机械通气患儿早期活动方案的构建及应用研究

doi:10.3761/j.issn.0254-1769.2022.08.001

摘要/Abstract

摘要：

目的构建机械通气患儿早期活动方案,并探讨其临床应用的安全性及效果。方法在文献分析的基础上构建早期活动方案。采用便利抽样法,选取2020年12月—2021年7月湖南省某三级甲等儿童医院重症医学科（pediatric intensive care unit,PICU）收治的50例3~14岁机械通气患儿作为试验组,在常规护理的基础上实施以护士为主导的早期活动方案;将2020年4月—2020年11月收治的50例患儿作为对照组,予以常规护理。收集试验组在活动前5 min、活动第15 min、活动结束后5 min的心率、呼吸、收缩压、血氧饱和度以及活动过程中非计划性拔管、跌倒、坠床等不良事件发生情况,同时计算早期活动方案的完成率,评价早期活动方案的安全性与可行性。比较两组入住PICU第1、3、6天肌力,以及谵妄发生率、机械通气时间、入住PICU时间,评价早期活动方案的应用效果。结果试验组在活动前5 min、活动第15 min、活动结束后5 min的心率、呼吸、血氧饱和度比较,差异无统计学意义（P>0.05）,收缩压比较,差异具有统计学意义（P<0.001）,活动过程中未发生非计划性拔管、跌倒和坠床,早期活动方案的完成率为86.96%。两组第1天、第3天肌力比较,差异均无统计学意义（P>0.05）,第6天试验组肌力高于对照组,差异具有统计学意义（P<0.001）;试验组谵妄发生率低于对照组,机械通气时间、入住PICU时间均少于对照组,差异具有统计学意义（P<0.05）。结论机械通气患儿早期活动方案是安全可行的,可改善患儿的肌力,降低谵妄发生率,缩短机械通气时间和入住PICU时间,有助于促进患儿康复。

关键词: 重症监护病房,儿科, 机械通气, 早期活动, 儿科护理学

Abstract:

Objective To construct an early activity program for children with mechanical ventilation,and to explore the safety and efficacy of its clinical application. Methods On the basis of literature analysis,the early activity program was constructed. The convenience sampling method was used to select 50 cases of 3~14-year-old children with mechanical ventilation into an experimental group from December 2020 to July 2021 at the pediatric intensive care unit（PICU） of a tertiary children’s hospital in Hunan province. A nurse-led early activity program was implemented on the basis of the routine nursing. 50 children admitted from April 2020 to November 2020 were selected into a control group,and the routine nursing was given. The heart rate,respiration,systolic blood pressure and oxygen saturation of the experimental group were collected 5 mins before the activity,at the 15th min of the activity and 5 mins after the activity,as well as the occurrence of adverse events such as unplanned extubation,falling and bed falling during the activity. Meanwhile,the completion rate of the early activity program was calculated to evaluate the safety and feasibility of the early activity. Muscle strength level,incidence of delirium,duration of mechanical ventilation and duration of PICU were compared between the 2 groups on day 1,day 3 and day 6,and the effect of the early activity program was evaluated. Results There were no statistically significant differences in heart rate,respiration and blood oxygen saturation of the experimental groups at 5 mins before the activity,at the 15th min of the activity and 5 mins after the activity（P>0.05）,while there were statistically significant differences in systolic blood pressure（P<0.001）. There were no unplanned extubation,fall and bed falling during the activity. The overall completion rate of the early activity program was 86.96%. There was no significant difference in muscle strength between the 2 groups on day 1 and day 3 （P>0.05）,and the muscle strength of the experimental group was higher than that of the control group on day 6（P<0.001）. The incidence of delirium in the experimental group was lower than that in the control group,and the time of mechanical ventilation and PICU stay were both shorter than that in the control group,with statistically significant differences（P<0.05）. Conclusion The early activity program for children with mechanical ventilation is safe and feasible,which can improve the muscle strength level of children,reduce the incidence of delirium,shorten the time of mechanical ventilation and PICU stay,and contribute to the early recovery of children.

Key words: Intensive Care Unit,Pediatrics, Mechanical Ventilation, Early Activity, Pediatric Nursing

刘美华, 彭剑雄, 罗翠, 郑焱, 朱丽辉, 肖政辉, 张新萍, 李庆博, 熊亮. 机械通气患儿早期活动方案的构建及应用研究[J]. 中华护理杂志, 2022, 57(8): 901-907.

LIU Meihua, PENG Jianxiong, LUO Cui, ZHENG Yan, ZHU Lihui, XIAO Zhenghui, ZHANG Xinping, LI Qingbo, XIONG Liang. Construction and application of an early activity program in children with mechanical ventilation[J]. Chinese Journal of Nursing, 2022, 57(8): 901-907.

图/表 4

表1 机械通气患儿早期活动方案

Table 1 The early activity program in children with PICU mechanical ventilation

表2 两组一般资料比较

Table 2 Comparison of the general data between the two groups

表3 试验组早期活动不同时间点的生命体征情况[n=46,M（P25,P75）]

Table 3 Changes in vital signs at different times of early activity for the children in the test group[n=46,M（P25,P75）]

表4 两组不同时间点肌力比较[分,M（P25,P75）]

Table 4 Comparison of muscle strength grade assessment between the two groups for different time periods[scores,M（P25,P75）]

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