Accident and Emergency Nursing Department, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand.
Adult Nursing Department, Faculty of Nursing, KhonKaen University, Thailand.
Int Emerg Nurs. 2021 May;56:101008. doi: 10.1016/j.ienj.2021.101008. Epub 2021 Apr 29.
Anxiety-related dyspnea is a compelling symptom among patients with acute heart failure (AHF). Breathing training is a nonpharmacological intervention to relieve dyspnea and anxiety. This study aimed to investigate the effects of breathing training on dyspnea and anxiety among patients with AHF at the emergency department (ED).
Two-group pre-post intervention study was conducted at the ED of one university hospital in the northeast of Thailand. Data were collected among 96 patients with AHF, which were equally assigned to breathing training (BT) and control groups. The training group received pursed-lip mindfulness breathing training, whereas the control group received usual care (UC). The pursed-lip mindfulness breathing was delivered from the first 40 min of arrival to the 4th hour in the ED. The breathing training consisted of positioning the patients in Fowler's position with the head of the bed elevated at 60 degrees or higher, supporting both arms with pillows, and breathing in through the nose with breathing out via the mouth with pursed lip while counting. Dyspnea and anxiety scores were measured with Dyspnea Visual Analog Scale and Anxiety Visual Analog Scale, respectively.
The dyspnea and anxiety scores significantly decreased after four hours in both groups. Dyspnea score decreased from 8.85 (SD 1.220) to 3.63 (SD 1.468) after BT (t = 26.111, p < 0.001) in the experimental group whereas in the control group it decreased from 8.98 (SD 1.194) to 6.94 (SD 1.590) after UC (t = 16.181, p < 0.001). Comparing between the groups, dyspnea score reductions were 5.22 (SD 1.468) in the experimental and 2.04 (SD 1.590) in the control (t = 0.101, p < 0.001). Anxiety score decreased from 9.35 (SD 1.000) to 4.44 (SD 1.219) after BT (t = 25.231, p < 0.001) in the experimental while the scores in the control group decreased from 9.48 (SD 1.072) to 8.15 (SD 1.502) after UC (t = 8.131, p < 0.001). The anxiety score reductions were 4.91 (SD 1.219) and 1.33 (SD 1.502) in the experimental and the control groups, respectively (t = 0. 066, p < 0.001). Both the dyspnea and anxiety scores after the intervention were significantly different between the experimental and control groups.
Both UC and BT with UC can reduce dyspnea and anxiety in patients admitted to ED with AHF. However, the effect of BT combined with UC was larger comparing to UC only.
焦虑相关的呼吸困难是急性心力衰竭（AHF）患者的一种强烈症状。呼吸训练是一种非药物干预措施，可缓解呼吸困难和焦虑。本研究旨在探讨呼吸训练对 AHF 患者在急诊科（ED）的呼吸困难和焦虑的影响。
这是一项在泰国东北部一所大学医院 ED 进行的 2 组前后干预研究。共收集了 96 例 AHF 患者的数据，将其平均分配到呼吸训练（BT）组和对照组。训练组接受缩唇正念呼吸训练，而对照组接受常规护理（UC）。缩唇正念呼吸从到达 ED 的前 40 分钟开始，持续到第 4 小时。呼吸训练包括将患者置于 Fowler 体位，床头抬高 60 度或更高，用枕头支撑双臂，通过鼻子吸气，通过撅嘴呼气，同时数数。使用呼吸困难视觉模拟量表和焦虑视觉模拟量表分别测量呼吸困难和焦虑评分。
两组患者在 4 小时后呼吸困难和焦虑评分均显著下降。实验组的呼吸困难评分从 8.85（SD 1.220）降至 3.63（SD 1.468）（t=26.111，p<0.001），而对照组从 8.98（SD 1.194）降至 6.94（SD 1.590）（t=16.181，p<0.001）。与对照组相比，实验组的呼吸困难评分降低了 5.22（SD 1.468），而对照组降低了 2.04（SD 1.590）（t=0.101，p<0.001）。实验组的焦虑评分从 9.35（SD 1.000）降至 4.44（SD 1.219）（t=25.231，p<0.001），而对照组从 9.48（SD 1.072）降至 8.15（SD 1.502）（t=8.131，p<0.001）。实验组和对照组的焦虑评分分别降低了 4.91（SD 1.219）和 1.33（SD 1.502）（t=0.066，p<0.001）。干预后，实验组和对照组的呼吸困难和焦虑评分均明显不同。
UC 和 BT 联合 UC 均可降低 ED 中 AHF 患者的呼吸困难和焦虑程度。然而，与 UC 相比，BT 联合 UC 的效果更大。
