以护士为主导的早期活动方案在机械通气患者中的应用研究

doi:10.3761/j.issn.0254-1769.2019.12.001

摘要/Abstract

摘要：

目的分析以护士为主导的早期活动方案在神经系统重症疾病机械通气患者中应用的安全性、依从性及效果。方法选取2019年1月—3月某三级甲等医院ICU收治的158例患者作为试验组,实施以护士为主导的早期活动方案;选取2018年10月—12月收治的神经系统重症疾病机械通气患者147例作为对照组,给予机械通气常规护理。观察试验组的安全性及依从性,比较两组恢复情况及并发症发生率。结果试验组运动前（5 min、10 min）,运动中（5 min、10 min）以及运动后（5 min、10 min）颅内压、心率、血氧饱和度变化差异无统计学意义（P>0.05）,平均动脉压变化差异有统计学意义（P<0.05）。试验组依从性为98.1%,对照组的依从性为74.8%,两组比较,差异具有统计学意义（P<0.05）。试验组机械通气时间、ICU住院时间、整体住院时间明显低于对照组（P<0.05）,出院日常生活能力评分明显高于对照组（P<0.05）。试验组呼吸机相关性肺炎、下肢深静脉血栓发生率明显低于对照组（P<0.05）;两组ICU谵妄发生率差异无统计学意义（P>0.05）。结论对神经系统重症疾病机械通气患者实施以护士为主导的早期活动方案具有较高的安全性及依从性,能够改善患者的恢复状况,减少并发症的发生,促进患者早期康复。

关键词: 以护士为主导, 早期活动流程, 机械通气, 重症监护

Abstract:

Objective To analyze the safety,compliance and effect of nurses-led early activity procedure in mechanically ventilated patients with severe neurological diseases. Methods Totally 158 patients from January to March 2019 were selected as the experimental group,and the early activity procedure led by nurses was implemented;147 ICU patients with mechanical ventilation in a tertiary hospital from October to December 2018 were selected as the control group and given routine nursing of mechanical ventilation. The safety and compliance of the experimental group were observed. Recovery and complication rate were compared between the two groups. Results There were no significant differences in intracranial pressure,heart rate and oxygen saturation before exercise（5 min,10 min）,during exercise（5 min,10 min） and after exercise（5 min,10 min） between the experimental group and the control group（P>0.05）,but there was significant difference in mean arterial pressure（P<0.05）. Compliance was 98.1% in the experimental group and 74.8% in the control group. There was significant difference between the two groups （P<0.05）. Length of mechanical ventilation,length of ICU stay and overall length of hospital stay in the experimental group were significantly lower than those in the control group（P<0.05）,and the scores of daily living ability of the experimental group were significantly higher than those of the control group（P<0.05）. The incidence of ventilator-associated pneumonia and deep venous thrombosis in the experimental group was significantly lower than that in the control group（P<0.05）. There was no significant difference in the incidence of delirium in ICU between the two groups（P>0.05）. Conclusion Nurse-led early activity procedure for mechanical ventilated patients with severe neurological diseases has high safety and compliance,which can improve the recovery of patients,reduce complications and promote early rehabilitation of patients.

Key words: Nurse-led, Early Activity Process, Mechanical ventilation, Intensive Care

魏丽丽, 韩斌如. 以护士为主导的早期活动方案在机械通气患者中的应用研究[J]. 中华护理杂志, 2019, 54(12): 1765-1770.

WEI Lili, HAN Binru. Application of nurse-led early activity procedure in patients with mechanical ventilation[J]. Chinese Journal of Nursing, 2019, 54(12): 1765-1770.

图/表 4

表1 以护士为主导的早期活动方案

图1 不同分级早期活动方案选择策略注：1 cmH2O=0.098 kPa.

表2 两组恢复情况比较($\bar{x}$±s)

表3 两组并发症发生情况比较[例(百分比,%)]

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