目标导向的集束化护理策略对多重耐药菌所致感染性休克患者28d预后的影响  

Effect of cluster goal-oriented nursing strategy on the 28-day prognosis of patients with septic shock caused by multi-drug resistant bacteria

作　　者：周润奭 郑敏 韩伟[2] 李尊柱 何朝凯 池熠 隆云 Zhou Runshi;Zheng Min;Han Wei;Li Zunzhu;He Chaokai;Chi Yi;Long Yun(Department of Critical Care Medicine,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences,Beijing 100730,China;Institute of Basic Medical Sciences,Chinese Academy of Medical Sciences,Beijing 100005,China)

机构地区：[1]中国医学科学院,北京协和医院重症医学科,北京100730 [2]中国医学科学院基础医学研究所,北京100005

出　　处：《中华重症医学电子杂志》2024年第3期236-242,共7页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：国家重点研发计划子课题项目(2022YFC2504505-07);北京协和医院中央高水平医院临床科研专项(专科提升项目)(2022-PUMCH-B-115);北京协和医院护理科研课题(XHHLKY202108)

摘　　要：目的探讨目标导向的集束化护理策略对多重耐药菌(MDRO)所致感染性休克患者28 d预后的影响。方法采用历史对照研究。入室后留取相关培养,参照临床指标及化验结果选取2018年1月1日至2021年12月31日收入北京协和医院ICU的MDRO所致感染性休克患者59例,以2018年1月1日至2019年12月31日期间实施常规护理管理的患者为对照组(35例),以2020年1月1日至2021年12月31日期间实施目标导向的集束化护理策略的患者为治疗组(24例)。比较2组患者呼吸机相关性肺炎(VAP)发生率、中心静脉导管感染(CLABSI)发生率、导管相关尿路感染(CAUTI)发生率、抗生素使用时间、机械通气时间、ICU住院时间、28 d病死率等数据的差异。结果与对照组比较,治疗组患者VAP发生率、抗生素使用时间、28 d病死率明显降低,差异有统计学意义(χ^(2)=4.48,P<0.05;Z=2.02,P<0.05;χ^(2)=4.47,P<0.05)。以28 d预后将患者分为存活组(40例)和死亡组(19例),存活组患者中接受目标导向的集束化护理策略的患者比例更多,差异有统计学意义(χ^(2)=4.47,P<0.05)。多元回归分析显示,目标导向的集束化护理策略是影响患者28 d病死率的保护因素(Z=1.98,P<0.05)。结论应用目标导向的集束化护理策略,可降低患者VAP发生率,减少抗生素使用时间,降低患者28 d病死率,改善患者的28 d预后。Objective To explore the effect of cluster goal-oriented nursing strategy on the 28-day prognosis of patients with septic shock caused by multi-drug resistant bacteria.Methods This study used a historical controlled trial approach.Patients with septic shock caused by multidrug-resistant bacteria from January 1,2018 to December 31,2021 in our hospital were included in the study according to clinical indicators and laboratory results.A total of 35 patients with conventional nursing management from January 1,2018 to December 31,2019 were included in the control group.A total of 24 patients who implemented cluster goal-oriented nursing management from January 1,2020 to December 31,2021 were included in the treatment group.The differences in the incidence of ventilator associated pneumonia(VAP),central line associated bloodstream infections(CLABSI),catheter associate urinary tract infections(CAUTI),duration of antibiotic use,duration of mechanical ventilation,and 28 d mortality during ICU stay were compared between the two groups.Results Compared with the control group,patients in the treatment group had a significantly lower incidence of VAP,time on antibiotics,and 28 d mortality(χ^(2)=4.48,Z=2.02,χ^(2)=4.47,all P<0.05).Patients were divided into survival group(40 cases)and death group(19 cases)according to their different prognosis(28 d mortality)and the results of the comparison of the two groups revealed that more patients in the survival group received the intensive goal-directed care management strategy(χ^(2)=4.47,P<0.05).Multiple regression analysis showed that cluster goal-oriented nursing strategy was a related factor affecting the mortality of patients on 28 days(Z=1.98,P<0.05).Conclusion The application of cluster-based goal-directed nursing management can reduce the incidence of VAP,the duration of antibiotic use,and the 28 d mortality of the patients,and improve the 28 d prognosis of patients.

关 键 词：危重症医学 感染性休克 28 d病死率 护理 

分 类 号：R473[医药卫生—护理学] R47[医药卫生—临床医学]