集束化护理预防急诊患者呼吸道感染的临床效果分析
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摘要
目的探讨预防急诊患者呼吸道感染的集束化护理方案及其临床应用效果。方法纳入2013年6月~2014年6月急诊及急诊ICU患者132例,按入院时间先后分为对照组64例和干预组68例,制定集束化护理干预方案。干预组在基础护理基础上给予集束化护理,对照组采用常规急危重症护理。对比两组急诊或急诊ICU患者住院期间呼吸道感染发生率、气管切开率、机械通气时间、呼吸机相关性肺炎发生率及其他并发症等。结果干预组呼吸道感染总发生率、上呼吸道感染发生率、下呼吸道感染发生率均显著低于对照组(P<0.05)。干预组机械通气患者气管切开率、VAP发生率均显著低于对照组(P<0.05),机械通气时间显著少于对照组(P<0.05)。干预组误吸、肺不张、痰痂阻塞发生率显著低于对照组(P<0.05)。结论集束化护理干预集合多种有效预防各类急诊患者呼吸道感染的护理方式,有序实施可减少自主呼吸及机械通气患者呼吸道感染及其他并发症发生率,减少机械通气时间和气管切口率。
Objective To investigate the prevention of respiratory tract infections in patients with cluster of emergency nursing program and the clinical application. Methods Selected 132 cases of patients in emergency and emergency ICU from June 2013 to June 2014, according to the admission time they were divided into control group(64 cases) and intervention group(68 cases), the development of cluster-based nursing interventions in primary care based on conventional care was given to the intervention group while the control group recieved conventional emergency critical care, the incidence of respiratory tract infections, tracheotomy rate, duration of mechanical ventilation, ventilator-associated pneumonia incidence and other complications were compared between two groups. Results The overall incidence of respiratory infections, the incidence of upper respiratory tract infection, lower respiratory incidence rate of intervention group were significantly lower than those of the control group(P<0.05). The mechanical ventilation in patients with tracheotomy rate, VAP incidence rate of intervention group were significantly lower than those of the control group(P<0.05), duration of mechanical ventilation of intervention group was significantly less than the control group(P<0.05). The rate of aspiration, atelectasis, sputum blocking incidence of intervention group were significantly lower than the control group(P <0.05). Conclusion The collection of a variety of cluster nursing interventions is effective in preventing respiratory tract infections in patients with various types of emergency care approach, can reduce the orderly implementation of spontaneous breathing and mechanical ventilation in patients with respiratory tract infections and other complications rate, reduce duration of mechanical ventilation and tracheal incision rates.
Objective To investigate the prevention of respiratory tract infections in patients with cluster of emergency nursing program and the clinical application. Methods Selected 132 cases of patients in emergency and emergency ICU from June 2013 to June 2014, according to the admission time they were divided into control group(64 cases) and intervention group(68 cases), the development of cluster-based nursing interventions in primary care based on conventional care was given to the intervention group while the control group recieved conventional emergency critical care, the incidence of respiratory tract infections, tracheotomy rate, duration of mechanical ventilation, ventilator-associated pneumonia incidence and other complications were compared between two groups. Results The overall incidence of respiratory infections, the incidence of upper respiratory tract infection, lower respiratory incidence rate of intervention group were significantly lower than those of the control group(P<0.05). The mechanical ventilation in patients with tracheotomy rate, VAP incidence rate of intervention group were significantly lower than those of the control group(P<0.05), duration of mechanical ventilation of intervention group was significantly less than the control group(P<0.05). The rate of aspiration, atelectasis, sputum blocking incidence of intervention group were significantly lower than the control group(P <0.05). Conclusion The collection of a variety of cluster nursing interventions is effective in preventing respiratory tract infections in patients with various types of emergency care approach, can reduce the orderly implementation of spontaneous breathing and mechanical ventilation in patients with respiratory tract infections and other complications rate, reduce duration of mechanical ventilation and tracheal incision rates.
引文
[1]卜永霞,刘月荣,苏立霞.神经外科危重症患者并发下呼吸道感染的高危因素分析及护理对策[J].中国实用护理杂志,2012,28(7):19-21.
[2]赵娜,崔文香.集束化护理措施预防呼吸机相关性肺炎效果评价的Meta分析[J].中国实用护理杂志,2014,30(10):20-24.
[3]龙彩英,龙兰.早期护理干预在急性上呼吸道感染所致心肌损害康复中的作用[J].国际护理学杂志,2014,33(2):383-385.
[4]鹿宁.神经外科危重患者下呼吸道感染高危因素的Logistic分析及护理对策[J].护士进修杂志,2013,33(21):1955-1956.
[5]沈雅舰,胡银燕,刘俏俊.重型颅脑损伤气管切开术后呼吸道感染的预防及护理[J].中国临床保健杂志,2013,16(1):89-90.
[6]刘清宏,周春兰.ICU机械通气患者下呼吸道感染相关危险因素及护理[J].护理学报,2014,23(6):42-45.
[7]林光霞,李敏,许彩云.神经外科113例下呼吸道感染调查分析与护理干预[J].中华医院感染学杂志,2014,24(2):436-437,440.
[8]周立芹,李树彦,高春枝.心脏外科ICU呼吸机相关性肺炎危险因素分析[J].中华医院感染学杂志,2014,24(5):1223-1224,1246.
[9]郭献阳,章义利,林孟相,等.早发型与迟发型呼吸机相关性肺炎的对比分析[J].中华医院感染学杂志,2014,24(9):2189-2191.
