综合安全项目在有创机械通气安全撤机中的应用  

Implementing a comprehensive unit-based safety program model to improve the weaning safety management of mechanically ventilated neurosurgical patients

作　　者：郭雪琴 熊莉娟 金环 黄娜 李炳 崔宏东 渠缘 王羡科[1] GUO Xueqin;XIONG Lijuan;JIN Huan;HUANG Na;LI Bing;CUI Hongdong;QU Yuan;WANG Xianke(Department of Neurosurgery ICU,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430022,China;Department of Nursing,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei 430022,China)

机构地区：[1]华中科技大学同济医学院附属协和医院神经外科ICU,湖北武汉430022 [2]华中科技大学同济医学院附属协和医院护理部,湖北武汉430022

出　　处：《中华神经外科疾病研究杂志》2024年第3期51-55,共5页Chinese Journal of Neurosurgical Disease Research

基　　金：华中科技大学同济医学院护理学院自主创新项目(ZZCX2024X008);华中科技大学2023年教学研究项目(2023125)。

摘　　要：目的探讨基于病区的综合安全项目的实施对神经外科有创机械通气患者撤机的影响。方法选取2021年1月至2021年12月华中科技大学同济医学院附属协和医院神经外科ICU收治的375例患者为对照组,实施常规撤机护理管理;选取2022年1月至2022年12月我院神经外科ICU收治的475例患者为干预组,实施基于病区的综合安全项目管理。比较两组患者撤机困难发生率、对干预前、干预3个月后病区护士有创机械通气撤机指征知信行水平及安全文化态度得分进行评价。结果干预前撤机困难发生率为29.60%,干预后撤机困难发生率为23.58%(χ^(2)=3.926,P=0.048);干预组护士对有创机械通气撤机指征知信行水平、安全氛围、工作满意度、工作条件、压力感知得分均分及总分均高于干预前(P<0.05)。结论基于病区的综合安全项目的应用可以有效降低机械通气患者撤机困难率,促进神经外科ICU安全文化的建立,提高护士对有创机械通气患者撤机的应用安全水平和护理质量。Objective To explore the impact of the implementation of a comprehensive unit-based safety program(CUSP)in weaning management for neurosurgical patients undergoing invasive mechanical ventilation.Methods 375 patients admitted to the neurosurgical ICU of our hospital from January 2021 to December 2021 were selected as the control group,and routine withdrawal nursing management was implemented;475 patients admitted to the neurosurgical ICU of our hospital from January 2022 to December 2022 were selected as the intervention group and the comprehensive unit-based safety program(CUSP)was implemented.The incidence of difficulty in ventilator weaning was compared between the two groups.The scores of knowledge,belief and practice level and safety culture attitude of nurses in the ward of invasive mechanical ventilation were evaluated before and 3 months after intervention.Results The incidence of difficulty in ventilator weaning before intervention was 29.60%,while the post-intervention incidence was 23.58%(χ^(2)=3.926,P=0.048).Nurses in the intervention group had a higher level of knowledge,beliefs and behaviours about the indications of the weaning of invasive mechanical ventilation(all P<0.05).The average score of safety atmosphere,job satisfaction,working conditions satisfaction and stress perception in the intervention group was higher than that before the intervention(P<0.05).Conclusion The application of the comprehensive unit-based safety program(CUSP)can effectively reduce the rate of difficulty of weaning the invasive mechanically ventilated patients,promote the establishment of neurosurgical ICU safety culture and improve the application safety level and nursing quality of nurses for invasive mechanically ventilated patients.

关 键 词：基于病区的综合安全项目 神经外科 重症监护病房 有创机械通气 撤机 

分 类 号：R192.6[医药卫生—卫生事业管理]