集束化护理方案预防呼吸机相关性肺炎的效果观察  

Effect of cluster nursing on prevention of ventilator-associated pneumonia

作　　者：张燕华 李建华 陆燕英 

机构地区：[1]从化市中心医院人保科,广东从化510900 [2]从化市中心医院ICU,广东从化510900

出　　处：《中华医院感染学杂志》2013年第13期3109-3110,3113,共3页Chinese Journal of Nosocomiology

基　　金：广东省科技计划项目(2012B061700004)

摘　　要：目的探讨集束化护理方案在预防呼吸机相关性肺炎(VAP)的效果,为临床治疗提供参考。方法选取2010年1-12月收住ICU的176例机械通气≥48h患者为集束化组,患者均采取抬高床头30～45度、持续声门下吸引、密闭式吸痰、人工鼻的应用、加强口咽部管理、严格洗手等集束化护理干预措施,选取2009年1-12月ICU收治的163例机械通气≥48h患者为对照组,比较两组患者VAP发生率、机械通气时间、ICU住院时间及痰病原学检查结果。结果与对照组相比,采用集束化护理方案后VAP发生率由25.15%降至15.91%,差异有统计学意义(P<0.05);机械通气时间由(13.5±5.6)d缩短至(8.5±4.2)d,差异有统计学意义(P<0.05),ICU住院时间由(21.17±17.62)d缩短至(13.42±9.23)d,差异有统计学意义(P<0.01);两组患者病原菌均以革兰阴性菌为主,差异无统计学意义。结论集束化护理方案对预防VAP有着重要的意义,加强对医护人员的培训,提高集束化护理方案的依从性和完善的质量控制是降低VAP的关键。OBJECTIVE To explore the effect of the cluster nursing scheme on the prevention of ventilator-associated pneumonia（VAP）so as to guide the clinical treatment.METHODS A total of 176patients with the mechanical ventilation more than 48hours,who hospitalized the ICU from Jan to Dec 2010,were selected as the cluster group,all the patients were taken such cluster nursing interventions as raising the bed head 30to 45degree,continuous subglottic attract,closed suctioning,application of artificial nose,strengthening the oropharynx management,and strict hand-washing.Totally 163cases of patients with the mechanical ventilation more than 48 hours,who hospitalized the ICU from Jan to Dec 2009,were set as the control group.The incidence of VAP,duration of mechanical ventilation,lengthen of ICU stay,and the result of sputum etiological examination were compared between the two groups.RESULTS As compared with the control group,the incidence of VAP decreased from 25.15%to 15.91%after adopting the cluster nursing interventions,the difference was statistically significant（P〈0.05）;the duration of mechanical ventilation shortened from（13.5±5.6）d to（8.5±4.2）d,the difference was statistically significant（P〈0.05）;the duration of ICU stay decreased from（21.17±17.62）d to（13.42±9.23）d,the difference was statistically significant（P〈0.01）;the gram-negative bacteria were dominant in the pathogens isolated from the two groups of patients.CONCLUSION The cluster nursing intervention is of great significance in the prevention of VAP.To strengthen the training of medical staff and improve the compliance of the cluster nursing programs and quality control is the key to reduce the incidence of VAP.

关 键 词：呼吸机相关性肺炎 集束化护理 机械通气 

分 类 号：R563.1[医药卫生—呼吸系统]