“四位一体”急救护理流程在百草枯中毒患者中的应用

发布时间：2018-01-30 19:05

本文关键词： 百草枯中毒护理流程病死率　出处：《河北医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:本研究是依据2013年中国急诊医师协会发布的《急性百草枯中毒诊治专家共识》[1],(以下简称“共识”),在百草枯中毒患者常规急救护理流程的基础上,利用科学的方法,制定出更加快速、合理、规范的新流程并应用于临床护理工作中,从而有效缩短百草枯中毒患者的首次治疗时间(如首次洗胃时间、首次血液净化时间、首次应用糖皮质激素时间等),为有效救治提供宝贵时间,促进护理工作效率的提高和质量的改进,降低百草枯中毒患者的病死率。方法:1研究方法本研究为随机对照研究,调查两组百草枯中毒患者分别使用不同的急救护理流程,比较两组的差异。选取某三甲医院急诊科2015年10月-2016年4月采用常规急救护理流程的百草枯中毒患者57例作为对照组,2016年8月-2017年1月使用“四位一体”急救护理流程的百草枯中毒患者60例作为观察组,分别收集两组患者首次洗胃时间、首次血液净化时间、首次应用糖皮质激素时间、病死率,将收集到的数据进行统计分析,以判断“四位一体”急救护理流程在百草枯中毒患者中的应用效果。首次洗胃时间:指百草枯中毒患者从服毒至医院开始洗胃所需要的时间。首次血液净化时间:指百草枯中毒患者从服毒至医院进行第一次血液净化所需要的时间。首次应用糖皮质激素时间:指百草枯中毒患者从服毒至医院第一次静脉滴注糖皮质激素所需要的时间。2统计学方法本实验结果采用SPSS21.0软件进行分析。计量资料不满足正态分布,用M(P25,P75)表示,两样本比较采用秩和检验。计数资料用实际数和百分比表示,两样本比较用卡方检验。检验水准α=0.05,P0.05认为差别具有统计学意义。结果:1选取的两组百草枯中毒患者,在性别、年龄、服毒量等基础资料方面的差异无统计学意义(p0.05),两样本比较不受以上因素的影响,具有可比性。2首次洗胃时间:应用“四位一体”急救护理流程后首次洗胃时间有所缩短。对照组的平均首次洗胃时间1.46h,观察组的平均首次洗胃时间1.20h,但两组的差异无统计学意义(p0.05)。3首次血液净化时间:应用“四位一体”急救护理流程后首次血液净化时间缩短。对照组的平均首次血液净化时间为4.90h,观察组的平均首次血液净化时间为4.30h,两组的差异具有统计学意义(p0.05)。4首次应用糖皮质激素时间:应用“四位一体”急救护理流程后首次应用糖皮质激素的时间缩短。对照组的首次应用糖皮质激素平均时间为4.30h,观察组的首次应用糖皮质激素平均时间为3.67h,两组的差异具有统计学意义(p0.05)。5病死率:应用“四位一体”急救护理流程后百草枯中毒患者的病死率比应用此流程前降低。对照组的病死率为59.65%,观察组的病死率为40%,两组的差异具有统计学意义(p0.05)。结论:1本研究依据“共识”结合自己科室救治急性百草枯中毒患者的经验,制定了“四位一体”急救护理流程,实现了从院前急救、院内急诊抢救室、急诊icu、急诊病房“四位一体”的急救护理工作流程,缩短了患者首次血液净化的时间,首次应用糖皮质激素的时间,从而缩短了救治患者所需要的时间,提高了抢救百草枯中毒患者的效率,降低了病死率。2本研究是在原有百草枯中毒患者的常规救治流程基础上进行了流程优化,改进后的流程更能满足临床需要,护理工作更加清晰、简单、明确、顺畅,医护配合更加协调,提高了医护的工作效率。3本研究在研究阶段,科室进行了医护血液净化的全员培训。医生熟练掌握各种血液净化技术的适应症及禁忌症、掌握深静脉置管技术、处理血液净化过程中出现的并发症,为血液净化的成功开展提供先决条件。护士熟练掌握各种血液净化机器的操作流程、报警处理、导管维护、机器维护等,科室的血液净化技术得以成功开展。
[Abstract]:Objective: This study is based on the 2013 China Emergency Physicians Association issued "experts consensus on diagnosis and treatment of acute paraquat poisoning (>[1], hereinafter referred to as the" consensus "), the basic routine emergency nursing process in patients with poisoning of paraquat, using scientific methods to develop a more rapid, rational, standardized processes and clinical application in the nursing work, so as to effectively shorten the time for the first time in treatment of patients with paraquat poisoning (such as the first time of gastric lavage, the first blood purification time, the first application of glucocorticoid time), providing valuable time for effective treatment, and improve the quality of nursing work efficiency, reduce the mortality of patients with paraquat poisoning. Methods: 1 research methods of this study is a randomized controlled study, investigation of two groups of patients with paraquat poisoning were used in emergency nursing process is different, the difference between the two groups. From the emergency department of a hospital In 57 patients as the control group in October 2015 -2016 year in April by the conventional emergency nursing process of paraquat poisoning, 60 patients as the observation group in August 2016 -2017 year in January the use of "four in one" emergency nursing process of paraquat poisoning, two groups of patients were collected for the first time the first time of gastric lavage, blood purification time, the first application of glucocorticoid time, the mortality rate, the collected data for statistical analysis, to determine the "four in one" emergency nursing process of poisoning effect in patients with paraquat. The first time of gastric lavage: refers to the time required to start the gastric lavage of patients from the hospital to commit paraquat poisoning. The first blood purification time: refers to the first blood purification the time required to commit to the hospital from patients with paraquat poisoning. The first application of glucocorticoid time: refers to the first intravenous drop from the poison to the hospital patients