住院患者经鼻套管吸氧舒适度情况及其影响因素研究

doi:10.12114/j.issn.1007-9572.2019.00.054

摘要/Abstract

摘要： 背景　大量文献报道经鼻套管吸氧患者常因发生吸氧不适感而拒绝或减少氧气使用。部分学者认为其不适感的产生与供氧装置的理化性质相关并提出诸多方式改善，但大多较为繁琐且临床普及性欠佳。国外一项研究提示在供氧装置相同的情况下，治疗因素及患者自身因素可能对吸氧舒适度产生影响，但目前国内尚无此类研究。目的　了解住院患者经鼻套管吸氧的舒适度，探究并分析其可能的影响因素。方法　采用整群抽样的方法选取2018-06-05长海医院各科室的住院患者329例。采用自行设计的《住院患者经鼻套管吸氧舒适度调查问卷》对患者进行一对一、面对面的问卷调查。调查问卷由11项封闭性问题及1项半开放性问题组成，主要包括患者的一般资料（性别、年龄、费用类别、文化程度、慢性鼻炎史、住院情况）、患者治疗因素（吸氧体位、吸氧流量、氧疗时程、吸氧频次、吸氧天数）及经鼻套管吸氧不适主诉。以患者在吸氧过程中是否产生不适主诉来评判经鼻套管吸氧舒适度。并采用多因素Logistic回归分析研究患者经鼻套管吸氧舒适度的影响因素。结果　共发放问卷329份，回收有效问卷324份，有效回收率98.5%。324例患者中男187例（57.7%），女137例（42.3%）；年龄23~96岁，平均年龄（59.1±14.9）岁，其中年龄≥65岁178例（54.9%）；有医保304例（93.8%）；文化程度为小学及以下180例（55.5%），初、高中100例（30.9%），本科及以上44例（13.6%）；既往有慢性鼻炎史22例（6.8%）；住院≥2次的患者有58例（17.9%）。324例患者中认为氧疗舒适275例（84.9%），氧疗不舒适49例（15.1%）。多因素Logistic回归分析结果显示，慢性鼻炎史〔OR=9.764，95%CI（1.427，66.824），P<0.05〕、吸氧流量〔OR=3.528，95%CI（2.134，5.830），P<0.05〕、吸氧时程〔中程（0.5~15.0 h）：OR=13.751，95%CI（3.114，60.729），P<0.05；长程（>15.0 h）：OR=29.902，95%CI（6.857，130.408），P<0.05〕、吸氧频次〔2次/d：OR=9.252，95%CI（1.383，61.896），P<0.05；≥3次/d：OR=11.120，95%CI（2.320，53.297），P<0.05〕是住院患者经鼻套管吸氧舒适度的影响因素。结论　住院患者经鼻套管吸氧的总体舒适度尚可，但仍有待进一步提高；同时经鼻套管吸氧舒适度的影响因素包括慢性鼻炎史、吸氧流量、吸氧时程、吸氧频次。临床医护人员应遵循《成人急诊氧疗指南》，在达到目标氧疗的前提下，尽量控制吸氧流量、时程及频次，避免过度用氧，减少氧疗不适感的发生，提高经鼻套管吸氧舒适度。

