集束化护理在极低出生体质量儿机械通气中的应用
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摘要
目的探讨集束化护理在极低出生体质量儿机械通气中的应用。方法选取2015年5月—2016年4月收治的行机械通气的极低出生体质量儿35例为对照组,2016年5月—2017年4月收治的行机械通气的极低出生体质量儿35例为观察组。70例患儿中,除家属放弃6例、死亡4例外,其余60例均顺利脱机并治愈出院,其中观察组31例,对照组29例。对照组采用常规护理,观察组采用集束化护理干预,包括严格执行手卫生制度及无菌操作、体位管理、口腔及皮肤管理、气管插管管理、呼吸道管理、密闭式吸痰、胃管管理、撤机管理等方法。观察2组患儿机械通气时间、住院天数、住院费用及每天体质量增长率。结果观察组患儿机械通气时间、住院天数、住院费用均少于对照组(P<0.05),观察组患儿每天体质量增长率高于对照组(P<0.05)。结论对极低出生体质量儿实施有效的集束化护理干预可在一定程度上减少机械通气时间,缩短住院天数,减少住院费用,促进体质量增长。
Objective To evaluate the nursing care bundles for very lowbirth weight(VLBW) infants with mechanical ventilation. Methods To tally 60 VLBW infants with mechanical ventilation were assigned to the control group( n = 29,between May,2015 and April,2016) and the observation group( n = 31,between May,2016 and April,2017) according to the admission sequence. The control group was given routine care during mechanical ventilation. The nursing care bundles including hand hygiene,sterile operation,position management,oral and skin care and management on trachea cannula,sputumsuction,sto mach tube,withdrawfrom ventilatory support were carried out in the observation. The duration of ventilatory support,length of stay,hospitalization costs and daily growth rate of bodyweight were recorded and compared between two groups. Results There was a shorter duration of ventilatory support,a shorter length of stay and a lower hospitalization cost in the observation group than that of controls,respectively( P <0. 05). The infants in the observation group gained a higher daily growth rate of bodyweight compared with those in the control group( P < 0. 05). Conclusion The application of care bundles is potentially effective to reduce the duration of ventilatory support and promote the growth of bodyweight in VLBW infants with mechanical ventilation.
Objective To evaluate the nursing care bundles for very lowbirth weight(VLBW) infants with mechanical ventilation. Methods To tally 60 VLBW infants with mechanical ventilation were assigned to the control group( n = 29,between May,2015 and April,2016) and the observation group( n = 31,between May,2016 and April,2017) according to the admission sequence. The control group was given routine care during mechanical ventilation. The nursing care bundles including hand hygiene,sterile operation,position management,oral and skin care and management on trachea cannula,sputumsuction,sto mach tube,withdrawfrom ventilatory support were carried out in the observation. The duration of ventilatory support,length of stay,hospitalization costs and daily growth rate of bodyweight were recorded and compared between two groups. Results There was a shorter duration of ventilatory support,a shorter length of stay and a lower hospitalization cost in the observation group than that of controls,respectively( P <0. 05). The infants in the observation group gained a higher daily growth rate of bodyweight compared with those in the control group( P < 0. 05). Conclusion The application of care bundles is potentially effective to reduce the duration of ventilatory support and promote the growth of bodyweight in VLBW infants with mechanical ventilation.
引文
[1]蒋青莲,包蕾.230例极低出生体质量儿随访至纠正6月龄生存质量分析[J].临床儿科杂志,2016,34(3):176-180.
[2]陈杰.集束化护理的临床应用及研究进展[J].全科护理,2014,12(19):1744-1745.
[3]宗小敏,王模奎.集束化护理干预措施预防新生儿呼吸机相关肺炎的效果[J].中国感染控制杂志,2016,15(4):266-268.
[4]郭伟,王秀英,张春凤,等.医院医护人员手卫生管理措施[J].中国消毒学杂志,2010,27(5):626-627.
[5]SHARMA V S,DUTTA S,TANEJA N,et al.Comparing Hand hygiene Measures in a Neonatal ICU:A Randomized Crossover Trial.[J].Indian Pediatrics,2013,50(10):917-921.
[6]吴玲玲,顾佳怡,金恋欢,等.呼吸机集束化策略依从性对ICU机械通气患者呼吸机相关性肺炎的影响[J].护理学杂志,2013,28(17):1-3.
[7]孙旭,曲斌,王宁.先天性心脏病术后婴儿在暖箱中取鸟巢式半卧位的护理[J].护理研究,2014,28(31):3913-3913.
[8]SHI Z,XIE H,WANG P,ZHANG Q,et al.Oral hygiene care for critically ill patients to prevent ventilator-associated pneumoniap[J].Cochrane Database Syst Rev,2013,13(8):CD008367.
[9]SCHENA E,SACCOMANDI P,SILVESTRI S,et al.Performances of heated humidifiers in mechanical ventilation:A preliminary intra-breath analysis[J].Conf Proc IEEE Eng Med Biol Soc,2013:934-937.