with paraquat poisoning .2 statistical methods need injection of glucocorticoid and the experimental results were analyzed with SPSS21.0 software. The measurement data does not meet the normal distribution, using M (P25, P75) said that the two samples analyzed by rank sum test. Enumeration data represented by the actual number and percentage, two samples were compared by chi square test. The test level alpha =0.05, P0.05 was considered statistically significant. Results: 1 selected two groups of paraquat poisoning patients in gender, age, no significant differences in the amount of poison and other basic information (P0.05), two samples from the above factors, comparable to.2 for the first time: the time of gastric lavage one of the four "emergency nursing process for the first time after gastric lavage time was shortened. The average control group for the first time gastric lavage time 1.46h, average time of gastric lavage in the observation group for the first time 1.20h, but there was no significant difference between the two groups (P0.05.3) for the first time blood net Time: the application of "four in one" emergency nursing process for the first time after blood purification time. The control group mean first blood purification time is 4.90h, the average for the first time in the observation group blood purification time is 4.30h, the difference was statistically significant in two groups (P0.05.4) for the first time using glucocorticoid time: the first application of glucocorticoids application of "four in one" emergency nursing process and shorten the time for the first time. After the application of glucocorticoid on average time for the control group 4.30h, the first application of glucocorticoid in the observation group the average time is 3.67h, the difference between the two groups was statistically significant (P0.05).5 mortality rate: the application of "four in one" emergency nursing process after paraquat poisoning mortality than the application of this process. The control group decreased the mortality rate was 59.65% in the observation group, the mortality rate was 40%, with statistically significant difference between the two groups (P0.05). Conclusion: 1 On the basis of the "consensus" with their own departments for treatment experience in patients with acute paraquat poisoning, formulated the "four in one" emergency nursing process, realized from the emergency pre hospital emergency hospital, resuscitation room, emergency ICU, emergency nursing workflow emergency ward "four in one", shorten the patients for the first time in blood purification the first time, the application of glucocorticoid, which shortens the time required for the treatment of patients, improve the efficiency of paraquat poisoning patients, reducing the mortality rate of.2 in this study is the original paraquat poisoning patients in the conventional treatment process based on the process optimization, the improved process can meet the clinical need, nursing work is more clear, simple, clear, smooth, health care with the more coordination, improve the work efficiency of medical.3 the study in the research stage, the Department of the medical staff of blood purification The training of doctors. Proficient in blood purification technology to master the indications and contraindications, deep vein catheter for blood purification treatment technology, which appears in the process of blood purification for complications, success to provide the prerequisite. Nurses master the blood purification machine operation, alarm processing, catheter maintenance, machine maintenance, department the blood purification technology to be successfully carried out.

【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.5

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