集束化护理管理对ICU脓毒症患者早期脱机的影响
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摘要
目的探讨集束化护理管理对ICU脓毒症患者早期脱机的影响。方法选择我院2013年6月～2014年6月收入ICU治疗的脓毒症并且接受机械通气的患者100例,随机分为观察组(n=50)及对照组(n=50),对照组采用常规护理干预措施,在此基础上观察组增加集束化护理管理。记录每位患者脱机开始时的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,血气分析,血钙、镁、磷,脱机前机械通气时间、脱机成功率、脱机成功所需次数、脱机全过程所需时间。结果脱机开始时,两组患者的APACHEⅡ评分、pH值、PaCO_2、血浆白蛋白水平、血清磷、镁、钙含量以及脱机前机械通气时间比较,差异均无统计学意义(P均>0.05)。观察组第7天和第14天时的脱机成功率显著高于对照组(76%vs 40%,86%vs 64%,χ~2=4.677,4.661,P=0.031,0.046)。此外,观察组脱机1次成功的患者明显高于对照组(40 vs 16,χ~2=5.350,P=0.034)。观察组脱机全过程所需时间明显低于对照组(8.54±2.09vs 13.32±2.19,t=9.320,P=0.045)。结论早期集束化护理干预可有效帮助ICU脓毒症患者的早期脱机,值得在临床上推广使用。
Objective To investigate the effect of clustered nursing management on early offline of ICU patients with sepsis. Methods 100 patients with sepsis who were admitted to ICU for treatment in our hospital from June 2013 to June2014 and were given mechanical ventilation were selected. They were randomly divided into observation group(n=50)and control group(n=50). The control group was given routine nursing interventions. On this basis, the observation group was further given the management of clustered care. The acute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ) score, blood gas analysis, blood calcium, magnesium, phosphorus, mechanical ventilation time before offline, offline success rate, the number of times required for successful offline, and the time required for the whole process of offline were recorded in each patient at the beginning of offline. Results At the beginning of offline, there were no statistically significant differences in APACHE Ⅱ score, pH value, PaCO_2, plasma albumin level, serum phosphorus, magnesium, calcium contents and mechanical ventilation time before offline between the two groups of patients(all P>0.05). The offline success rate on the 7 th and 14 th day in the observation group was significantly higher than that in the control group(76% vs 40%, 86% vs 64%, χ~2=4.677, 4.661, P=0.031, 0.046). In addition, the number of patients with one-time successful offline in the observation group was significantly higher than that in the control group(40 vs 16, χ~2=5.350, P=0.034). The time required for the whole process of offline in the observation group was significantly lower than that in the control group(8.54±2.09 vs 13.32±2.19, t=9.320, P=0.045). Conclusion Early clustered nursing intervention can effectively help the early offline of ICU patients with sepsis, which is worthy of clinical promotion and application.
Objective To investigate the effect of clustered nursing management on early offline of ICU patients with sepsis. Methods 100 patients with sepsis who were admitted to ICU for treatment in our hospital from June 2013 to June2014 and were given mechanical ventilation were selected. They were randomly divided into observation group(n=50)and control group(n=50). The control group was given routine nursing interventions. On this basis, the observation group was further given the management of clustered care. The acute physiology and chronic health status scoring system Ⅱ(APACHE Ⅱ) score, blood gas analysis, blood calcium, magnesium, phosphorus, mechanical ventilation time before offline, offline success rate, the number of times required for successful offline, and the time required for the whole process of offline were recorded in each patient at the beginning of offline. Results At the beginning of offline, there were no statistically significant differences in APACHE Ⅱ score, pH value, PaCO_2, plasma albumin level, serum phosphorus, magnesium, calcium contents and mechanical ventilation time before offline between the two groups of patients(all P>0.05). The offline success rate on the 7 th and 14 th day in the observation group was significantly higher than that in the control group(76% vs 40%, 86% vs 64%, χ~2=4.677, 4.661, P=0.031, 0.046). In addition, the number of patients with one-time successful offline in the observation group was significantly higher than that in the control group(40 vs 16, χ~2=5.350, P=0.034). The time required for the whole process of offline in the observation group was significantly lower than that in the control group(8.54±2.09 vs 13.32±2.19, t=9.320, P=0.045). Conclusion Early clustered nursing intervention can effectively help the early offline of ICU patients with sepsis, which is worthy of clinical promotion and application.
引文
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[13]郭晓敏,张春苗,刘阳,等.集束化护理应用研究进展[J].护理研究,2015,(6):647-649.
[14]田晓华,刘卫荣,袁玲.集束化护理方案预防呼吸机相关性肺炎的临床观察[J].护士进修杂志,2014,29(3):241-243.
