成批烧伤患者肺部护理集束化管理方案的构建与应用  

Establishment and application of a clustered management plan for pulmonary care of massive burn casualties

作　　者：王淑君[1] 马春亭 鲁虹言 宋喜鹤 钮跃增 陈国杰 周体[2] 申传安[1] Wang Shujun;Ma Chunting;Lu Hongyan;Song Xihe;Niu Yuezeng;Chen Guojie;Zhou Ti;Shen Chuan′an(Department of Burns and Plastic Surgery,the Fourth Medical Center of PLA General Hospital,Beijing 100048,China;Department of Nursing,the Fourth Medical Center of PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第四医学中心烧伤整形科,北京100048 [2]解放军总医院第四医学中心护理部,北京100048

出　　处：《中华烧伤杂志》2020年第8期665-670,共6页Chinese Journal of Burns

基　　金：军队后勤科研计划重大项目(ALB18J001)。

摘　　要：目的构建成批烧伤患者肺部护理集束化管理方案(下称肺部护理集束化管理方案)并探讨其应用效果。方法(1)成立由解放军总医院第四医学中心(下称笔者单位)烧伤整形科、呼吸内科和感染控制科医护人员组成的集束化干预小组;针对成批烧伤患者的肺部护理关键点和难点,梳理出肺部护理评估、胸肺物理治疗、人工气道管理、专科感染控制4个主要环节;应用循证护理的方法以"成批烧伤、肺部护理、集束化管理"等为中文检索词,以"mass burn、respiratory management、airway management"等为英文检索词,检索《PubMed》《中国期刊全文数据库》《维普数据库》《万方数据库》中与前述4个环节相关的文献,经阅读讨论并结合临床实践经验制订肺部护理集束化管理方案。(2)本非随机对照研究中,将肺部护理集束化管理方案应用于2016年1月-2019年12月笔者单位收治的符合入选标准的73例32(25,38)岁成批烧伤患者(男48例、女25例),将其设为集束化护理组;回顾性将2013年1月-2015年12月笔者单位收治的符合入选标准的43例35(17,45)岁行常规护理的成批烧伤患者(男25例、女18例)设为常规护理组。统计2组患者住院期间肺部感染率和病死率。对数据行χ^2检验、Mann-Whitney U检验和独立样本t检验。结果(1)肺部护理集束化管理方案包括涵盖肺部护理4个主要环节的12项具体措施,肺部护理评估中明确评估内容包括既往病史、受伤史、呼吸状况、声音嘶哑情况、肺部听诊等,胸肺物理治疗中包括如何指导患者有效咳嗽、缩唇呼吸与腹式呼吸联合训练等,人工气道管理中明确接诊即做好人工气道建立的准备、气管切开后的观察指标和频率、湿化方法、吸痰方法与频次、机械通气的管理等,专科感染控制中强化手卫生和呼吸机的管理。(2)集束化护理组患者肺部感染率和病死率分别为2.74%(2/73)、4.11%(3/73),�Objective To establish a clustered management plan for pulmonary care of massive burn casualties(hereinafter referred to as the clustered management plan for pulmonary care),and to explore its application effects.Methods(1)A clustered care intervention group was established,including the medical and nursing staff from the Department of Burns and Plastic Surgery,Department of Respiratory Medicine,and Department of Infection Control at the Fourth Medical Center of PLA General Hospital(hereinafter referred to as our hospital).Four major links,including pulmonary care assessment,chest and lung physical therapy,artificial airway management,and specialized infection control were sorted out according to the key points and difficulties in pulmonary care for massive burn casualties.Evidence-based nursing methods were employed to retrieve articles related to the above-mentioned four links from PubMed,Chinese Journal Full-Text Database,VIP Database and Wanfang Data using terms of"mass burn,respiratory management and airway management"and terms of"成批烧伤,肺部护理,集束化管理",and the clustered management plan for pulmonary care was established based on reading and discussion in combination with clinical practice and experience.(2)In this non-randomized controlled study,the clustered management plan for pulmonary care was applied to 73 massive burn patients(48 males and 25 females,aged 32(25,38)years)who were admitted to our hospital from January 2016 to December 2019 and met the inclusion criteria,and they were included into the clustered care group;43 massive burn patients(25 males and 18 females,aged 35(17,45)years)who were admitted to our hospital from January 2013 to December 2015,received routine care and met the inclusion criteria were retrospectively included into routine care group.The pulmonary infection rate and mortality of patients in the two groups were recorded during the hospital stay.Data were statistically analyzed with chi-square test,Mann-Whitney U test,and independent sample t test.Results(1

关 键 词：烧伤 事故 护理估计 成批烧伤 肺部护理 集束化管理 

分 类 号：R64[医药卫生—外科学] Q463[医药卫生—临床医学]