴,可整合到術後患者重症監護管理的舒適護理中。

【來源:中國網醫療頻道】

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