[15]范晓华,曹岳蓉,徐娟,等.呼吸机相关性肺炎集束化护理方案预防的效果研究[J].中华医院感染学杂志,2015,25(18):4203-4205.
[16]Kuczmarska A,Long H N,Guess J,et al.Detection of Delirium in Hospitalized Older General Medicine Patients:A Comparison of the 3D-CAM and CAM-ICU[J].Journal of General Internal Medicine,2016,31(3):1-7.
[17]Lin WL,Chan YF,Wang J.Factors associated with the development of delirium in elderly patients in intensive care units[J].Journal of Nursing Research Jnr,2015,23(4):322-323.
[18]陈霞.集束化护理理念的临床应用现状[J].天津护理,2015,23(2):181-182.
[19]冼慧仪,杨连芳.ABCDE集束化管理在机械通气患者撤机的临床研究[J].临床医学工程,2017,24(8):1141-1142.
[20]张红梅,任卫红,蔡立华.ABCDE集束化管理在ICU机械通气患者撤机中的应用[J].中国农村卫生,2017,10:70-71.
[2]Loss SH,de Oliveira RP,Maccari JG,et al.The reality of patients requiring prolonged mechanical ventilation:Amulticenter study[J].Rev Bras Ter Intensiva,2015,27(1):26-35.
[3]单君,朱健华,顾艳荭.集束化护理理念及其临床应用的研究进展[J].护士进修杂志,2010,25(10):889-891.
[4]Rosenzweig AB,Sittambalam CD.A new approach to the prevention and treatment of delirium in elderly patients in the intensive care unit[J].Journal of Community Hospital Internal Medicine Perspectives,2015,5(4):27950-27953.
[5]MacIntyre NR,Cook DJ,Ely EW Jr,et al.Evidencebased guidelines for weaning and discontinuing ventilatory support:A collective task force facilitated by the American College of Chest Physicians,the American Association for Respiratory Care,and the American College of Critical Care Medicine[J].Chest,2001,120(6 Suppl):375S-395S.
[6]黄小菲,倪海滨,刘克琴,等.脓毒症患者合并高钠血症的危险因素分析及其与预后的关系[J].中国急救医学,2015,35(3):203-206.
[7]王伟,常平,李夏西,等.乌司他丁对严重脓毒症患者远期预后及体内降钙素原的影响[J].安徽医科大学学报,2016,(5):744-747.
[8]瞿海龙,周英莲,刘鹏,等.脓毒症致急性呼吸窘迫综合征的研究进展[J].医学研究与教育,2016,33(5):30-34.
[9]Teixeira C,Maccari JG,Vieira SR,et al.Impact of a mechanical ventilation weaning protocol on the extubation failure rate in difficult-to-wean patients[J].J Bras Pneumol,2012,38(3):364-371.
[10]Daniel Martin A,Smith BK,Gabrielli A.Mechanical ventilation,diaphragm weakness and weaning:A rehabilitation perspective[J].Respir Physiol Neurobiol,2013,189(2):377-383.
[11]Dellinger RP,Carlet JM,Masur H,et al.Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock[J].Crit Care Med,2004,32(3):858-873.
[12]陈娟,石敏.综合护理干预对体外循环心脏手术后ICU综合征的预防作用[J].实用临床医药杂志,2015,19(23):217-218.
[13]郭晓敏,张春苗,刘阳,等.集束化护理应用研究进展[J].护理研究,2015,(6):647-649.
[14]田晓华,刘卫荣,袁玲.集束化护理方案预防呼吸机相关性肺炎的临床观察[J].护士进修杂志,2014,29(3):241-243.
[15]范晓华,曹岳蓉,徐娟,等.呼吸机相关性肺炎集束化护理方案预防的效果研究[J].中华医院感染学杂志,2015,25(18):4203-4205.
[16]Kuczmarska A,Long H N,Guess J,et al.Detection of Delirium in Hospitalized Older General Medicine Patients:A Comparison of the 3D-CAM and CAM-ICU[J].Journal of General Internal Medicine,2016,31(3):1-7.
[17]Lin WL,Chan YF,Wang J.Factors associated with the development of delirium in elderly patients in intensive care units[J].Journal of Nursing Research Jnr,2015,23(4):322-323.
[18]陈霞.集束化护理理念的临床应用现状[J].天津护理,2015,23(2):181-182.
[19]冼慧仪,杨连芳.ABCDE集束化管理在机械通气患者撤机的临床研究[J].临床医学工程,2017,24(8):1141-1142.
[20]张红梅,任卫红,蔡立华.ABCDE集束化管理在ICU机械通气患者撤机中的应用[J].中国农村卫生,2017,10:70-71.