比较护士主导与医生主导的双水平气道正压通气治疗高碳酸血症呼吸衰竭的疗效：一项回顾性队列研究
Comparing Nurse-Led and Physician-Led Bilevel Positive Airway Pressure Management in Hypercapnic Respiratory Failure: A Retrospective Cohort Study.
作者信息
Zhao Zhimin, Zhang Zhen, Li Xinlei, Peng Bo, Xiong Jinqian
机构信息
School of Medicine, Henan Kaifeng College of Science Technology and Communication, Kaifeng, China.
Department of Respiratory and Critical Medicine, The First Affiliated Hospital of Henan University, Kaifeng, China.
出版信息
Nurs Open. 2025 Apr;12(4):e70232. doi: 10.1002/nop2.70232.
AIM
Bilevel positive airway pressure (BiPAP) management is a cornerstone in treating acute hypercapnic respiratory failure, with varying outcomes depending on the care model. This retrospective cohort study aims to compare the effectiveness of nurse-led versus physician-led BiPAP management in this context.
DESIGN
Retrospective cohort study.
METHODS
We analysed medical records of 189 patients with acute hypercapnic respiratory failure treated with BiPAP between January 2020 and December 2022. Patients were divided into nurse-led (n = 101) and physician-led (n = 88) groups based on their BiPAP management leadership. Outcomes measured included arterial blood gas (ABG) parameter improvements, intubation rates, length of hospital stay and 30-day readmission rates. Statistical analysis involved chi-squared tests, t-tests, Mann-Whitney U tests and multivariable regression to adjust for confounders.
RESULTS
Both groups demonstrated significant improvements in ABG parameters, with no significant differences between groups. The nurse-led group exhibited a lower intubation rate (9.9% vs. 21.6%, p = 0.026) and higher patient satisfaction scores (median 8 vs. 6, p < 0.001). Mortality rates, complication rates and 30-day readmission rates were similar between the groups. Multivariable logistic regression confirmed the nurse-led group had a lower likelihood of intubation (AOR: 0.401, p = 0.032) and higher patient satisfaction (AOR: 7.770, p < 0.001).
PATIENT OR PUBLIC CONTRIBUTION
Our findings indicate that nurse-led and physician-led BiPAP management strategies for acute hypercapnic respiratory failure are equally effective in terms of ABG improvement, intubation rates, hospital stay length, and readmission rates. This suggests that with adequate training and supervision, nurse-led BiPAP management can be as effective as physician-led management, offering a viable alternative in healthcare settings where physician resources are limited.
目的
双水平气道正压通气（BiPAP）管理是治疗急性高碳酸血症性呼吸衰竭的基石，其结果因护理模式而异。这项回顾性队列研究旨在比较在这种情况下护士主导与医生主导的BiPAP管理的有效性。
设计
回顾性队列研究。
方法
我们分析了2020年1月至2022年12月期间接受BiPAP治疗的189例急性高碳酸血症性呼吸衰竭患者的病历。根据BiPAP管理的主导人员，将患者分为护士主导组（n = 101）和医生主导组（n = 88）。测量的结果包括动脉血气（ABG）参数改善情况、插管率、住院时间和30天再入院率。统计分析包括卡方检验、t检验、曼-惠特尼U检验和多变量回归以调整混杂因素。
结果
两组的ABG参数均有显著改善，组间无显著差异。护士主导组的插管率较低（9.9%对21.6%，p = 0.026），患者满意度得分较高（中位数8对6，p < 0.001）。两组的死亡率、并发症发生率和30天再入院率相似。多变量逻辑回归证实，护士主导组插管的可能性较低（比值比：0.401，p = 0.032），患者满意度较高（比值比：7.770，p < 0.001）。
患者或公众贡献
我们的研究结果表明，对于急性高碳酸血症性呼吸衰竭，护士主导和医生主导的BiPAP管理策略在ABG改善、插管率、住院时间和再入院率方面同样有效。这表明，经过充分的培训和监督，护士主导的BiPAP管理可以与医生主导的管理一样有效，在医生资源有限的医疗环境中提供了一种可行的替代方案。
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