ICU护士对体外循环心血管术后成年患者机械通气管理的现况调查  

Investigation on the Current Status of ICU Nurses′Management of Mechanical Ventilation in Adult Patients after Cardiovascular Surgery with CPB

作　　者：王艺 邱璐鑫 訾明娇 何立环[1] 万建红[1] Wang Yi;Qiu Luxin;Zi Mingjiao(The Second Hospital of Shandong University,Jinan Shandong 250033,China)

机构地区：[1]山东大学第二医院,山东济南250033

出　　处：《齐鲁护理杂志》2024年第18期5-8,共4页Journal of Qilu Nursing

基　　金：山东省医务职工科技创新计划项目(编号:SDYWZGKCJH2023065)。

摘　　要：目的:调查国内ICU护士对体外循环(CPB)心血管术后成年患者机械通气管理的临床实践现况。方法:采用横断面问卷调查方法,2023年4月1日~6月1日向全国15个省、自治区、直辖市36家医疗机构的心脏外科重症监护病房(CSICU)护士发送电子调查问卷,并对调查结果进行分析。结果:共回收有效问卷132份,有效回收率99.25%。心脏外科术后初始机械通气模式中容量触发通气模式占60.61%,压力触发通气模式占19.70%,选择兼容2种触发优势的新型通气模式占15.91%。心脏外科术后潮气量初始设置中81名(61.36%)采用标准体重核算潮气量;有关PEEP的设定,60名(45.45%)护士选择5cm H_(2)O。机械通气管理权属44.70%医生负责、41.66%医生/护士协同调整,9.09%呼吸治疗师主导,4.55%护士主导。患者脱机时使用呼吸机通气模式CPAP为42.42%、SIMV为37.12%、PSV为8.33%、SPONT及其他12.12%。脱机拔管标准化流程,脱机前100.00%行自主呼吸实验,71.97%行气管插管气囊上分泌物清除,35.61%选择行气囊漏气实验,33.33%行最大吸气压监测,30.30%行咳嗽峰流速检测。结论:大多数CSICU护士对CPB心血管术后成人患者机械通气管理具备一定专业知识,但临床实践存在较大差异,亟需出台相关指南/专家共识等指导性文件。Objective:To investigate the current status of clinical practice of ICU nurses in the management of mechanical ventilation in adult patients after cardiovascular surgery with cardiopulmonary bypass(CPB).Methods:A cross-sectional questionnaire survey was conducted from April 1 to June 1,2023.Electronic survey questionnaires were sent to nurses in cardiac surgery intensive care units(CSICU)of 36 medical institutions in 15 provinces,autonomous regions and municipalities in China,and the survey results were analyzed.Results:A total of 132 valid questionnaires were collected,and the effective recovery rate was 99.25%.Among the initial mechanical ventilation modes after cardiac surgery,the volume trigger ventilation mode accounted for 60.61%,the pressure trigger ventilation mode accounted for 19.70%,and the new ventilation mode compatible with the two trigger advantages accounted for 15.91%.In the initial setting of tidal volume after cardiac surgery,the standard body weight of 81 patients(61.36%)was used to calculate tidal volume.About the setting of PEEP,60(45.45%)nurses chose 5 cm H_(2)O.The management(44.70%)of mechanical ventilation was administered by doctors,41.66%was left to doctors/nurses through coordinated adjustment,9.09%left to respiratory therapists,and 4.55%led by nurses.CPAP was 42.42%,SIMV was 37.12%,PSV was 8.33%,SPONT and others were 12.12%at the time of weaning from mechanical ventilation.Abiding by standardized process of weaning from mechanical ventilation,100.00%of the patients underwent spontaneous breathing test,71.97%underwent the removal of secretions by airbag of tracheal incubation,35.61%underwent the airbag leak test,33.33%underwent the maximum inspiratory pressure monitoring,and 30.30%underwent the peak cough flow detection.Conclusion:Most CSICU nurses have certain professional knowledge of mechanical ventilation management in adult patients after cardiovascular surgery with CPB,but great differences exist in clinical practice.Therefore guidance documents such as relevant guidelines/exper

关 键 词：机械通气 成年 体外循环 肺保护性通气 护士主导 心血管 

分 类 号：R473.54[医药卫生—护理学]