王建中 王筱 刘洋

【摘要】 目的：探討明胶海绵联合PVA颗粒支气管动脉栓塞治疗大咯血围手术期综合康复护理干预效果。方法：选取本院呼吸科2017年1月至2019年5月收治并行明胶海绵联合PVA颗粒支气管动脉栓塞治疗的大咯血患者52例，依据治疗前后顺序分为对照组和观察组各26例。对照组给予呼吸科常规护理，观察组则于常规护理基础上实施围术期综合康复护理干预。对比两组干预后止血效果、并发症、心理变化和生活质量。结果：干预后，两组患者均于24h内停止咯血，随访1个月，观察组无术后再次咯血情况发生，但对照组术后有2例再次出现咯血，均再次行支气管动脉栓塞治疗。观察组术后有2例低热和1例胸痛现象的并发症发生，对照组术后有6例低热和4例胸痛现象，观察组并发症明显少于对照组（χ2=6.566，P=0.038）。干预前，两组焦虑抑郁评分无明显差异（P>0.05）;干预后，观察组焦虑抑郁评分均明显低于对照组。随访1个月，观察组生活质量各项评分明显优于对照组（P<0.05）。结论：加强大咯血明胶海绵联合PVA颗粒支气管动脉栓塞治疗围术期的综合康复护理干预，可明显提高患者治疗效果，减少复发及术后并发症，显著缓解患者焦虑、恐惧心理反应，提高生活质量。

【关键词】 大咯血;支气管动脉栓塞;康复干预;心理反应;生活质量

Treatment of Massive Hemoptysis Comprehensive Rehabilitation with Gelatin Sponge Combined with PVA Bronchial Artery Embolization

Wang Jianzhong1，Wang Xiao1，Liu Yang2

1.Department of Respiratory， Yancheng First People's Hospital， Yancheng，Jiangsu 224000;

2.Department of Intervention， Yancheng First People's Hospital， Yancheng， Jiangsu 224000

[Abstract] Objective：To investigate the effect of gelatin sponge combined with PVA bronchial artery embolization on the comprehensive rehabilitation nursing intervention of large hemoptysis. Methods： 52 patients with massive hemoptysis treated with parallel gelatin sponge combined with PVA bronchial artery embolization were enrolled in our hospital from January 2017 to May 2019. They were divided into control group and observation group according to the order of treatment. The control group received routine nursing care in the respiratory department， while the observation group performed perioperative comprehensive rehabilitation nursing intervention on the basis of routine nursing. The hemostatic effects， complications， psychological changes and quality of life were compared between the two groups. Results： After the intervention， both groups of patients stopped hemoptysis within 24 hours. After 1 month of followup， there was no postoperative hemoptysis in the observation group. However， 2 cases of hemoptysis occurred again in the control group， and bronchial artery embolization was performed again. There were 2 cases of low fever and 1 case of chest pain after operation in the observation group. There were 6 cases of hypothermia and 4 cases of chest pain in the control group. The complications of the observation group were significantly less than those of the control group （χ2=6.566，P=0.038）. Before the intervention， there was no significant difference in anxiety and depression scores between the two groups （P>0.05）. After the intervention， the anxiety and depression scores of the observation group were significantly lower than those of the control group. After 1 month of followup， the scores of quality of life in the observation group were significantly better than those in the control group （P<0.05）. Conclusion： Strengthening the hemoptysis sponge combined with PVA bronchial artery embolization for perioperative comprehensive rehabilitation nursing intervention can significantly increase the patient's therapeutic effect， reduce recurrence and postoperative complications， significantly relieve patients' anxiety， fear and psychological response， and improve quality of life.

[Key words]Large hemoptysis; Bronchial artery embolization; Rehabilitation intervention; Psychological reaction; Quality of life

支气管扩张大咯血是临床常见的呼吸系统疾病危急症，具有起病急、发展快的特点，可发生窒息和失血性休克導致患者短时间内死亡，是临床上最常见的需要紧急抢救和治疗的急诊之一。当前临床常用的大咯血的治疗方法包括内科保守治疗、选择性支气管动脉栓塞治疗以及外科手术治疗几种治疗方案[1]。明胶海绵联合PVA颗粒支气管动脉栓塞治疗大咯血是本院呼吸科近年来临床治疗大咯血的安全、有效的方法，其中，加强患者围术期观察与护理直接影响治疗质量和结果[2]。本文……