本文選題：有創(chuàng)呼吸機(jī) + 管路更換��； 參考：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:全面了解目前山西省三甲綜合醫(yī)院ICU護(hù)士對(duì)有創(chuàng)呼吸機(jī)管路更換的執(zhí)行現(xiàn)狀,以及ICU護(hù)理人員對(duì)其相關(guān)知識(shí)的掌握和需求狀況,借此探討管路更換時(shí)間執(zhí)行不一致的可能原因,為規(guī)范和明確管路更換時(shí)間提供依據(jù);并探討有創(chuàng)呼吸機(jī)管路系統(tǒng)更換時(shí)間在呼吸機(jī)相關(guān)性肺炎(Ventilator-associated Pneumonia,VAP)發(fā)生中發(fā)揮的作用和產(chǎn)生的影響,從而為醫(yī)護(hù)人員在臨床實(shí)踐中的具體操作提供參考。方法:(1)在調(diào)查研究中,查閱國(guó)內(nèi)外相關(guān)文獻(xiàn)自行設(shè)計(jì)調(diào)查問卷,采取現(xiàn)場(chǎng)發(fā)放和郵寄兩種方式,隨機(jī)整群抽取山西省13家三甲綜合醫(yī)院的ICU護(hù)士就管路更換時(shí)間認(rèn)知現(xiàn)況進(jìn)行調(diào)查。(2)在病例對(duì)照研究中,將2015年4月15日—2015年10月14日和2015年10月15日—2016年4月14日收治于某三甲綜合醫(yī)院神經(jīng)內(nèi)科ICU、神經(jīng)外科ICU和呼吸內(nèi)科ICU接受有創(chuàng)機(jī)械通氣的患者分別設(shè)為對(duì)照組1和對(duì)照組2,管路系統(tǒng)均為7 d更換1次。2016年4月15日—2016年10月14日患者設(shè)為病例組,管路僅在肉眼可見明顯污染或功能障礙時(shí)予以更換。結(jié)果:(1)問卷調(diào)查研究結(jié)果調(diào)查13家醫(yī)院34間ICU的護(hù)士,發(fā)放問卷724份,回收有效問卷717份,有效率為99.03%,有統(tǒng)一管路更換時(shí)間的ICU占73.8%。目前ICU科室規(guī)定和護(hù)士臨床實(shí)際工作中執(zhí)行管路更換時(shí)間都趨向于7 d。不同ICU規(guī)定和護(hù)士實(shí)際更換管路時(shí)間比較差異均有統(tǒng)計(jì)學(xué)意義(c2=24.84、35.76,p0.01)。(2)病例對(duì)照研究結(jié)果觀察組和對(duì)照組患者年齡、機(jī)械通氣前炎性指標(biāo)、機(jī)械通氣期間痰檢陽(yáng)性率和在機(jī)械通氣期間VAP的發(fā)生率等比較均無(wú)顯著差異(P0.05)。結(jié)論:(1)醫(yī)院應(yīng)選擇合適的途徑,加強(qiáng)對(duì)ICU護(hù)士管路更換時(shí)間及其相關(guān)知識(shí)的培訓(xùn),制定適合自身環(huán)境的安全管路更換期限,從而減輕護(hù)士的工作量,降低醫(yī)療費(fèi)用,促進(jìn)護(hù)理服務(wù)質(zhì)量的改進(jìn)和提升。(2)管路僅在出現(xiàn)肉眼可見污染或功能障礙時(shí)予以更換并不影響患者的預(yù)后效果,同時(shí)可明顯降低管路更換頻率,減少患者經(jīng)濟(jì)負(fù)擔(dān)和人力、物力資源的消耗。建議管路僅在肉眼可見明顯污染或功能障礙時(shí)予以更換。
[Abstract]:Objective: to understand the current situation of ICU nurses' implementation of the replacement of invasive ventilator in Shanxi Sanjia General Hospital, and the knowledge and requirements of ICU nurses. This paper discusses the possible reasons for the inconsistent implementation of the pipeline replacement time, and provides the basis for standardizing and clarifying the pipeline replacement time. To explore the role and influence of the time of replacement of invasive ventilator piping system in Ventilator-associated pneumonia (VAPs), so as to provide reference for medical staff in clinical practice. Methods: in the investigation and research, the questionnaire was designed by itself by referring to the relevant literature at home and abroad, and the questionnaire was distributed on the spot and sent by mail. In a case-control study, random cluster sampling of ICU nurses from 13 hospitals in Shanxi Province was conducted to investigate the cognitive status of pipeline replacement time. The patients who received invasive mechanical ventilation from 15 April 2015 to 14 October 2015 and from 15 October 2015 to 14 April 2016 in the department of neurology, neurosurgery ICU and ICU of respiratory department in a general hospital were divided into two groups. Group 1 and control group 2, the piping system was changed once for 7 days. Patients from April 15, 2016 to October 14, 2016 were selected as the case group. The pipeline is replaced only when visible contamination or dysfunction is visible to the naked eye. Results the results of the questionnaire survey showed that the nurses of 34 ICU in 13 hospitals were investigated. 724 questionnaires were distributed and 717 valid questionnaires were collected. The effective rate was 99.030.The ICU with uniform pipeline replacement time accounted for 73.8%. At present, the time of pipeline replacement in ICU department and nurses' clinical work tends to be 7 days. There were significant differences between different ICU regulations and the actual replacement time of nurses. The results of Case-control study showed that the patients in the observation group and the control group had age and inflammatory indexes before mechanical ventilation. There was no significant difference between the sputum positive rate during mechanical ventilation and the incidence of VAP during mechanical ventilation. Conclusion 1) the hospital should choose the appropriate way, strengthen the training of the ICU nurses' pipeline replacement time and related knowledge, and establish the safe pipeline replacement period suitable for their own environment, so as to reduce the workload of nurses and reduce the medical expenses. To promote the improvement of nursing service quality and to improve the quality of nursing service. The replacement of pipeline only when visible pollution or dysfunction in the naked eye does not affect the prognosis of patients, and it can obviously reduce the frequency of pipeline replacement, reduce the economic burden and manpower of patients, and improve the quality of nursing service. The consumption of material resources. It is recommended that the pipeline be replaced only if visible contamination or dysfunction is visible to the naked eye.
【學(xué)位授予單位】：山西醫(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)】：R47

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