高血压脑出血术后肺部感染患者多重用药管理方案的构建及应用  

Construction and application of multiple medication management scheme for patients with pulmonary infection after hypertensive cerebral hemorrhage operation

作　　者：周芳 邓扬 苏莹 陈钫[1] 刘兴智[1] 李兴燕[1] 赵柏皓 ZHOU Fang;DENG Yang;SU Ying;CHEN Fang;LIU Xingzhi;LI Xingyan;ZHAO Baihao(Department of Neurosurgery,the First People's Hospital of Longquanyi District Chengdu,Chengdu Sichuan 610000,China)

机构地区：[1]成都市龙泉驿区第一人民医院神经外科,四川成都610000

出　　处：《中国急救复苏与灾害医学杂志》2025年第3期333-338,共6页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：2022年成都市医学科研课题立项项目(2022062)。

摘　　要：目的构建高血压脑出血术后肺部感染患者多重用药管理方案,并探讨其临床应用价值。方法以循证方法为基础系统检索国内外文献,以4R危机管理理论为指导,由研究小组共同商议后构建高血压脑出血术后肺部感染患者多重用药管理方案初稿,再经德尔菲法形成终稿。选取2022年10月—2023年6月于成都市龙泉驿区第一人民医院接受治疗的120例高血压脑出血术后肺部感染患者。将2022年10月—2023年1月入院的60例患者纳入对照组,给予常规护理联合传统多重用药管理方案,将2023年2月—2023年6月入院的60例患者纳入研究组,给予常规护理联合新构建的多重用药管理方案。对比两组肺部感染控制效果、气管置管及ICU治疗情况、护理满意度。结果2轮函询分别发放18份问卷,收回有效问卷16份,有效回收率为88.89%。2轮函询专家的权威系数是0.91,熟悉程度是0.89。首次函询中,指标重要性:变异系数(CV)为0.11~0.24、肯德尔和谐系数(W)为0.163(P<0.001);指标可行性:CV为0.09~0.23、W为0.168(P<0.001)。再次函询时,指标重要性:CV为0.02~0.14、W为0.201(P<0.001);指标可行性:CV为0~0.13、W为0.243(P<0.001)。最后形成包含4项一级指标、6项二级指标及17项三级指标内容的高血压脑出血术后肺部感染多重用药管理方案终稿。应用于临床中发现,研究组有效率高于对照组,气管置管时长、肺部感染控制时间及ICU治疗时长均短于对照组(P<0.05),专业知识水平、实际护理能力、服务态度及总分均明显高于对照组(P<0.05)。结论构建的高血压脑出血术后肺部感染患者多重用药管理方案具有科学性、全面性和实用性,可在多重用药管理时为临床工作提供参考和指导。Objective To construct a multi-drug management scheme for patients with pulmonary infection after hypertensive cerebral hemorrhage,and to explore its clinical application value.Methods Based on the evidencebased method,the domestic and foreign literatures were systematically searched.Under the guidance of 4R crisis management theory,the first draft of multi-drug management scheme for patients with pulmonary infection after hypertensive cerebral hemorrhage was constructed by the research team,and then the final draft was formed by Delphi method.From October 2022 to June 2023,120 patients with pulmonary infection after hypertensive cerebral hemorrhage were treated in the First People's Hospital of Longquanyi District,Chengdu.60 patients admitted from October 2022 to January 2023 were divided into control group,and were given routine nursing combined with traditional multi-drug management scheme.60 patients admitted to the hospital from February 2023 to June 2023 were divided into study group,and were given routine nursing combined with newly constructed multiple medication management scheme.The control effect of pulmonary infection,tracheal intubation and ICU treatment,and nursing satisfaction were compared between the two groups.Results 18 questionnaires were distributed in the two rounds of letters and inquiries,and 16 valid questionnaires were recovered,with an effective recovery rate of 88.89%.The authoritative coefficient of the experts in the second round of correspondence was 0.91,and the familiarity was 0.89.In the first inquiry,the index importance:coefficient of variability(CV)was 0.11-0.24,and Kendall coefficiency of harmony(W)was 0.163(P<0.001);The index feasibility:CV was 0.09-0.23 and W was 0.168(P<0.001).When inquiring again,the index importance:CV was 0.02-0.14,W was 0.201(P<0.001).The index feasibility:CV was 0-0.13 and W was 0.243(P<0.001).Finally,the final draft of the multi-drug management plan for pulmonary infection after hypertensive cerebral hemorrhage was formed,which included 4 first-level

关 键 词：高血压 脑出血 肺部感染 多重用药 德尔菲法 危机管理理论 

分 类 号：R743.2[医药卫生—神经病学与精神病学]