本文關(guān)鍵詞： 百草枯 中毒 護(hù)理 流程 病死率　出處：《河北醫(yī)科大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:本研究是依據(jù)2013年中國(guó)急診醫(yī)師協(xié)會(huì)發(fā)布的《急性百草枯中毒診治專家共識(shí)》[1],(以下簡(jiǎn)稱“共識(shí)”),在百草枯中毒患者常規(guī)急救護(hù)理流程的基礎(chǔ)上,利用科學(xué)的方法,制定出更加快速、合理、規(guī)范的新流程并應(yīng)用于臨床護(hù)理工作中,從而有效縮短百草枯中毒患者的首次治療時(shí)間(如首次洗胃時(shí)間、首次血液凈化時(shí)間、首次應(yīng)用糖皮質(zhì)激素時(shí)間等),為有效救治提供寶貴時(shí)間,促進(jìn)護(hù)理工作效率的提高和質(zhì)量的改進(jìn),降低百草枯中毒患者的病死率。方法:1研究方法本研究為隨機(jī)對(duì)照研究,調(diào)查兩組百草枯中毒患者分別使用不同的急救護(hù)理流程,比較兩組的差異。選取某三甲醫(yī)院急診科2015年10月-2016年4月采用常規(guī)急救護(hù)理流程的百草枯中毒患者57例作為對(duì)照組,2016年8月-2017年1月使用“四位一體”急救護(hù)理流程的百草枯中毒患者60例作為觀察組,分別收集兩組患者首次洗胃時(shí)間、首次血液凈化時(shí)間、首次應(yīng)用糖皮質(zhì)激素時(shí)間、病死率,將收集到的數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,以判斷“四位一體”急救護(hù)理流程在百草枯中毒患者中的應(yīng)用效果。首次洗胃時(shí)間:指百草枯中毒患者從服毒至醫(yī)院開(kāi)始洗胃所需要的時(shí)間。首次血液凈化時(shí)間:指百草枯中毒患者從服毒至醫(yī)院進(jìn)行第一次血液凈化所需要的時(shí)間。首次應(yīng)用糖皮質(zhì)激素時(shí)間:指百草枯中毒患者從服毒至醫(yī)院第一次靜脈滴注糖皮質(zhì)激素所需要的時(shí)間。2統(tǒng)計(jì)學(xué)方法本實(shí)驗(yàn)結(jié)果采用SPSS21.0軟件進(jìn)行分析。計(jì)量資料不滿足正態(tài)分布,用M(P25,P75)表示,兩樣本比較采用秩和檢驗(yàn)。計(jì)數(shù)資料用實(shí)際數(shù)和百分比表示,兩樣本比較用卡方檢驗(yàn)。檢驗(yàn)水準(zhǔn)α=0.05,P0.05認(rèn)為差別具有統(tǒng)計(jì)學(xué)意義。結(jié)果:1選取的兩組百草枯中毒患者,在性別、年齡、服毒量等基礎(chǔ)資料方面的差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05),兩樣本比較不受以上因素的影響,具有可比性。2首次洗胃時(shí)間:應(yīng)用“四位一體”急救護(hù)理流程后首次洗胃時(shí)間有所縮短。對(duì)照組的平均首次洗胃時(shí)間1.46h,觀察組的平均首次洗胃時(shí)間1.20h,但兩組的差異無(wú)統(tǒng)計(jì)學(xué)意義(p0.05)。3首次血液凈化時(shí)間:應(yīng)用“四位一體”急救護(hù)理流程后首次血液凈化時(shí)間縮短。對(duì)照組的平均首次血液凈化時(shí)間為4.90h,觀察組的平均首次血液凈化時(shí)間為4.30h,兩組的差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。4首次應(yīng)用糖皮質(zhì)激素時(shí)間:應(yīng)用“四位一體”急救護(hù)理流程后首次應(yīng)用糖皮質(zhì)激素的時(shí)間縮短。對(duì)照組的首次應(yīng)用糖皮質(zhì)激素平均時(shí)間為4.30h,觀察組的首次應(yīng)用糖皮質(zhì)激素平均時(shí)間為3.67h,兩組的差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。5病死率:應(yīng)用“四位一體”急救護(hù)理流程后百草枯中毒患者的病死率比應(yīng)用此流程前降低。對(duì)照組的病死率為59.65%,觀察組的病死率為40%,兩組的差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。結(jié)論:1本研究依據(jù)“共識(shí)”結(jié)合自己科室救治急性百草枯中毒患者的經(jīng)驗(yàn),制定了“四位一體”急救護(hù)理流程,實(shí)現(xiàn)了從院前急救、院內(nèi)急診搶救室、急診icu、急診病房“四位一體”的急救護(hù)理工作流程,縮短了患者首次血液凈化的時(shí)間,首次應(yīng)用糖皮質(zhì)激素的時(shí)間,從而縮短了救治患者所需要的時(shí)間,提高了搶救百草枯中毒患者的效率,降低了病死率。2本研究是在原有百草枯中毒患者的常規(guī)救治流程基礎(chǔ)上進(jìn)行了流程優(yōu)化,改進(jìn)后的流程更能滿足臨床需要,護(hù)理工作更加清晰、簡(jiǎn)單、明確、順暢,醫(yī)護(hù)配合更加協(xié)調(diào),提高了醫(yī)護(hù)的工作效率。3本研究在研究階段,科室進(jìn)行了醫(yī)護(hù)血液凈化的全員培訓(xùn)。醫(yī)生熟練掌握各種血液凈化技術(shù)的適應(yīng)癥及禁忌癥、掌握深靜脈置管技術(shù)、處理血液凈化過(guò)程中出現(xiàn)的并發(fā)癥,為血液凈化的成功開(kāi)展提供先決條件。護(hù)士熟練掌握各種血液凈化機(jī)器的操作流程、報(bào)警處理、導(dǎo)管維護(hù)、機(jī)器維護(hù)等,科室的血液凈化技術(shù)得以成功開(kāi)展。
[Abstract]:Objective: This study is based on the 2013 China Emergency Physicians Association issued "experts consensus on diagnosis and treatment of acute paraquat poisoning (>[1], hereinafter referred to as the" consensus "), the basic routine emergency nursing process in patients with poisoning of paraquat, using scientific methods to develop a more rapid, rational, standardized processes and clinical application in the nursing work, so as to effectively shorten the time for the first time in treatment of patients with paraquat poisoning (such as the first time of gastric lavage, the first blood purification time, the first application of glucocorticoid time), providing valuable time for effective treatment, and improve the quality of nursing work efficiency, reduce the mortality of patients with paraquat poisoning. Methods: 1 research methods of this study is a randomized controlled study, investigation of two groups of patients with paraquat poisoning were used in emergency nursing process is different, the difference between the two groups. From the emergency department of a hospital In 57 patients as the control group in October 2015 -2016 year in April by the conventional emergency nursing process of paraquat poisoning, 60 patients as the observation group in August 2016 -2017 year in January the use of "four in one" emergency nursing process of paraquat poisoning, two groups of patients were collected for the first time the first time of gastric lavage, blood purification time, the first application of glucocorticoid time, the mortality rate, the collected data for statistical analysis, to determine the "four in one" emergency