角度测量器和提醒装置在提高机械通气患者床头抬高依从性及降低VAP发生率中的应用  

Effects of angle measuring device and reminding device on head-of-bed elevation compliance and decreasing the incidence of VAP in patients with mechanical ventilation

作　　者：王霞[1] 王琳[2] 陈秀芹[3] 宗呈祥[1] 孙玲[1] 苏祥[1] Wang Xia;Wang Lin;Chen Xiuqin;Zong Chengxiang;Sun Ling;Su Xiang(Infection Management Department, Tengzhou Central People＇s Hospital, Shandong Province, Tengzhou 277599, China（Wang X, Zong CX, Sun L, Su X;Operating Room, Tengzhou Central People＇s Hospital, Shandong Province, Tengzhou 277599, China（Wang L;Nursing Department, Tengzhou Central People＇s Hospital, Shandong Province, Tengzhou 277599, China（Chen XQ)

机构地区：[1]山东省滕州市中心人民医院感染管理科,277599 [2]山东省滕州市中心人民医院手术室,277599 [3]山东省滕州市中心人民医院护理部,277599

出　　处：《中华现代护理杂志》2018年第7期778-781,共4页Chinese Journal of Modern Nursing

基　　金：滕州市中心人民医院“扬帆”计划院级科研立项项目（YJKY201616）

摘　　要：目的 通过安装床头角度测量器和床头抬高提醒装置,提高护士对经气管插管或者气切管使用呼吸机辅助呼吸且无床头抬高禁忌证患者床头抬高的依从性,以期降低VAP发生率.方法 选取2014年和2016年入住山东省滕州市中心人民医院ICU经气管插管或者气切管使用呼吸机辅助呼吸的患者575例和473例,2014年（实施前）全面掌握集束化护理落实情况及VAP相关监测数据的一般资料水平;2015年通过对ICU 26张病床安装角度测量及提醒装置,2016年（实施后）收集集束化护理落实情况及VAP相关监测数据的一般资料水平;通过SPSS 17.0对干预前后数据进行统计分析.结果 实施后较实施前护士抬高机械通气患者床头依从性升高（χ2=1691.675,P〈0.001）;VAP发生率明显降低（χ2=9.248, P=0.002）,VAP千日导管发生率有所降低,但差异无统计学意义（χ2=2.694,P=0.058）.结论 通过安装床头角度测量器和床头抬高提醒装置,能有效提高机械通气患者床头抬高依从性,降低VAP发病率.Objective To improve the nurses＇ compliance of elevating the head-of-bed of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation, who had no contraindications of head-of-bed elevation by the installation of angle measuring device and reminding device for head-of-bed elevation, so as to reduce the incidence of ventilator-associated pneumonia （VAP）. Methods A total of 575 and 473 cases of patients with endotracheal intubation or tracheostomy tube using mechanical ventilation were selected respectively rom the patients who were hospitalized in Tengzhou Central People＇s Hospital in Shandong Province in the year of 2014 and 2016. In 2014, before intervention, the implementation of cluster nursing and the general monitoring data of VAP were comprehensively grasped. In 2015, a total of 26 beds in ICU were installed with angle measuring device and reminding device for head-of-bed elevation. In 2016, after intervention, the implementation of cluster nursing and the general information level of the monitoring data of VAP were collected. SPSS 17.0 software was applied for data statistical analysis before and after intervention. Results The nurse compliance of head-of-bed elevation for mechanical ventilation patients was improved after intervention （χ2=1 691.675, P〈0.001）, as well as the incidence of VAP significantly decreased （χ2=9.248, P=0.002）. The incidence of VAP millennium catheterization decreased, but the difference was not statistically significant （χ2=2.694, P=0.058）. Conclusions The installation of bed angle measuring device and reminding device can effectively improve nurse compliance of head-of-bed elevation in patients with mechanical ventilation and reduce the incidence of VAP.

关 键 词：重症监护病房 呼吸 人工 呼吸机相关肺炎 床头抬高 依从性 

分 类 号：R472[医药卫生—护理学]