机械通气危重症患儿镇静评估的最佳证据应用  

Application of best evidence on sedation assessment of critically ill children on mechanical ventilation

作　　者：张清 张文婷[2] 谢俊霞 孙雨 苗丰 严萌玮 姚文英[5] 王文超 谢安慰[3] Zhang Qing;Zhang Wenting;Xie Junxia;Sun Yu;Miao Feng;Yan Mengwei;Yao Wenying;Wang Wenchao;Xie Anwei(Department of Hematology,Children′s Hospital of Soochow University,Suzhou 215025,China)

机构地区：[1]苏州大学附属儿童医院血液科,江苏苏州215025 [2]苏州大学附属儿童医院SICU,江苏苏州215025 [3]苏州大学附属儿童医院感染科,江苏苏州215025 [4]苏州大学医学部护理学院 [5]苏州大学附属儿童医院护理部,江苏苏州215025 [6]复旦大学附属儿科医院急诊科

出　　处：《护理学杂志》2024年第24期1-6,共6页Journal of Nursing Science

摘　　要：目的评价机械通气危重症患儿镇静评估最佳证据的应用效果,为临床实践提供参考。方法筛选机械通气危重症患儿镇静评估的最佳证据,经过基线审查、障碍因素分析,构建最佳证据应用策略,于2023年8月至2024年1月在1所三级甲等儿童医院ICU实施。比较证据应用前后ICU护士对机械通气危重症患儿镇静评估相关知识掌握度以及镇静评估执行率,机械通气危重症患儿躁动发生率、机械通气时间、ICU住院时间以及非计划性拔管率。结果证据应用后,ICU护士对机械通气危重症患儿镇静评估相关知识评分显著提高,7个审查指标的执行率显著高于基线水平(均P<0.05);患儿躁动发生率显著下降,机械通气时间、ICU住院时间显著缩短(均P<0.05);证据应用前后患儿均未发生非计划性拔管。结论最佳证据的应用可提高ICU护士对机械通气危重症患儿镇静评估知识以及镇静评估执行率,降低患儿躁动发生率、缩短机械通气及ICU住院时间。Objective To evaluate the application effect of best evidence for sedation assessment in critically ill children on mechanical ventilation and provide a reference for clinical practice.Methods Best evidence for sedation assessment in critically ill children on mechanical ventilation was selected,followed by baseline review and barrier analysis to construct an evidence application strategy.This strategy was implemented in the ICU of a tertiary children′s hospital from August 2023 to January 2024.The study compared ICU nurses′knowledge mastery of sedation assessment for mechanically ventilated critically ill children,sedation assessment implementation rate,incidence of agitation,duration of mechanical ventilation,ICU length of stay,and rate of unplanned extubation before and after evidence application.Results After the application of evidence,ICU nurses′scores on knowledge related to sedation assessment of mechanically ventilated critically ill children significantly improved,and the implementation rates of seven audit indicators were significantly higher than baseline levels(all P<0.05).The incidence rate of agitation in patients significantly decreased,and the duration of mechanical ventilation and ICU stay were significantly shortened(all P<0.05).No unplanned extubations occurred in patients before or after evidence application.Conclusion The application of best evidence can improve ICU nurses′knowledge and sedation assessment implementation rate for mechanically ventilated critically ill children,reduce the incidence rate of agitation,and shorten both mechanical ventilation duration and ICU stay.

关 键 词：ICU 重症患儿 机械通气 镇静 镇静评估 躁动 非计划性拔管 循证护理 

分 类 号：R473.72[医药卫生—护理学]