心脏外科患者加速康复气道管理方案的制订与应用研究

doi:10.3761/j.issn.0254-1769.2020.11.001

摘要/Abstract

摘要：

目的基于心脏外科加速康复流程,制订患者气道管理方案,并观察其临床应用情况。方法便利选取南京市某三级甲等医院2018年7月—2019年6月行心脏手术患者为研究对象,其中2019年1月—6月的685例患者为试验组,在常规护理基础上,采用心脏外科患者加速康复气道管理方案;2018年7月—12月的704例患者为对照组,采用常规护理。比较两组机械通气时间、ICU住院时间、住院费用、并发症（术后肺上叶不张、呼吸机相关性肺炎、误吸、谵妄、ICU再转入）发生率、术后血气分析次数、吸痰次数。结果试验组机械通气时间、ICU住院时间、住院费用、术后血气分析次数、吸痰次数低于对照组（P<0.05）;除术后误吸外,其他并发症发生率均低于对照组（P<0.05）。结论心脏外科患者加速康复气道管理方案能够加快患者康复,提升护理质量。

关键词: 胸外科学, 加速康复, 气道管理, 护理质量审核, 围手术期护理

Abstract:

Objective Based on the cardiac enhanced recovery after surgery,airway nursing was developed,and the results of application were observed. Methods Patients undergoing cardiac surgery of a tertiary hospital in Nangjing from July 2018 to June 2019 were included. Among them,685 patients from January to June 2019 who were received airway nursing in cardiac enhanced recovery after surgery were allocated as the study group. Another 704 patients in the control group from July to December 2018 received routine care. We compared the results of duration of mechanical ventilation,length of ICU stay,cost of hospitalization,incidence of complications（postoperative atelectasis,ventilator-associated pneumonia,aspiration,delirium,ICU re-transfer）,number of postoperative blood gas analysis and sputum aspiration between the 2 groups. Results The duration of mechanical ventilation,the length of ICU stay,hospitalization expenses,postoperative blood gas analysis and sputum suction were significantly lower in the study group（P<0.05）. The incidence of complications was reduced except aspiration（P<0.05）. Conclusion Airway nursing in cardiac enhanced recovery after surgery can improve the quality of nursing care,and accelerate the rehabilitation of patients.

Key words: Thoracic Surgery, Enhanced Recovery, Airway Management, Nursing Audit, Perioperative Nursing

王哲芸,杨燕,王岩,赵志刚,叶家欣,傅巧美. 心脏外科患者加速康复气道管理方案的制订与应用研究[J]. 中华护理杂志, 2020, 55(11): 1605-1611.

WANG Zheyun,YANG Yan,WANG Yan,ZHAO Zhigang,YE Jiaxin,FU Qiaomei. Construction and application of airway nursing in cardiac enhanced recovery after surgery[J]. Chinese Journal of Nursing, 2020, 55(11): 1605-1611.

图/表 3

表1 心脏外科患者加速康复气道管理方案

Table 1 Airway nursing in cardiac enhanced recovery after surgery

表2 两组恢复情况、住院费用、术后血气分析和吸痰次数比较[M（P25,P75）]

Table 2 Comparison of recovery, hospitalization expenses, postoperative blood gas analysis and sputum suction frequency between two groups [M（P25,P75）]

表3 两组并发症发生率比较[例（百分率,%）]

Table 3 Comparison of morbidity between two groups[cases,（%）]

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