Retrospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2021; 9(21): 5840-5849
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5840
Value of refined care in patients with acute exacerbation of chronic obstructive pulmonary disease
Na Na, Su-Ling Guo, Ying-Ying Zhang, Mei Ye, Na Zhang, Gui-Xia Wu, Le-Wei Ma
Na Na, Gui-Xia Wu, Department of Respiratory and Critical Care Medicine, The Affiliated Hospital of Qingdao University, Qingdao 266003, Shandong Province, China
Su-Ling Guo, Department of Hematology, The Eighth Medical Center, General Hospital of Chinese PLA, Beijing 100091, China
Ying-Ying Zhang, Operation Room, The Fourth People’s Hospital of Jinan, Jinan 250031, Shandong Province, China
Mei Ye, Department of Gynecology and Pediatrics, PLA Rocket Force Characteristic Medical Center, Beijing 100088, China
Na Zhang, Department of Cardiovascular Surgery, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong Province, China
Le-Wei Ma, Department of Respiratory and Critical Care Medicine, Jinan Central Hospital, Jinan 250013, Shandong Province, China
Author contributions: Na N and Guo SL design the study; Zhang YY drafted the work; Ye M and Wu GX collected the data; Wu GX analyzed and interpreted the data; Zhang N and Ma LE wrote the article.
Institutional review board statement: The study was approved by the Medical Ethics Committee of the Affiliated Hospital of Qingdao University.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Le-Wei Ma, Bachelor degree, Supervisor nurse, Department of Respiratory and Critical Care Medicine, Jinan Central Hospital, No. 105 Jiefang Road, Jinan 250013, Shandong Province, China. mlwjn0828@163.com
Received: February 23, 2021
Peer-review started: February 23, 2021
First decision: March 25, 2021
Revised: April 6, 2021
Accepted: May 21, 2021
Article in press: May 21, 2021
Published online: July 26, 2021
Abstract
BACKGROUND

Under physiological conditions, sputum produced during acute exacerbation of chronic obstructive pulmonary disease (AECOPD) can move passively with the cilia in the airway; the sputum is gradually excreted from the depth of the airways through the stimulation of the coughing reflex on the sensory nerve on the surface of the airway. However, when the sputum is thick, the cough is weak, or the tracheal cilia are abnormal, sputum accumulation may occur and affect the exchange of oxygen and carbon dioxide in the lung. Furthermore, the presence of pathogenic microorganisms in sputum may cause or aggravate the symptoms of pulmonary infection in patients, which is the main factor leading to AECOPD. Therefore, promoting effective drainage of sputum and maintaining airway opening are key points requiring clinical attention.

AIM

To explore the effect of refined nursing strategies in patients with AECOPD and dysphagia.

METHODS

We selected 126 patients with AECOPD and difficulty of expectoration at our hospital, and divided them into a refined care group and a routine care group, with 63 cases each, using a random number table. The two groups of patients were treated with expectorant, anti-infection, oxygen inhalation, and other basic treatment measures; patients in the refined care group were given refined nursing intervention during hospitalization, and the routine care group received conventional nursing intervention. The differences in sputum expectoration, negative pressure suction rate, blood gas parameters, dyspnea score measured through the tool developed by the Medical Research Council (MRC), and quality of life were compared between the two groups.

RESULTS

After 7 d of intervention, the sputum expectoration effect of the refined care group was 62.30%, the effective rate was 31.15%, and the inefficiency rate was 6.56%. The sputum expectoration effect of the routine care group was 44.07%, the effective rate was 42.37%, and the inefficiency rate was 13.56%. The refined care group had better sputum expectoration than the routine care group (P < 0.05). The negative pressure suction rate in the refined care group was significantly lower than that of the routine care group during the treatment (22.95% vs 44.07%, P < 0.05). Before the intervention, the arterial oxygen saturation (PaO2) and arterial carbon dioxide saturation (PaCO2) values were not significantly different between the two groups (P > 0.05); the PaO2 and PaCO2 values in the refined care group were comparable to those in the routine care group after 7 d of intervention (P > 0.05). Before the intervention, there was no significant difference in the MRC score between the two groups (P > 0.05); the MRC score of the refined care group was lower than that of the routine care group after 7 d of intervention, but the difference was not statistically significant (P > 0.05). Before intervention, there was no significant difference in the symptoms, activities, disease impact, or St. George’s Respiratory questionnaire (SGRQ) total scores between the two groups (P> 0.05). After 7 days of intervention, the symptoms, activities, and total score of SGRQ of the refined care group were higher than those of the routine care group, but the difference was not statistically significant (P > 0.05).

CONCLUSION

AECOPD with thick sputum, weak coughing reflex, and abnormal tracheal cilia function will lead to sputum accumulation and affect the exchange of oxygen and carbon dioxide in the lung. Patients with AECOPD who have difficulty expectorating sputum may undergo refined nursing strategies that will promote expectoration, alleviate clinical symptoms, and improve the quality of life.

Keywords: Refined care, Chronic obstructive pulmonary disease, Acute exacerbation period, Difficulty in expectoration

Core Tip: This study confirmed the positive effect of refined nursing strategy on acute exacerbation of chronic obstructive pulmonary disease patients with difficulty in expectoration. It can promote expectoration, improve clinical symptoms, and improve the quality of life.