专人监督执行集束化管理方案对预防呼吸机相关肺炎的效果  

Efficacy of bundle care under the supervision of professionals in preventing ventilator-associated pneumonia

作　　者：康福新[1] 王小智[1] 

机构地区：[1]海南省农垦总医院,海南海口570311

出　　处：《中国感染控制杂志》2017年第2期134-137,共4页Chinese Journal of Infection Control

基　　金：海南省自然科学基金项目(811166)

摘　　要：目的探讨专人监督执行集束化管理方案预防呼吸机相关肺炎(VAP)的效果。方法选择某院重症监护病房(ICU)2013年7月—2014年6月使用机械通气的患者,其中2013年7—12月设为对照组(150例),采取集束化管理措施,无专人监管;2014年1—6月(177例)设为专人监督管理组,采取集束化管理措施,专人负责监管,比较两组患者VAP发病率、机械通气时间和ICU停留时间。结果专人监督管理组有创机械通气患者141例,有创机械通气日为1 937 d,发生VAP9例,VAP发病率为4.65‰;对照组有创机械通气患者127例,有创机械通气日为1 965 d,发生VAP21例,VAP发病率为10.69‰,两组比较,差异有统计学意义(χ~2=5.68,P=0.042)。专人监督管理组集束化管理方案总依从率、平均有创机械通气时间以及停留ICU时间分别为94.92%、(11.11±2.57)d、(15.11±2.88)d,对照组分别为48.67%、(14.67±4.35)d、(19.33±5.81)d,两组间比较,差异均有统计学意义(均P<0.05)。结论专人监督执行集束化管理方案可以有效预防VAP的发生,应建立符合临床科室实际情况的集束化管理方案。ObjectiveTo investigate the efficacy of bundle care under the supervision of professionals in preventing ventilatorassociated pneumonia（VAP）. MethodsPatients who received mechanical ventilation between July 2013 and June 2014 in the intensive care unit（ICU） of a hospital were selected, JulyDecember 2013 was as control group （n=150）, patients received bundle care, but without special supervision; JanuaryJune 2014 was as special supervision group （n=177）, patients received bundle care under the supervision of professionals, incidence of VAP, duration of mechanical ventilation, and length of ICU stay were compared between two groups. ResultsIn special supervision group, 141 patients received invasive mechanical ventilation, mechanical ventilation day were 1 937 days, 9 patients developed VAP, incidence of VAP was 4.65‰; in control group, 127 patients received invasive mechanical ventilation, mechanical ventilation day were 1 965 days, 21 patients developed VAP, incidence of VAP was 10.69‰, difference was statistically significant between two groups（χ^2=5.68,P=0.042）. In special supervision group, overall compliance rate of bundle management strategies, duration of average invasive mechanical ventilation, and length of ICU stay were 94.92%,（11.11±2.57）days, and（15.11±2.88）days respectively,in control group were 48.67%,（14.67±4.35）days, and（19.33±5.81）days respectively,difference was statistically significant between two groups （all P〈0.05）. ConclusionBundle care strategies supervised by professionals can effectively prevent the occurrence of VAP, the implementation of bundle care strategies should be set up according to the clinical practice.

关 键 词：重症监护病房 集束化方案 机械通气 呼吸机相关肺炎 

分 类 号：R563.1[医药卫生—呼吸系统]