基于喷雾的口咽保湿程序对心脏手术后患者拔管的影响:随机对照三臂试验| 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.
摘要翻译(仅供参考)
背景
当患者从心脏手术中出来时,他们可能会在气管内拔管后出现强烈的口渴和不适,甚至吞咽障碍。这可能会导致窒息、绝望、恐惧和焦虑的感觉。尽管口渴缓解和吞咽困难预防具有相似的机制,但联合干预以缓解口渴和预防吞咽困难的证据有限。此外,迄今为止还没有针对术后心脏病患者的研究。
目标
评估基于喷雾的口咽部保湿程序对气管内拔管后心脏手术患者的安全性、可行性和效果。
设计
2017 年 10 月至 2019 年 12 月进行了一项随机、对照的三臂试验。
环境
三级医疗中心心脏监护室。
参与者
参与者(N=145)是接受心脏手术并接受机械通气的患者。
方法
参与者被随机分配到三组之一:一个由四部分组成的计划,提供基于喷雾的治疗,采用恒定低温冷喷雾(计划 A;n=47)或低温至常温喷雾(计划 B;n =49),或那些接受常规护理的人(对照组;n = 49)。抱怨口渴的对照组患者被给予湿棉签来润湿他们的嘴。主要结果包括不适和不同程度的口渴强度;次要结局包括吞咽困难和不良事件。在干预后的时间 0(基线)、时间 1(3 小时)、时间 2(6 小时)和时间 3(96 小时)评估结果。使用广义估计方程进行重复测量分析。
结果
基线评估表明各组之间没有显着差异。参与者(平均年龄:55 岁;53.8% 为男性)接受了心脏手术:瓣膜性心脏病(64.8%)、冠状动脉粥样硬化性心脏病(25.5%)或主动脉夹层(9.7%)。基线评分表明中度严重口渴(6.24±1.57)和不适(9.88±2.23)。干预后,干预组的口渴强度显着低于对照组(p<0.001)。广义估计方程分析显示,在控制干预条件和时间时,程序 A 和 B 之间的口渴强度降低没有显着差异(调整后的 β = 0.08,95% CI:-0.59-0.76,p = 0.810)。在减少口渴不适方面发现了类似的结果(调整后的 β=0.36,95% CI:-0.66-1.38,p=0.493)。三组吞咽困难频率无显着差异。在干预期间没有报告可观察到的不良事件。
结论
基于喷雾的口咽保湿程序是一种实用且有效的干预措施,可缓解心脏手术和气管插管后患者的口渴,可整合到术后患者重症监护管理的舒适护理中。
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