低氧性呼吸衰竭患者清醒状态下俯卧位通气Checklist核对单设计与应用  

Design and application of a checklist for prone ventilation in hypoxic respiratory failure in the awake state

作　　者：汤天娟 诸琳 谈玉泉 荣欢 TANG Tianjuan;ZHU Lin;TAN Yuquan;RONG Huan(Department of Respiratory Medicine,No.904 Hospital of Joint Support Force,Wuxi 214044;Cadre Ward,No.904 Hospital of Joint Support Force,Wuxi 214044,China)

机构地区：[1]联勤保障部队第九〇四医院呼吸内科,无锡214044 [2]联勤保障部队第九〇四医院干部病区,无锡214044

出　　处：《空军航空医学》2023年第6期521-524,共4页AVIATION MEDICINE OF AIR FORCE

基　　金：无锡市卫生健康委科技成果与适宜技术推广项目(T202010)。

摘　　要：目的设计能够用于低氧性呼吸衰竭患者清醒状态下俯卧位通气期间的Checklist核对单并应用于临床实践过程,以完善俯卧位患者的管理安全。方法在循证医学转化基础上设计低氧性呼吸衰竭清醒状态俯卧位通气Checklist核对单,采用回顾性队列设计法将联勤保障部队第九〇四医院2018年1月—2020年10月(使用核对单前)41例低氧性呼吸衰竭患者纳入对照组、2020年11月—2022年6月(使用核对单后)43例低氧性呼吸衰竭患者纳入观察组,分析俯卧位通气操作时间、不良事件发生情况。结果观察组俯卧位通气操作时间、回归仰卧位时间及总操作时间均短于对照组(Z=8.002、5.141、6.575,P均<0.001);观察组俯卧位通气准备时间长于对照组(Z=3.346,P=0.001);观察组患者仅发生1例非计划拔管、2例黏胶相关皮肤损伤不良反应,其不良反应发生率(6.98%)与对照组比较差异有统计学意义(χ^(2)=4.865,P=0.027)。结论低氧性呼吸衰竭患者清醒俯卧位通气Checklist核对单能够使俯卧位通气操作时间缩短,患者俯卧位通气期间的干预安全性有所改善,但会增加患者的通气前准备时间。Objective To design a checklist that can be used during prone ventilation in the awake state in patients with hypoxic respiratory failure to ensure the safety of patients in the prone position.Methods A checklist for prone ventilation in case of hypoxic respiratory failure in the awake state was designed using brainstorming on the basis of evidence-based translation of medicine.Using a retrospective cohort design method,the 41 patients treated between January 2018 and October 2020(before the checklist was used)were assigned to the control group while another 43 cases treated between November 2020 and June 2022 were assigned to the observation group(after the checklist was used).The duration of prone ventilation and the incidence of adverse events were recorded.Results The duration of prone ventilation,the time taken to return to the supine position and the total duration of surgery in the observation group were shorter than in the control group(Z=8.002,5.141,6.575,all P<0.001).The preparation for prone ventilation took a longer time in the observation group than in the control group(Z=3.346,P=0.001).Only one case of unplanned extubation and two cases of mucus-related skin injury occurred in the observation group,where the incidence of adverse reactions was 6.98%,with no statistically significant difference compared with the control group(χ^(2)=4.865,P=0.027).Conclusion The checklist for prone ventilation in the awake state in patients with hypoxic respiratory failure can shorten prone ventilation and enhance the safety of interventions,but the patients’pre-ventilation preparation can take more time。

关 键 词：低氧性呼吸衰竭 俯卧位通气 Checklist核对单 

分 类 号：R563.8[医药卫生—呼吸系统]