發(fā)布時(shí)間：2018-09-12 12:43

【摘要】：目的通過(guò)對(duì)重癥監(jiān)護(hù)病房(ICU)機(jī)械通氣患者進(jìn)行呼吸機(jī)集束化策略(VCB)干預(yù),并利用綜合措施提高醫(yī)護(hù)人員對(duì)VCB的執(zhí)行率,降低呼吸機(jī)相關(guān)肺炎(VAP)的發(fā)生率。方法采取整群抽樣的方法,分別選取2015年5-7月和2015年9月-2016年8月入住重癥ICU且行機(jī)械通氣≥48h的患者37例和151例,分為干預(yù)前組和干預(yù)后組;基線(xiàn)調(diào)查結(jié)束后,通過(guò)問(wèn)卷調(diào)查找出綜合ICU醫(yī)護(hù)人員對(duì)VCB不執(zhí)行的原因,采取綜合干預(yù)措施后比較兩組醫(yī)護(hù)人員對(duì)機(jī)械通氣患者VCB的執(zhí)行率及患者VAP發(fā)生率,評(píng)價(jià)干預(yù)效果。結(jié)果 ICU醫(yī)護(hù)人員中認(rèn)為VAP是可預(yù)防的僅占43.5%,對(duì)各項(xiàng)防控措施的知曉率為21.7%~52.2%,所有人員均認(rèn)為表格繁瑣是VAP防控措施未執(zhí)行的主要原因;干預(yù)前后患者呼吸機(jī)使用率分別為26.8%和28.1%,差異無(wú)統(tǒng)計(jì)學(xué)意義;干預(yù)前VCB整體執(zhí)行達(dá)標(biāo)率為19.2%,干預(yù)后達(dá)到76.5%;床頭抬高30~45°、每日拔管撤機(jī)評(píng)估、洗必泰口腔護(hù)理、氣囊壓力≥20cmH_2O和手衛(wèi)生的執(zhí)行達(dá)標(biāo)率干預(yù)前與干預(yù)后比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論 ICU醫(yī)護(hù)人員對(duì)VAP防控措施知曉率及規(guī)范執(zhí)行率較低,綜合措施可提高ICU醫(yī)護(hù)人員對(duì)患者VCB的執(zhí)行率,降低VAP發(fā)病率,但呼吸機(jī)使用率未見(jiàn)顯著降低。
[Abstract]:Objective to improve the implementation rate of (ICU) in intensive care unit (ICU) by (VCB) intervention of ventilator cluster strategy, and to reduce the incidence of ventilator-associated pneumonia (VAP). Methods by cluster sampling, 37 and 151 patients admitted to severe ICU from May to July 2015 and from September 2015 to August 2016 were divided into pre-intervention group and post-intervention group. Through the questionnaire survey to find out the reason why the comprehensive ICU medical staff do not carry out the VCB, after taking the comprehensive intervention measure, compare the execution rate of VCB and the incidence of VAP of the patients with mechanical ventilation between the two groups of medical and nursing staff, and evaluate the effect of the intervention. Results among the medical staff of ICU, only 43.5% believed that VAP was preventable, and the awareness rate of various preventive and control measures was 21.7% and 52.2%. All the staff thought that the tedious form was the main reason why the preventive and control measures of VAP were not carried out. Before and after intervention, the utilization rate of ventilator was 26.8% and 28.1respectively, there was no significant difference between the two groups, before and after the intervention, the overall rate of VCB reached the standard of 19.2and reached 76.5g after the intervention, the bed head was raised 3045 擄, the daily extubation and withdrawal machine was evaluated, and the oral care of chlorhexidine was taken out. Air bag pressure 鈮，

本文編號(hào)：2239038