集束化干预措施在ICU病房应用呼吸机进行机械通气患者中的应用效果
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摘要
目的探讨应用集束化措施对ICU机械通气患者的效果,为临床治疗提供参考。方法选择2017年1月～2018年6月在西安交通大学第二附属医院ICU治疗的220例应用呼吸机辅助呼吸的重症患者,采用随机数字表法均分为对照组和观察组,每组各110例。对照组予以常规护理方案进行干预,观察组在此基础上同时予以集束化干预措施进行护理。比较两组患者机械通气时间、ICU住院时间、住院费用、病原菌检出数、呼吸机相关性肺炎发生率及患者满意度。结果观察组患者的机械通气时间、ICU住院时间、住院费用、病原菌检出数、呼吸机相关性肺炎发生率均低于对照组,且观察组患者满意率高于对照组,差异有统计学意义(P <0.05)。结论集束化干预措施可有效缩短患者的机械通气时间和ICU住院时间,并能降低患者住院费用和呼吸机相关性肺炎发生率,同时可提高患者满意度。
Objective To explore the effect of clustering intervention on patients with mechanical ventilation, in order to provide a reference for clinical treatment. Methods From January 2017 to June 2018, in the Second Affiliated Hospital of Xi'an Jiaotong University, 220 patients with severe ventilator-assisted breathing in ICU were selected, according to random number table method, they were divided into control group and observation group, with 110 cases in each group. The control group was given routine nursing, in addition, the observation group was simultaneously treated with clustering intervention. The indicators included mechanical ventilation time, ICU hospitalization time, hospitalization cost, pathogen detection, VAP incidence and satisfaction rate of patients in two groups were compared. Results The mechanical ventilation time, ICU hospitalization time, hospitalization cost, the incidence of VAP and the total number of plants detected by the pathogen of the observation group were significantly lower than those of the control group, and the satisfaction rate was higher than that in the control group, the differences were statistically significant(P < 0.05).Conclusion The results indicated that cluster intervention might reduce the mechanical ventilation time, ICU hospital-ization time, the hospitalization cost and the incidence of ventilator-associated pneumonia, and improve patients′ satisfaction simultaneously.
Objective To explore the effect of clustering intervention on patients with mechanical ventilation, in order to provide a reference for clinical treatment. Methods From January 2017 to June 2018, in the Second Affiliated Hospital of Xi'an Jiaotong University, 220 patients with severe ventilator-assisted breathing in ICU were selected, according to random number table method, they were divided into control group and observation group, with 110 cases in each group. The control group was given routine nursing, in addition, the observation group was simultaneously treated with clustering intervention. The indicators included mechanical ventilation time, ICU hospitalization time, hospitalization cost, pathogen detection, VAP incidence and satisfaction rate of patients in two groups were compared. Results The mechanical ventilation time, ICU hospitalization time, hospitalization cost, the incidence of VAP and the total number of plants detected by the pathogen of the observation group were significantly lower than those of the control group, and the satisfaction rate was higher than that in the control group, the differences were statistically significant(P < 0.05).Conclusion The results indicated that cluster intervention might reduce the mechanical ventilation time, ICU hospital-ization time, the hospitalization cost and the incidence of ventilator-associated pneumonia, and improve patients′ satisfaction simultaneously.
引文
[1]余燕梅,刘利华,蒋玉芳,等.ICU护理风险管理对急性呼吸窘迫综合征患者呼吸机相关性肺炎的影响研究[J].中华医院感染学杂志,2016(3):695-697.
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[8]陆蕾,吴蕾,刘琼.预防中心静脉导管相关性血流感染集束化护理的效果观察[J].中华医院感染学杂志,2014(22):5548-5550.
[9]Flicker L.Intervention research in nursing homes:the rise and rise of the cluster randomized trial[J].J Am Med Dir Assoc,2008,9(4):213-214.
[10]Cheng ST,Chow PK,Song YQ,et al.Can leisure activities slow dementia progression in nursing home residents?A cluster-randomized controlled trial[J].Int Psychogeriatr,2014,26(4):637-643.
[11]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[12]黄妮妮,胡美春,韦思尊,等.呼吸机相关肺炎发病率及危险因素前瞻性研究[J].中国感染控制杂志,2016,15(11):845-848.
[13]蒋玉兰,明旭华,李晓琳,等.集束化综合护理方案预防呼吸机相关性肺炎的效果[J].护理研究:下旬刊,2014,28(5):1881-1882.
[14]Wheeler KE,Cook DJ,Mehta S,et al.Use of probiotics to prevent ventilator-associated pneumonia:A survey of pharmacists′attitudes[J].J Crit Care,2016,31(1):221-226.
