农彩梅 邓惠英 罗梅银 覃雪梅 马丽雅

【摘要】 目的 探討改良早期预警评分（MEWS）结合医护一体化肺康复管理模式对老年慢性阻塞性肺疾病急性加重（AECOPD）患者肺功能及生活质量的影响。方法 将呼吸内科收治的符合纳入标准的老年AECOPD患者40例，随机分为对照组和观察组各20例。对照组给予常规治疗及康复护理措施，观察组运用MEWS结合医护一体化的肺康复管理模式进行康复治疗护理。观察两组患者肺功能检测、生活质量评分（CAT）等。结果 观察组的肺功能指标：第一秒用力呼气容积（FEV1）由干预前的（1.65±0.31） L提升至干预后的（1.98±0.32） L，第一秒用力呼气容积占用力肺活量百分比（FEV1/FVC）由干预前的（55.42±8.36）%提升至干预后的（65.31±6.54）%，CAT问卷评分由干预前的（20.76±6.20）分降至干预后（14.14±6.12）分，差异有统计学意义（P<0.05）;且干预后观察组FEV1、FEV1/FVC、CAT评分与对照组比较差异有统计学意义（P<0.05）。患者对护理人员服务态度、基础护理、健康教育、总体评价方面满意度评分均优于对照组（P<0.05）。结论 改良早期预警评分结合医护一体化肺康复管理模式能改善老年AECOPD患者肺功能，提高生活质量和患者满意度。

【关键词】 改良早期预警评分;医护一体化;肺康复;AECOPD;肺功能;生活质量

中图分类号：R692   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2020.07.007

【Abstract】 Objective To explore the effect of modified early warning score（MEWS） combined with medical-nursing pulmonary rehabilitation management mode on lung function and quality of life in elderly patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods 40 elderly patients with AECOPD who admitted to department of respiratory medicine and met the inclusion criteria were randomly divided into control group and observation group，with 20 cases in each group.The control group were given conventional treatment and rehabilitation nursing measures，and the observation group were given MEWS combined with medical-nursing pulmonary rehabilitation management mode for rehabilitation treatment and nursing.And then，the lung function test and quality of life score（CAT） of the two groups were observed.Results The pulmonary function index of the intervention group：forced expiratory volume in the first second（FEV1） increased from（1.65±0.31） L before the intervention to （1.98±0.32） L after the intervention，and forced expiratory volume in the first second/forced vital capacity（FEV1/FVC） increased from （55.42±8.36）% before intervention to （65.31±6.54）% after intervention，CAT questionnaire score decreased from （20.76±6.20） before intervention to （14.14±6.12） after the intervention，difference was statistically significant（P<0.05）;and the difference of FEV1，FEV1/FVC and CAT scores of the observation group and the control group was statistically significant after intervention（P<0.05）.The satisfaction scores of patients to the nursing staff's service attitude，basic nursing，health education and overall evaluation were better than those of the control group（P<0.05）.Conclusion MEWS combined with medical-nursing pulmonary rehabilitation can improve the pulmonary function，quality of life and patient satisfaction in elderly patients with AECOPD.

【Key words】 MEWS;medical integration;pulmonary rehabilitation;AECOP;lung function;quality of life

慢性阻塞性肺疾病急性加重（acute exacerbation of chronic obstructive pulmonary disease，AECOPD）是一种急性事件，特征为呼吸道症状的急性加重，典型的症状是咳嗽、痰量增多、呼吸频率加快、出现严重的呼吸困难症状和一系列并发症。AECOPD是慢性阻塞性肺部疾病患者死亡的重要原因[1]。据统计，AECOPD住院患者的病死率为2.5%～10%，而老年AECOPD患者常由于机体功能衰退、病程长，急性发作后患者病死率甚至可达15%，严重影响患者的生命安全[2]。加之病人基础疾病多，起病隐匿且病情进展快，生命体征的细微改变可能预示病情恶化的风险。如何对住院老年AECOPD患者的病情进行风险管理，做到早评估、早预警、早干预以改善病人预后，成为我们临床医护工作者急需解决的问题。……