集束化护理在危重症病人人工气道精细化管理中的应用  

Application of cluster nursing in fine management of artificial airway in critically ill patients

作　　者：邓秋霞[1] 李虹彦[1] 昝涛[1] 丰小星[1] 高岚[1] 

机构地区：[1]吉林大学第一医院

出　　处：《护理研究（下旬版）》2017年第3期1072-1076,共5页Chinese Nursing Researsh

基　　金：中华护理学会2014年度立项科研课题;编号:ZHKY201401

摘　　要：[目的]探讨集束化护理方案在危重症病人人工气道精细化管理中的应用效果。[方法]选择2014年8月—2015年1月我院重症监护病房收治的142例应用人工气道的病人为观察组,选择2013年8月—2014年2月收治的148例应用人工气道病人作为对照组。对照组采取人工气道的常规护理方法。观察组在常规护理的基础上实施人工气道精细化管理的集束化方案,对护士进行规范化培训,使护士遵循此集束化方案。观察两组病人住院期间人工气道建立后3d^5d、6d^10d的肺部感染发生率及机械通气病人机械通气时间、呼吸机相关性肺炎(VAP)发生率。[结果]人工气道建立3d^5d观察组病人肺部感染发生率为12.0%、VAP发生率为13.3%,对照组肺部感染发生率19.6%、VAP发生率为25.0%,两组肺部感染发生率及VAP发生率比较差异均有统计学意义(P<0.05)。人工气道建立6d^10d观察组病人肺部感染发生率为16.9%、VAP发生率为17.3%,对照组肺部感染发生率为43.9%、VAP发生率为38.5%,两组肺部感染发生率及VAP发生率比较差异均有统计学意义(P<0.01)。观察组机械通气病人机械通气时间为7.61d±2.16d,对照组机械通气时间为10.74d±2.77d,两组机械通气时间比较差异有统计学意义(P<0.01)。[结论]在危重症病人人工气道精细化管理中应用集束化方案,可降低人工气道病人肺部感染的发生率及机械通气病人VAP的发生率,缩短病人机械通气时间。Objective：To probe into the application effect of cluster nursing program in fine management of artificial airway in critically ill patients.Methods：A total of 142 patients applying artificial airway in our hospital ICU from August 2014 to January 2015 was observation group,while a total of 148 patients from August 2013 to February 2014 as control group.The control group adopted routine nursing method of artificial airway.Observation group added bundle of fine management,through standardize training to nurses who followed the cluster scheme.The incidence of pulmonary infection,mechanical ventilation time and the incidence of ventilator associated pneumonia（VAP）in two groups of patients with artificial airway during 3d-5d、6d-10dwere observed.Results：Artificial airway was established 3days to 5days,in the observation group the incidence of pulmonary infection was 12.0%,the incidence of VAP was 13.3%;while in the control group,the incidence of pulmonary infection was 19.6%,the incidence of VAP was 25.0%.There were statistically significant in two groups of the incidences of pulmonary infection and VAP（P〈0.05）.Artificial airway was established 6dto 10 d,in the observation group the incidence of pulmonary infection was 16.9%,the incidence of VAP was 17.3%;while in the control group,the incidence of pulmonary infection was 43.9%,the incidence of VAP was 38.5%.There were statistically significant differences in the incidences of pulmonary infection and VAP between both groups（P〈0.01）.The mechanical ventilatin time in observation group was 7.61d±2.16 d,while the control group was 10.74d±2.77 d.There were statistically significant in two groups of mechanical ventilation time（P〈0.01）.Conclusions：Application of cluster nursing program in the fine management of artificial airway in critically ill patients could reduce the incidencing of pulmonary infection and the incidence of VAP in patients with mechanical ventilation and shorten the mechanical ventilation time.

关 键 词：集束化护理 危重症病人 人工气道 精细化护理 呼吸道感染 

分 类 号：R472[医药卫生—护理学]