婴幼儿气管插管意外脱管原因及干预对策优化研究  

Reasons for accidental extubation on infants mechanical ventilation and optimization research of in- tervention countermeasures

作　　者：王国琴 张美英 陈义平 芦玮玮 

机构地区：[1]安徽省儿童医院护理部,合肥230054 [2]安徽省儿童医院PICU,合肥230054 [3]安徽省儿童医院NICU,合肥230054

出　　处：《中国实用护理杂志》2015年第23期1752-1753,共2页Chinese Journal of Practical Nursing

摘　　要：目的分析机械通气患儿意外拔管的原因，探讨有效干预对策。方法将我院儿科重症监护病房（PICU）2013年5月至2014年2月收治的气管插管行常规护理的患儿148例设为对照组，2014年3．12月收治的气管插管实施干预的患儿152例设为观察组，对其发生意外拔管的次数、人工气道方式和发生的原因及干预对策进行回顾性分析。结果对照组总带管日283d，脱管19例次，脱管率6．7％；观察组总带管日253d，脱管8例次，脱管率3．2％，2组比较差异有统计学意义x2=5．25，P〈0．05。患儿意识状况异常是造成计划外拔管的主要原因，导管固定不牢占第二位因素，其次为患儿舒适度改变，护理操作不当致气管插管过短过浅等均可导致意外拔管。结论优化护理干预对策，对建立人工气道的患儿应高度重视意外拔管的预防干预，适度镇静、肢体约束、正确固定气管套管及呼吸机管道是有效的护理对策。Objective To analyze the reasons for accidental extubation in infants during mechanical ventilation and to explore effective intervention countermeasures. Methods A total of 148 infants with accidental extubation from May 2013 to February 2014 who given routine nursing care were selected as control group. Another 152 infants with accidental extubation in pediatric intensive care unit （PICU） who given optimization nursing care from March to December 2014 were selected as observation group. Retrospective analysis of accidental extubation, artificial airway way and intervention care were conducted. Results The total intratracheal tube time was 283 d in control group and 253 d in observation group. Nineteen cases （6.7%） suffered accidental exudation in control group and that of 8 cases（3.2%） in observation group, and there was significant difference between two groups, x2=5.25, P〈0.05.The primary reason of unplanned extubation was that infants with unconsciousness,the second cause was the improper catheter fixed. The third cause was the patient＇s coznfort level and so on the improper nursing operation leading to accidental extubation too short or too shallow. Conclusion Infants given mechanical ventilation should pay more attention to the intervention of accidental extubation, appropriate calm, physical constraints and correct fixed oioeline.

关 键 词：通气机 负压 护理 婴幼儿 意外脱管 原因 

分 类 号：R473.72[医药卫生—护理学]