[15]李娟.集束化护理措施预防呼吸机相关性肺炎效果观察[J].中国消毒学杂志,2013,30(6):567-568.
[16]Larsson J,Itenov TS,Bestle MH.Risk prediction models for mortality in patients with ventilator-associated pneumonia:A systematic review and meta-analysis[J].J Crit Care,2017,37:112-118.
[17]梁鹏,陈海为,增锦霞,等.ICU呼吸机相关性肺炎综合预防及发病机制的研究[J].中国医药导报,2014,11(16):48-51.
[18]Wigmore G,Sethuraman R.Compliance of a ventilatorassociated pneumonia care bundle in an adult intensive care setting[J].Crit Care,2014,18(1):1-182.
[19]郑伟,茅一萍,周宏,等.重症监护病房呼吸机相关肺炎集束化干预效果[J].中国感染控制杂志,2016(1):31-33.
[20]Speck K,Rawat N,Weiner NC,et al.A systematic approach for developing a ventilator-associated pneumonia prevention bundle[J].Am J Infect Control,2016,44(6):652-656.
[2]Kalil AC,Metersky ML,Klompas M,et al.Executive Summary:Management of Adults With Hospital-acquired and Ventilator-associated Pneumonia:2016 Clinical Practice Guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J].Clin Infect Dis,2016,63(5):575-582.
[3]甘文思,王笑青,夏优秀,等.ICU呼吸机相关性肺炎的危险因素分析[J].中国消毒学杂志,2016,33(5):451-453.
[4]Mongodi S,Via G,Girard M,et al.Lung ultrasound for early diagnosis of ventilator-associated pneumonia[J].Chest,2016,149(4):969-980.
[5]Ramirez P,Lopezferraz C,Gordon M,et al.From starting mechanical ventilation to ventilator-associated pneumonia,choosing the right moment to start antibiotic treatment[J].Crit Care,2016,20(1):169.
[6]胡敏.集束化护理在胸部外伤患者中的应用研究[J].中华现代护理杂志,2014,49(7):824-826.
[7]Husebo BS,Ballard C,Sandvik R,et al.Efficacy of treating pain to reduce behavioural disturbances in residents of nursing homes with dementia:cluster randomised clinical trial[J].BMJ,2011,343(7816):193-193.
[8]陆蕾,吴蕾,刘琼.预防中心静脉导管相关性血流感染集束化护理的效果观察[J].中华医院感染学杂志,2014(22):5548-5550.
[9]Flicker L.Intervention research in nursing homes:the rise and rise of the cluster randomized trial[J].J Am Med Dir Assoc,2008,9(4):213-214.
[10]Cheng ST,Chow PK,Song YQ,et al.Can leisure activities slow dementia progression in nursing home residents?A cluster-randomized controlled trial[J].Int Psychogeriatr,2014,26(4):637-643.
[11]中华医学会重症医学分会.呼吸机相关性肺炎诊断、预防和治疗指南(2013)[J].中华内科杂志,2013,52(6):524-543.
[12]黄妮妮,胡美春,韦思尊,等.呼吸机相关肺炎发病率及危险因素前瞻性研究[J].中国感染控制杂志,2016,15(11):845-848.
[13]蒋玉兰,明旭华,李晓琳,等.集束化综合护理方案预防呼吸机相关性肺炎的效果[J].护理研究:下旬刊,2014,28(5):1881-1882.
[14]Wheeler KE,Cook DJ,Mehta S,et al.Use of probiotics to prevent ventilator-associated pneumonia:A survey of pharmacists′attitudes[J].J Crit Care,2016,31(1):221-226.
[15]李娟.集束化护理措施预防呼吸机相关性肺炎效果观察[J].中国消毒学杂志,2013,30(6):567-568.
[16]Larsson J,Itenov TS,Bestle MH.Risk prediction models for mortality in patients with ventilator-associated pneumonia:A systematic review and meta-analysis[J].J Crit Care,2017,37:112-118.
[17]梁鹏,陈海为,增锦霞,等.ICU呼吸机相关性肺炎综合预防及发病机制的研究[J].中国医药导报,2014,11(16):48-51.
[18]Wigmore G,Sethuraman R.Compliance of a ventilatorassociated pneumonia care bundle in an adult intensive care setting[J].Crit Care,2014,18(1):1-182.
[19]郑伟,茅一萍,周宏,等.重症监护病房呼吸机相关肺炎集束化干预效果[J].中国感染控制杂志,2016(1):31-33.
[20]Speck K,Rawat N,Weiner NC,et al.A systematic approach for developing a ventilator-associated pneumonia prevention bundle[J].Am J Infect Control,2016,44(6):652-656.