前馈控制理念在群体烧爆复合伤患者翻身床治疗中的应用效果  

Application effects of feedforward control theory in the rollover bed treatment of mass patients with burn-explosion combined injury

作　　者：陈华清 封秀琴[1] 徐彩娟[1] 张玉萍[1] 曾妃[1] 钟祖爱[1] 夏一兰[1] 韩春茂[1] Chen Huaqing;Feng Xiuqin;Xu Caijuan;Zhang Yuping;Zeng Fei;Zhong Zu'ai;Xia Yilan;Han Chunmao(Department of Burn and Wound Repair,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China)

机构地区：[1]浙江大学医学院附属第二医院烧伤与创面修复科,杭州310009

出　　处：《中华烧伤与创面修复杂志》2022年第4期373-377,共5页Chinese Journal of Burns And Wounds

基　　金：浙江省卫生健康重大科技计划重点项目(WKJ-ZJ-2123)。

摘　　要：目的探讨前馈控制理念在群体烧爆复合伤患者进行翻身床治疗中的应用效果。方法采用回顾性观察性研究方法。浙江大学医学院附属第二医院于2020年6月13—14日收治15例符合入选标准的因液化天然气槽罐车爆炸所致重度烧爆复合伤患者,其中男13例、女2例,年龄33~92(66±17)岁。对所有患者从入院48 h后开始进行翻身床治疗,并导入前馈控制理念,包括组建翻身床前馈控制专项管理团队,明确医护人员在患者翻身床治疗中的职责,采取多学科医师配合策略,以“翻身床工作坊”形式对临时组建的护士团队中的80名护士进行培训并考核,制订翻身床治疗核查表、评估单并持续质控。统计患者入院30 d内翻身床翻身频率、翻身操作总次数及一次性体位变换成功率。观察治疗过程中因翻身床操作不当造成患者呼吸心搏骤停、治疗中断、非计划性拔管、坠床、皮片移位等不良事件的发生情况。记录患者入院2 d内和入院30 d动脉血氧分压(PaO2)和动脉血二氧化碳分压(PaCO_(2))最低值、氧合指数>300 mmHg(1 mmHg=0.133 kPa)患者数及急性呼吸窘迫综合征(ARDS)发生情况。结果患者入院30 d内每日行翻身床翻身2~6次,共进行翻身操作1320次,一次性体位变换成功率为99.9%(1319/1320)。翻身床治疗过程中,无一例患者发生不良事件。患者入院2 d内PaO2、PaCO_(2)最低值分别为(100±19)、(42±4)mmHg,轻、中、重度ARDS患病人数分别为10、2、3例,无一例患者氧合指数>300 mmHg。患者入院30 d时PaO2、PaCO_(2)最低值分别为(135±28)、(37±8)mmHg,中、重度ARDS患病人数分别为3、1例,有11例患者氧合指数>300 mmHg。结论在群体烧爆复合伤患者翻身床治疗中导入前馈控制理念,通过提前控制翻身床应用过程中不良事件发生的风险,确保翻身床翻身安全顺利完成,可促进烧伤创面修复和呼吸功能改善,提高患者救治质量。Objective To explore the application effects of feedforward control theory in the rollover bed treatment of mass patients with burn-explosion combined injury.Methods A retrospective observational research was conducted.From June 13 to 14,2020,15 patients with severe burn-explosion combined injury caused by liquefied natural gas tank car explosion and conforming to the inclusion criteria were admitted to the Second Affiliated Hospital of Zhejiang University School of Medicine.There were 13 males and 2 females,aged 33-92(66±17)years.All the patients were treated with rollover bed from 48 h post admission,and the feedforward control theory was introduced,including establishing a special feedforward control management team for rollover bed,clarifying the duties of the medical staff in the rollover bed treatment of patients,implementing the cooperation strategy of multidisciplinary physician,training and examining for 80 nurses in the temporarily organized nurse team in the form of"rollover bed workshop",and formulating the checklist and valuation list of rollover bed treatment for continuous quality control.The frequency and the total number of turning over,and successful rate of one-time posture change with the rollover bed of patients within 30 days of admission were recorded,the occurrences of adverse events caused by improper operation for the rollover bed during the treatment were observed,including respiratory and cardiac arrests,treatment interruption,unplanned extubation,bed falling,and skin graft displacement.The lowest levels of arterial partial pressure of oxygen(PaO2)and arterial partial pressure of carbon dioxide(PaCO2),the number of patients with oxygenation index>300 mmHg(1 mmHg=0.133 kPa),and the occurrence of acute respiratory distress syndrome(ARDS)of patients within 2 days of admission and on the 30th day of admission were recorded.Results Within 30 days of admission,the patients were turned over with the rollover bed for 2 to 6 times each day,with a total of 1320 turning over operations,the succe

关 键 词：烧伤 事故 烧爆复合伤 翻身床 前馈控制 

分 类 号：R473.6[医药卫生—护理学]