基于ICU重症患者气管插管非计划性拔管临床决策支持系统的建立与应用  

Establishment and application of clinical decision support system for unplanned extubation of tracheal intubation in ICU patients

作　　者：侯胜芳[1] 刘春霞[2] 高伟[3] 李艳伟[4] 张红梅 刘新平[3] HOU Sheng-fang;LIU Chun-xia;GAO Wei;LI Yan-wei;ZHANG Hong-mei;LIU Xin-ping(Department of Nephrology,Hebei People's Hospital,Shijiazhuang 050051,Hebei,China;ICU,Hebei People's Hospital,Shijiazhuang 050051,Hebei,China;Department of Information,Hebei People's Hospital,Shijiazhuang 050051,Hebei,China;CCU,Hebei People's Hospital,Shijiazhuang 050051,Hebei,China)

机构地区：[1]河北省人民医院肾内科,河北石家庄050051 [2]河北省人民医院ICU,河北石家庄050051 [3]河北省人民医院信息处,河北石家庄050051 [4]河北省人民医院CCU,河北石家庄050051

出　　处：《川北医学院学报》2022年第12期1649-1652,共4页Journal of North Sichuan Medical College

基　　金：河北省医学科学研究重点课题计划项目(20170358)。

摘　　要：目的:建立基于重症监护病房(ICU)重症患者气管插管非计划性拔管(UEE)的预警及临床决策支持系统(CDSS),并探讨其临床应用价值。方法:构建UEE预警及CDSS,包括登录、评估、决策、预警及指导模块。比较系统实施前、后ICU护士对UEE的认知度及UEE预防措施执行率、UEE发生率、ICU护士对系统的满意度等。结果:系统使用后,ICU护士对UEE的认知度评分达标率高于使用前(P<0.05);ICU护士UEE预防措施执行率提高,在风险识别、管道固定、肌力评估、意识状态评估及约束管理的执行率均高于使用前(P<0.05)。使用后UEE发生率低于使用前(2.00%vs.6.50%)(P<0.05)。ICU护士对系统满意度总分为(91.33±6.41)分。结论:基于ICU重症患者UEE的预警及CDSS能提高IUC护士对UEE的认知度,提高其UEE预防措施执行率,能够有效减少UEE的发生。Objective:To establish an early warning and clinical decision support system(CDSS)based on unplanned endotracheal extubation(UEE)of tracheal intubation in critically ill patients in intensive care unit(ICU),and to explore its clinical application value.Methods:Build UEE early warning and CDSS,including login,evaluation,decision-making,early warning and guidance modules.The cognition of ICU nurses to UEE,the implementation rate of UEE preventive measures,the incidence of UEE and the satisfaction of ICU nurses to the system before and after the implementation of the system were compared.Results:After the implementation of the system,the compliance rate of ICU nurses cognition score of UEE was higher than that before the implementation of the system(P<0.05).The implementation rate of UEE preventive measures in ICU nurses was improved,and the implementation rate of risk identification,pipeline fixation,muscle strength assessment,consciousness state assessment and constraint management were higher than that before implementation(P<0.05).The incidence of UEE after implementation was 2.00%,which was lower than 6.50%before system implementation(P<0.05).The total score of system satisfaction of ICU nurses was(91.33±6.41).Conclusion:Early warning and CDSS based on ICU severe patients with UEE can improve the awareness of UEE among IUC nurses,improve the implementation rate of UEE preventive measures,and effectively reduce the occurrence of UEE.

关 键 词：重症监护病房 非计划性拔管 临床决策 预警 

分 类 号：R472[医药卫生—护理学]