nursing process of poisoning effect in patients with paraquat. The first time of gastric lavage: refers to the time required to start the gastric lavage of patients from the hospital to commit paraquat poisoning. The first blood purification time: refers to the first blood purification the time required to commit to the hospital from patients with paraquat poisoning. The first application of glucocorticoid time: refers to the first intravenous drop from the poison to the hospital patients with paraquat poisoning .2 statistical methods need injection of glucocorticoid and the experimental results were analyzed with SPSS21.0 software. The measurement data does not meet the normal distribution, using M (P25, P75) said that the two samples analyzed by rank sum test. Enumeration data represented by the actual number and percentage, two samples were compared by chi square test. The test level alpha =0.05, P0.05 was considered statistically significant. Results: 1 selected two groups of paraquat poisoning patients in gender, age, no significant differences in the amount of poison and other basic information (P0.05), two samples from the above factors, comparable to.2 for the first time: the time of gastric lavage one of the four "emergency nursing process for the first time after gastric lavage time was shortened. The average control group for the first time gastric lavage time 1.46h, average time of gastric lavage in the observation group for the first time 1.20h, but there was no significant difference between the two groups (P0.05.3) for the first time blood net Time: the application of "four in one" emergency nursing process for the first time after blood purification time. The control group mean first blood purification time is 4.90h, the average for the first time in the observation group blood purification time is 4.30h, the difference was statistically significant in two groups (P0.05.4) for the first time using glucocorticoid time: the first application of glucocorticoids application of "four in one" emergency nursing process and shorten the time for the first time. After the application of glucocorticoid on average time for the control group 4.30h, the first application of glucocorticoid in the observation group the average time is 3.67h, the difference between the two groups was statistically significant (P0.05).5 mortality rate: the application of "four in one" emergency nursing process after paraquat poisoning mortality than the application of this process. The control group decreased the mortality rate was 59.65% in the observation group, the mortality rate was 40%, with statistically significant difference between the two groups (P0.05). Conclusion: 1 On the basis of the "consensus" with their own departments for treatment experience in patients with acute paraquat poisoning, formulated the "four in one" emergency nursing process, realized from the emergency pre hospital emergency hospital, resuscitation room, emergency ICU, emergency nursing workflow emergency ward "four in one", shorten the patients for the first time in blood purification the first time, the application of glucocorticoid, which shortens the time required for the treatment of patients, improve the efficiency of paraquat poisoning patients, reducing the mortality rate of.2 in this study is the original paraquat poisoning patients in the conventional treatment process based on the process optimization, the improved process can meet the clinical need, nursing work is more clear, simple, clear, smooth, health care with the more coordination, improve the work efficiency of medical.3 the study in the research stage, the Department of the medical staff of blood purification The training of doctors. Proficient in blood purification technology to master the indications and contraindications, deep vein catheter for blood purification treatment technology, which appears in the process of blood purification for complications, success to provide the prerequisite. Nurses master the blood purification machine operation, alarm processing, catheter maintenance, machine maintenance, department the blood purification technology to be successfully carried out.

【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.5

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