[10]张小艳,田思维,范满红.气管插管按时吸痰和按需吸痰的比较[J].中国保健营养,2015,25(16):106.
[11]钱敏,刘艳林,顾娟.巧用T组合婴儿复苏器面罩进行新生儿叩背[J].中华现代护理杂志,2012,18(19):2328.
[12]刘经飘,陈俏贤,谭雪婵.小儿简易呼吸器面罩在机械通气新生儿扣背排痰中的应用[J].护理实践与研究,2016,13(2):92-93.
[13]何必子,孙秀静,王丹华,等.强化母乳喂养对住院早产儿生长代谢的影响[J].中华围产医学杂志,2013,16(7):404-409.
[14]陈运彬,颜慧恒.早产儿住院期间母乳喂养的现状及对策[J].中华围产医学杂志,2012,15(9):518-520.
[15]胡娅,李禄全.重症监护病房与普通病房新生儿肺炎病原菌与药敏结果比较[J].中华实用儿科临床杂志,2014,29(2):120-125.
[16]李威,彭粤铭,曹静.呼吸机相关性肺炎集束化护理策略的实施及效果评价[J].中国感染控制杂志,2010,9(4):282-284.
[17]DAMKLIANG J,CONSIDINE J,KENT B,et al.Nurses'perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury:A qualitative study[J].Int Emerg Nurs,2015,23(4):299-305.
[18]Jensen E A,Demauro S B,Kornhauser M,et al.Effects of Multiple Ventilation Courses and Duration of Mechanical Ventilation on Respiratory Outcomes in Extremely Low-Birth-Weight Infants.[J].JAMA Pediatr,2015,169(11):1011-1117.
[2]陈杰.集束化护理的临床应用及研究进展[J].全科护理,2014,12(19):1744-1745.
[3]宗小敏,王模奎.集束化护理干预措施预防新生儿呼吸机相关肺炎的效果[J].中国感染控制杂志,2016,15(4):266-268.
[4]郭伟,王秀英,张春凤,等.医院医护人员手卫生管理措施[J].中国消毒学杂志,2010,27(5):626-627.
[5]SHARMA V S,DUTTA S,TANEJA N,et al.Comparing Hand hygiene Measures in a Neonatal ICU:A Randomized Crossover Trial.[J].Indian Pediatrics,2013,50(10):917-921.
[6]吴玲玲,顾佳怡,金恋欢,等.呼吸机集束化策略依从性对ICU机械通气患者呼吸机相关性肺炎的影响[J].护理学杂志,2013,28(17):1-3.
[7]孙旭,曲斌,王宁.先天性心脏病术后婴儿在暖箱中取鸟巢式半卧位的护理[J].护理研究,2014,28(31):3913-3913.
[8]SHI Z,XIE H,WANG P,ZHANG Q,et al.Oral hygiene care for critically ill patients to prevent ventilator-associated pneumoniap[J].Cochrane Database Syst Rev,2013,13(8):CD008367.
[9]SCHENA E,SACCOMANDI P,SILVESTRI S,et al.Performances of heated humidifiers in mechanical ventilation:A preliminary intra-breath analysis[J].Conf Proc IEEE Eng Med Biol Soc,2013:934-937.
[10]张小艳,田思维,范满红.气管插管按时吸痰和按需吸痰的比较[J].中国保健营养,2015,25(16):106.
[11]钱敏,刘艳林,顾娟.巧用T组合婴儿复苏器面罩进行新生儿叩背[J].中华现代护理杂志,2012,18(19):2328.
[12]刘经飘,陈俏贤,谭雪婵.小儿简易呼吸器面罩在机械通气新生儿扣背排痰中的应用[J].护理实践与研究,2016,13(2):92-93.
[13]何必子,孙秀静,王丹华,等.强化母乳喂养对住院早产儿生长代谢的影响[J].中华围产医学杂志,2013,16(7):404-409.
[14]陈运彬,颜慧恒.早产儿住院期间母乳喂养的现状及对策[J].中华围产医学杂志,2012,15(9):518-520.
[15]胡娅,李禄全.重症监护病房与普通病房新生儿肺炎病原菌与药敏结果比较[J].中华实用儿科临床杂志,2014,29(2):120-125.
[16]李威,彭粤铭,曹静.呼吸机相关性肺炎集束化护理策略的实施及效果评价[J].中国感染控制杂志,2010,9(4):282-284.
[17]DAMKLIANG J,CONSIDINE J,KENT B,et al.Nurses'perceptions of using an evidence-based care bundle for initial emergency nursing management of patients with severe traumatic brain injury:A qualitative study[J].Int Emerg Nurs,2015,23(4):299-305.
[18]Jensen E A,Demauro S B,Kornhauser M,et al.Effects of Multiple Ventilation Courses and Duration of Mechanical Ventilation on Respiratory Outcomes in Extremely Low-Birth-Weight Infants.[J].JAMA Pediatr,2015,169(11):1011-1117.