[10]方阿嫦.脑卒中患者下呼吸道感染危险因素分析及护理[J].浙江临床医学,2013,23(3):424-425.
[11]AH Rosenstein.Using information management to implement a clinical resource management program[J].The Joint Commission Journal on Quality Improvement,2007,23(12):653-666.
[12]赖志珍,许秀娟,胡马洪,等.持续声门下吸引预防重型颅脑外伤患者呼吸机相关性肺炎的临床研究[J].中华医院感染学杂志,2014,24(6):2119-2121.
[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,2014,33(15):1881-1882.
[14]PJ Schweich,KM Smith,MD Dowd.Pediatric emergency medicine practice patterns:a comparison of pediatric and general emergency physicians[J].Pediatric Emergency Care,2008,14(2):89-94.
[15]刘东岩,孙铁英.集束化护理措施在呼吸机相关性肺炎患者中应用效果[J].中国医药导报,2013,10(3):147-149.
[16]沈爱仙,贾献荣.实施集束化护理干预对ICU呼吸机相关性肺炎患者治疗效果的影响[J].中国现代医生,2014,52(25):80-82.
[17]朱成秀.集束化护理方案预防呼吸机相关性肺炎的临床研究[J].中国现代医生,2013,51(19):96-97.
[18]刘慧英,周小玲.改良集束化护理在慢性阻塞性肺疾病伴呼吸衰竭患者中应用的效果评价[J].中国实用护理杂志,2014,30(21):40-41.
[19]陈莲芳,史倩,段缓.集束化护理干预策略对重型颅脑损伤患者呼吸机相关性肺炎的影响[J].中华全科医学,2014,12(3):475-477.
[20]谭景予,陈锦秀.呼吸机相关性肺炎集束化护理方案的制订与管理[J].中华护理杂志,2011,46(7):731-733.
[21]PA Younge,TJ Coats,D Gurney.Interpretation of the Ws statistic:Application to an integrated trauma system[J].The Journal of Trauma,2007,43(3):511-515.
[2]赵娜,崔文香.集束化护理措施预防呼吸机相关性肺炎效果评价的Meta分析[J].中国实用护理杂志,2014,30(10):20-24.
[3]龙彩英,龙兰.早期护理干预在急性上呼吸道感染所致心肌损害康复中的作用[J].国际护理学杂志,2014,33(2):383-385.
[4]鹿宁.神经外科危重患者下呼吸道感染高危因素的Logistic分析及护理对策[J].护士进修杂志,2013,33(21):1955-1956.
[5]沈雅舰,胡银燕,刘俏俊.重型颅脑损伤气管切开术后呼吸道感染的预防及护理[J].中国临床保健杂志,2013,16(1):89-90.
[6]刘清宏,周春兰.ICU机械通气患者下呼吸道感染相关危险因素及护理[J].护理学报,2014,23(6):42-45.
[7]林光霞,李敏,许彩云.神经外科113例下呼吸道感染调查分析与护理干预[J].中华医院感染学杂志,2014,24(2):436-437,440.
[8]周立芹,李树彦,高春枝.心脏外科ICU呼吸机相关性肺炎危险因素分析[J].中华医院感染学杂志,2014,24(5):1223-1224,1246.
[9]郭献阳,章义利,林孟相,等.早发型与迟发型呼吸机相关性肺炎的对比分析[J].中华医院感染学杂志,2014,24(9):2189-2191.
[10]方阿嫦.脑卒中患者下呼吸道感染危险因素分析及护理[J].浙江临床医学,2013,23(3):424-425.
[11]AH Rosenstein.Using information management to implement a clinical resource management program[J].The Joint Commission Journal on Quality Improvement,2007,23(12):653-666.
[12]赖志珍,许秀娟,胡马洪,等.持续声门下吸引预防重型颅脑外伤患者呼吸机相关性肺炎的临床研究[J].中华医院感染学杂志,2014,24(6):2119-2121.
[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,2014,33(15):1881-1882.
[14]PJ Schweich,KM Smith,MD Dowd.Pediatric emergency medicine practice patterns:a comparison of pediatric and general emergency physicians[J].Pediatric Emergency Care,2008,14(2):89-94.
[15]刘东岩,孙铁英.集束化护理措施在呼吸机相关性肺炎患者中应用效果[J].中国医药导报,2013,10(3):147-149.
[16]沈爱仙,贾献荣.实施集束化护理干预对ICU呼吸机相关性肺炎患者治疗效果的影响[J].中国现代医生,2014,52(25):80-82.
[17]朱成秀.集束化护理方案预防呼吸机相关性肺炎的临床研究[J].中国现代医生,2013,51(19):96-97.
[18]刘慧英,周小玲.改良集束化护理在慢性阻塞性肺疾病伴呼吸衰竭患者中应用的效果评价[J].中国实用护理杂志,2014,30(21):40-41.
[19]陈莲芳,史倩,段缓.集束化护理干预策略对重型颅脑损伤患者呼吸机相关性肺炎的影响[J].中华全科医学,2014,12(3):475-477.
[20]谭景予,陈锦秀.呼吸机相关性肺炎集束化护理方案的制订与管理[J].中华护理杂志,2011,46(7):731-733.
[21]PA Younge,TJ Coats,D Gurney.Interpretation of the Ws statistic:Application to an integrated trauma system[J].The Journal of Trauma,2007,43(3):511-515.