全国30个省市三级医院重症监护病房医护人员呼吸治疗工作现状的问卷调查  

A questionnaire survey on the current practices of respiratory care in intensive care unit in 30 provinces

作　　者：李洁[1] 詹庆元[1] 梁宗安[2] 杜美莲 代华平[1] 孙兵[1] 姚秀丽[1] 罗祖金[1] 夏金根[1] 王辰[1] 

机构地区：[1]首都医科大学附属北京朝阳医院北京呼吸疾病研究所,100020 [2]四川大学华西临床医学院呼吸治疗与危重症监护专业 [3]台湾高雄长庚医院呼吸治疗科

出　　处：《中国危重病急救医学》2009年第4期211-214,共4页Chinese Critical Care Medicine

基　　金：北京市科技新星计划项目（2005B03）

摘　　要：目的调查我国三级医院重症监护病房（ICU）呼吸治疗的仪器装备、工作内容和完成人等，为规范和发展呼吸治疗工作提供依据。方法在2006年8月国内召开的三次大规模会议上发放问卷，调查30个省264家三级医院320个ICU的491名医护人员。结果有创、无创呼吸机数与床位数之比分别为0．52：1（2189／4185）和0．16：1（672／4185）。320个ICU中，超声、喷射式以及定量雾化吸人器的配用率分别为55．9％（179／320）、33．8％（108／320）和12．1％（39／320）；机械通气中呼吸机设置、撤机、拔管主要由医师完成的ICU占92．1％、93．1％、83．5％，更换管路、吸痰、雾化、湿化主要由护士完成的ICU占83．7％、93．9％、91．6％、90．2％。491名回答者中撤机前行自主呼吸试验者占40．9％，不知道或从来不做者占26．2％；有创通气时未监测气道开口端温度者占27．1％；对撤机未拔管患者应用气管内持续滴入／泵入盐水湿化者占34．4％；55．6％的人员使用前检测呼吸机；管路更换频率依次为每周1次占48．1％，1～3d和3～5d更换1次者为25．0％、14．7％。结论目前国内三级医院ICU的呼吸机数量较前已大幅增加，但对其他实用装置的应用尚不足；呼吸治疗工作主要由医生和护理人员共同承担，尚缺少专业的呼吸治疗师；机械通气、气道管理和呼吸机管理等呼吸治疗工作差异较大，缺乏统一的规范。Objective To investigate respiratory care equipments, operators and conditions of performance in intensive care units （ICU）, with the aim of providing data for standardization and developing respiratory care in China. Methods A questionnaire survey was performed in one national and two international conferences in August, 2006. Four hundred and ninety-one doctors and nurses from 320 ICUs in 264 tertiary hospitals responded. Results Ratios of invasive and noninvasive mechanical ventilators to beds were 0. 52：1 （2 189/4 185） and 0. 16 ：1 （672/4 185）, respectively. Of 320 ICUs, ratios of ICU equipped with ultrasound, jet nebulizers and MDI were 55.9% （179/320）, 33.8% （108/320） and 12.1%（39/320）, respectively, and percentages of doctors in charge of setting modes and parameters, weaning and extubation were 92.1%, 93.1%, 83.5%, respectively. Suction （93.9%）, humidification （90. 2%）, aerosol therapy （91.6%） and circuit changing （83.7%） were nurses＇ duties. Among 491 responders, 40.9% of them implemented spontaneous breathing trials （SBT） before weaning, 13.4% were ignorant of it, and 12. 8% never. 27.1% of ICU never monitored air temperature during invasive mechanical ventilation, 34.4% provided humidification by instilling or pumping saline continuously for those patients who were weaned from ventilators but not extubated, 55.6% checked ventilator before use. Ventilator circuits were changed once a week in 48.1%, 1 - 3 days in 25.0% and 3 - 5 days in 14.7%. Conclusion The quantity of ventilators in the ICU has increased, but other practical respiratory care equipments have not been used widely. Most of respiratory care services are still provided by nurses and doctors, lacking professional staffs. The management is evidently variable but without a standardized guideline.

关 键 词：问卷调查 重症监护病房 呼吸治疗 

分 类 号：R686[医药卫生—骨科学]