ICU机械通气患者逐日目标清单在多学科查房中的应用  

Application of daily target list of patients with mechanical ventilation in ICU in multidisciplinary ward round

作　　者：王辉[1] 高春华[1] 俞超[1] Wang Hui;Gao Chunhua;Yu Chao(Department of General Intensive Care Unit,the First Affiliated Hospital of Medical College of Zhejiang University,Hangzhou 310003,China)

机构地区：[1]浙江大学医学院附属第一医院综合监护室,杭州310003

出　　处：《中国实用护理杂志》2023年第2期95-101,共7页Chinese Journal of Practical Nursing

基　　金：浙江省医药卫生科技计划项目(2020KY568)。

摘　　要：目的探讨基于多学科查房设计的ICU机械通气患者逐日目标清单在ICU的临床应用效果,为临床护理提供参考。方法采用类试验设计的非同期对照研究,选取浙江大学医学院附属第一医院综合监护室2019年1—12月收治的1071例机械通气患者为试验组,应用逐日目标清单规范沟通多学科查房内容指导临床护理过程;选择2018年1—12月收治的950例机械通气患者为对照组,使用常规医护沟通和护理交班。比较2组患者机械通气时间与ICU住院时间、院内导管使用率及相关性感染发生率、每日护理措施落实率、护理不良事件发生率以及医务人员对多学科合作的满意度。结果干预前,2组患者基本资料比较差异均无统计学意义(P>0.05)。干预后,试验组机械通气时间、ICU住院时间[M(Q1,Q3)]分别是4(2,9)h、3(3,7)d,低于对照组的6(5,35)h、4(3,8)d,差异均有统计学意义(Z=-13.76、-3.62,均P<0.01)。试验组镇静达标率、早期活动执行率、静脉血栓栓塞预防措施落实率分别是83.10%(4435/5337)、80.16%(3155/3936)、93.97%(5530/5885),高于对照组的81.42%(4190/5146)、68.83%(2197/3192)、87.86%(5839/6646),差异均有统计学意义(χ2=5.05、120.93、138.50,均P<0.05)。试验组身体约束使用率、失禁性皮炎发生率、医用粘胶相关性皮肤损伤发生率、深静脉血栓发生率、谵妄发生率分别是39.75%(2936/7387)、3.64%(39/1071)、4.11%(44/1071)、5.23%(56/1071)、6.54%(70/1071),低于对照组的43.50%(3180/7312)、5.90%(56/950)、8.53%(81/950)、9.26%(88/950)、12.42%(118/950),差异均有统计学意义(χ2值为5.71~20.67,均P<0.05)。ICU医护团队对多学科团队合作的平均分为(3.83±0.38)分,对照组为(3.61±0.51)分,使用逐日目标清单后合作水平有明显提高(t=-3.33,P<0.01)。结论目标清单的使用可提高重症患者的治疗和护理措施落实率,提高多学科合作水平和团队满意度,降低ICU住院时间、机械通气时间、护理不Objective To explore the clinical effect of daily target list of ICU patients with mechanical ventilation(hereinafter referred to as target list)for patients with mechanical ventilation in ICU based on multidisciplinary ward round design.Methods A non contemporaneous controlled study with a quasi experimental design was conducted.One thousand and seventy-one patients with mechanical ventilation admitted to the comprehensive care unit of the First Affiliated Hospital of Medical College of Zhejiang University from January to December 2019 were selected as the experimental group.The target list was used to standardize the communication of multidisciplinary ward rounds and guide the clinical nursing process.Nine hundred and fifty patients with mechanical ventilation admitted from January to December 2018 were selected as the control group.Routine medical communication,ward rounds and nursing shift handover were used.The duration of mechanical ventilation and the length of stay in ICU,the utilization rate of catheter and related infection rate,the implementation rate of daily nursing measures,the incidence of nursing adverse events and the satisfaction of medical staff with multidisciplinary cooperation were compared.Results Before the intervention,there was no significant difference in the basic data between the two groups(P>0.05).After the intervention,the duration of mechanical ventilation and the length of stay in ICU were 4(2,9)h and 3(3,7)d in the experimental group,which were lower than those in the control group 6(5,35)h and 4(3,8)d,the differences were statistically significant(Z=-13.76,-3.62,both P<0.01).The standard rate of sedation,the implementation rate of early activities and the implementation rate of venous thromboembolism preventive measures in the experimental group were 83.10%(4435/5337),80.16%(3155/3936)and 93.97%(5530/5885)respectively,which were higher than the 81.42%(4190/5146),68.83%(2197/3192)and 87.86%(5839/6646)in the control group,the differences were statistically significant(χ2=5.05,120

关 键 词：重症监护病房 呼吸 人工 多学科查房 目标清单 

分 类 号：R472.2[医药卫生—急诊医学]