关键词: 氧吸入疗法, 舒适度, 影响因素分析, 横断面研究, 住院病人

Abstract: Background　A lot of literatures have reported the refusal or the reduction of oxygen use by patients inhaling via nasal cannula which is more often caused by discomfort they have in such process.Some scholars believed that the occurrence of this discomfort was related to the physicochemical properties of oxygen supply apparatus and thus suggested many ways to improve it.However，none of them is simple and with good clinical popularity.A foreign study has suggested that some treatment related factors and individual factors of a specific patient may have impact on the comfort level of oxygen inhaling.China so far does not have any study in this field.Objective　To understand the comfort level for in-patients inhaling of oxygen via nasal cannula，and to further explore and analyze its possible influential factors.Methods　Cluster sampling method was adopted in selecting in-patients from various departments of Changhai Hospital on June 5th，2018.A self-designed questionnaire Survey on In-patients Inhaling of Oxygen via Nasal Cannula was used to conduct a one by one and face to face questionnaire survey on each of those in-patients.The questionnaire included 11 close-ended questions and 1 semi-closed question in total，which mainly covered general information （sex，age，expense categories，level of education，history of chronic rhinitis and times of hospitalization），treatment related factors （position being maintained while receiving oxygen therapy，flow rate of oxygen being inhaled，time for oxygen therapy，frequency of oxygen inhaling and days of oxygen inhaling） and main complaints of discomfort while inhaling oxygen.The evaluation of the comfort level in the case of inhaling oxygen via nasal cannula was conducted by whether or not there was any discomfort reported as a main complaint from the patients inhaling oxygen.Multivariate Logistic regression analysis was adopted to analyze the factors influencing the comfort level for patients inhaling oxygen via nasal cannula.Results　A total of 329 copies of questionnaires were sent and we received 324 copies of effective ones，with an effective response rate of 98.5%.Among 324 patients，187 were male （57.7%），and 137 were female （42.3%）；their age ranged from 23 to 96 years，with average age of （59.1±14.9） years.One hundred and seventy-eight patients were older than 65 years （54.9%）；304 cases （93.8%） had medical insurance；180 patients （55.5%） had the level of education which equals to primary school or below，100 had the level of education of junior or senior middle school（30.9%），and 44 had the level of education of undergraduate or above（13.6%）；22 patients （6.8%） had the medical history of chronic rhinitis；58 patients （17.9%） had a record of multiple hospitalization.Of the 324 patients，275 patients （84.9%） believed that the oxygen therapy was comfortable while 49 patients （15.1%） felt that it was discomfort.The results of multivariate Logistic regression analysis showed that the medical history of chronic rhinitis 〔OR=9.764，95%CI（1.427，66.824），P<0.05〕，flow rate of the oxygen being inhaled 〔OR=3.528，95%CI（2.134，5.830），P<0.05〕，time for oxygen therapy 〔0.5~15.0 h：OR=13.751，95%CI（3.114，60.729），P<0.05；>15.0 h：OR=29.902，95%CI（6.857，130.408），P<0.05〕 and frequency of oxygen inhaling 〔2 times/day：OR=9.252，95%CI（1.383，61.896），P<0.05；≥3 times/day：OR=11.120，95%CI（2.320，53.297），P<0.05〕 were the factors influencing the comfort level for in-patients inhaling oxygen via nasal cannula．Conclusion　The comfort level for in-patients inhaling oxygen via nasal cannula，in general，is acceptable but still there is room for further improvement.Influential factors of oxygen inhalation through nasal cannula include history of chronic rhinitis，oxygen flow rate，time and frequency of oxygen inhalation.Clinical medical care personnel should follow the Guidelines for Emergency Oxygen Therapy for Adults.On the premise that the purpose of oxygen therapy is achieved，they should try to control the flow rate of the oxygen being inhaled，and time and frequency of oxygen inhaling so as to avoid the excessive use of oxygen and reduce the occurrence of discomfort in the process of oxygen therapy，thus increasing the comfort level for inhaling of oxygen via nasal cannula.

Key words: Oxygen inhalation therapy, Comfort level, Root cause analysis, Cross-sectional studies, Inpatients

竺易君,李萍,韩一平. 住院患者经鼻套管吸氧舒适度情况及其影响因素研究[J]. 中国全科医学, 2019, 22(21): 2582-2587. DOI: 10.12114/j.issn.1007-9572.2019.00.054.
ZHU Yijun,LI Ping,HAN Yinping. Comfort Level for In-patients Inhaling Oxygen via Nasal Cannula and Its Influential Factors　[J]. Chinese General Practice, 2019, 22(21): 2582-2587. DOI: 10.12114/j.issn.1007-9572.2019.00.054.

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