ICU患者气管插管非计划性拔管影响因素调查及防范措施效果评价  

Investigation on the influencing factors of unplanned extubation of tracheal intubation in ICU patients and evaluation on the effect of preventive measures

作　　者：刘瑶[1] 叶东花[1] 郑益娇[2] 

机构地区：[1]浙江省丽水市中心医院重症监护室,浙江丽水323000 [2]浙江省丽水市中心医院护理部,浙江丽水323000

出　　处：《中国现代医生》2017年第11期149-152,共4页China Modern Doctor

基　　金：浙江省医药卫生科技计划项目(2017KY723)

摘　　要：目的调查重症监护病房(Intensive care unit,ICU)患者非计划性拔管(unplanned extubation,UEX)的影响因素,并对相关防范措施进行效果评价。方法选取我院于2014年2月~2016年8月收治的ICU气管插管患者792例,按治疗时间和预防措施的不同,分为观察组和对照组。对照组394例于2014年2月~2015年7月行常规护理防范措施,观察组398例于2015年8月~2016年8月给予优化护理干预。总结ICU患者非计划性拔管的影响因素,并比较两组非计划性拔管的发生率。结果 792例气管插管患者中发生UEX的有28例,其影响因素主要有导管固定不牢(7例)、肢体约束不当(4例)、护士操作不当(2例)和患者因意识状态异常或舒适度改变自行拔管(15例);另外,夜晚和不使用镇静剂的UEX发生率(71.43%,64.29%)比白天、使用镇静剂的发生率(28.57%,35.71%)更高(P<0.05)。经Logistic回归分析发现:导管固定不牢、肢体约束不当、护士操作不当、患者自行拔管、夜间行气管插管、未使用镇静剂为UEX发生的影响因素。两组非计划性拔管率比较,观察组(1.76%)明显低于对照组(5.33%),且差异有统计学意义(P<0.05)。结论引起ICU患者非计划性拔管的因素主要有导管固定不牢、肢体约束不当、患者自行拔管等,同时夜间、不使用镇静剂时,UEX的发生率更高。对于以上原因,为降低非计划性拔管的发生率,规范护理操作,促使患者早日康复,采取有针对性的护理防范措施相比常规防范措施更加安全有效。Objective To investigate the influencing factors of unplanned extubation （UEX） in intensive care unit （ICU） patients and evaluate the effect of corresponding preventive measures. Methods A total of 792 patients with ICU tracheal intubation who were enrolled in our hospital from February 2014 to August 2016 were selected. According to the treatment time and preventive measures, the patients were divided into the observation group and the control group. 394 patients in the control group from February 2014 to July 2015 were given routine nursing preventive measures, and 398 patients in the observation group were given optimal nursing interventions from August 2015 to August 2016. The influencing factors of unplanned extubation in ICU patients were summarized, and the incidence rate of unplanned extubation in both groups were compared. Results Of the 792 patients with tracheal intubation, 28 patients had UEX. The main factors were ustable catheter fixation （7 cases）, improper limb restriction （4 cases）, improper operation of nurses （2 cases） and patients＇ self-extubation（15 cases） due to abnormal state of consciousness or change of comfort; in addition, the incidence rate of UEX at night and without sedatives（71.43%, 64.29%） was higher than that during daytime and with sedatives （28.57%, 35.71%） （P〈0.05）. According to the Logistic regression analysis： ustable catheter fixation, improper limb restriction, improper operation of nurses, patients＇ self-extubation, tracheal intubation during night time, lack of sedatives were influencing factors for UEX. The unplanned extubation rate of the two groups was compared, and the observation group （1.76%） was significantly lower than that in the control group （5.33%）, The difference was statistically significant （P〈0.05）. Conclusion The factors that cause unplanned extubation in ICU patients are ustable catheter fixation, improper limb restriction, improper operation of nurses, patients＇ self-extubation, etc. At the sam

关 键 词：ICU UEX 影响因素 预防措施 

分 类 号：R472[医药卫生—护理学]