专科护理主导的多学科协作模式在主动脉夹层术后早期ICU高压氧救治中的应用  

Application of specialized nursing care-led MDT model in early-stage ICU hyperbaric oxygen treatment after aortic dissection surgery

作　　者：涂超群 李君 陈旭 曾碧茹 张流利 陈文清 陈文豪 龙颖 Chaoqun Tu;Jun Li;Xu Chen;Biru Zeng;Liuli Zhang;Wenqing Chen;Wenhao Chen;Ying Long(Hyperbaric Medicine Department,Shenzhen People’s Hospital,Shenzhen 518020,China;Cardiac Surgery Department,Shenzhen People’s Hospital,Shenzhen 518020,China)

机构地区：[1]深圳市人民医院高压氧科,深圳518020 [2]深圳市人民医院心外科,深圳518020

出　　处：《中华航海医学与高气压医学杂志》2022年第3期345-349,共5页Chinese Journal of Nautical Medicine and Hyperbaric Medicine

摘　　要：目的:总结专科护理主导的多学科协作(MDT)模式应用于Stanford A型主动脉夹层(AD)术后脑部并发症患者早期ICU高压氧(ICU-HBO)的治疗效果。方法:2018年1月至2020年12月在18例AD术后出现脑部并发症的患者行ICU-HBO治疗中运用MDT模式,观察其呼吸机耐受及撤机时间、转归、医疗(安全)不良事件发生次数及护理满意度。结果:15例机械通气患者经1~5次ICU-HBO治疗顺利撤机。16例患者接受2~13次ICU-HBO治疗,意识恢复正常,总有效率88.89%;2例深度昏迷患者经2次ICU-HBO治疗后患者家属放弃。随访6个月至2年,临床痊愈11例,有效1例,失访4例,放弃治疗的2例患者并发感染死亡。ICU-HBO治疗期间未发生医疗(安全)不良事件。护理满意度100%。结论:Stanford A型AD术后脑部并发症患者早期ICU-HBO治疗时,运用专科护理主导的MDT模式有利于控制治疗风险,保障治疗有效性,改善AD患者的长期预后及生活质量。Objective To explore the effect of applying the multi-disciplinary team(MDT)model led by specialized nursing care in the treatment carried out at early stage in intensive care unit of hyperbaric oxygen(ICU-HBO)for patients with brain complications after Stanford type A aortic dissection(AD)surgery.Method From January 2018 to December 2020,a total of 18 patients with brain complications after AD surgery were included and treated by ICU-HBO with MDT model.The patients’ventilator tolerance and weaning time,outcome,occurrence of adverse events,and satisfaction rate of nursing care were observed.Results(1)Fifteen mechanically ventilated patients were successfully weaned off the machine after 1-5 times of ICU-HBO treatment.(2)Sixteen patients regained their consciousness to the normal level after 2-13 times of ICU-HBO treatments,with the total effective rate of 88.89%;two patients in persistent vegetative state(deep coma)discontinued the treatment after two times of ICU-HBO treatments as their family gave up.During the follow-up period of six months to two years,11 cases were found clinically cured,one case was considered effective,four cases lost contact,and the two cases that had gave up treatment died of complications.(3)No adverse medical event(related to safety)occurred during the ICU-HBO treatment.(4)The satisfaction rate of nursing care was 100%.Conclusion In the early ICU-HBO treatment of patients with brain complications after Stanford type A AD surgery,the application of MDT mode led by specialized nursing care is beneficial to the treatment risk control,ensure the treatment effectiveness,and improve the long-term prognosis,and quality of life of AD patients.

关 键 词：主动脉夹层 ICU 高压氧 多学科协作模式 脑部并发症 

分 类 号：R473.6[医药卫生—护理学]