有创呼吸机管路更换时间对VAP发生的影响

发布时间：2018-05-27 11:19

本文选题：有创呼吸机 + 管路更换　；参考：《山西医科大学》2017年硕士论文

【摘要】：目的:全面了解目前山西省三甲综合医院ICU护士对有创呼吸机管路更换的执行现状,以及ICU护理人员对其相关知识的掌握和需求状况,借此探讨管路更换时间执行不一致的可能原因,为规范和明确管路更换时间提供依据;并探讨有创呼吸机管路系统更换时间在呼吸机相关性肺炎(Ventilator-associated Pneumonia,VAP)发生中发挥的作用和产生的影响,从而为医护人员在临床实践中的具体操作提供参考。方法:(1)在调查研究中,查阅国内外相关文献自行设计调查问卷,采取现场发放和邮寄两种方式,随机整群抽取山西省13家三甲综合医院的ICU护士就管路更换时间认知现况进行调查。(2)在病例对照研究中,将2015年4月15日—2015年10月14日和2015年10月15日—2016年4月14日收治于某三甲综合医院神经内科ICU、神经外科ICU和呼吸内科ICU接受有创机械通气的患者分别设为对照组1和对照组2,管路系统均为7 d更换1次。2016年4月15日—2016年10月14日患者设为病例组,管路仅在肉眼可见明显污染或功能障碍时予以更换。结果:(1)问卷调查研究结果调查13家医院34间ICU的护士,发放问卷724份,回收有效问卷717份,有效率为99.03%,有统一管路更换时间的ICU占73.8%。目前ICU科室规定和护士临床实际工作中执行管路更换时间都趋向于7 d。不同ICU规定和护士实际更换管路时间比较差异均有统计学意义(c2=24.84、35.76,p0.01)。(2)病例对照研究结果观察组和对照组患者年龄、机械通气前炎性指标、机械通气期间痰检阳性率和在机械通气期间VAP的发生率等比较均无显著差异(P0.05)。结论:(1)医院应选择合适的途径,加强对ICU护士管路更换时间及其相关知识的培训,制定适合自身环境的安全管路更换期限,从而减轻护士的工作量,降低医疗费用,促进护理服务质量的改进和提升。(2)管路仅在出现肉眼可见污染或功能障碍时予以更换并不影响患者的预后效果,同时可明显降低管路更换频率,减少患者经济负担和人力、物力资源的消耗。建议管路仅在肉眼可见明显污染或功能障碍时予以更换。
[Abstract]:Objective: to understand the current situation of ICU nurses' implementation of the replacement of invasive ventilator in Shanxi Sanjia General Hospital, and the knowledge and requirements of ICU nurses. This paper discusses the possible reasons for the inconsistent implementation of the pipeline replacement time, and provides the basis for standardizing and clarifying the pipeline replacement time. To explore the role and influence of the time of replacement of invasive ventilator piping system in Ventilator-associated pneumonia (VAPs), so as to provide reference for medical staff in clinical practice. Methods: in the investigation and research, the questionnaire was designed by itself by referring to the relevant literature at home and abroad, and the questionnaire was distributed on the spot and sent by mail. In a case-control study, random cluster sampling of ICU nurses from 13 hospitals in Shanxi Province was conducted to investigate the cognitive status of pipeline replacement time. The patients who received invasive mechanical ventilation from 15 April 2015 to 14 October 2015 and from 15 October 2015 to 14 April 2016 in the department of neurology, neurosurgery ICU and ICU of respiratory department in a general hospital were divided into two groups. Group 1 and control group 2, the piping system was changed once for 7 days. Patients from April 15, 2016 to October 14, 2016 were selected as the case group. The pipeline is replaced only when visible contamination or dysfunction is visible to the naked eye. Results the results of the questionnaire survey showed that the nurses of 34 ICU in 13 hospitals were investigated. 724 questionnaires were distributed and 717 valid questionnaires were collected. The effective rate was 99.030.The ICU with uniform pipeline replacement time accounted for 73.8%. At present, the time of pipeline replacement in ICU department and nurses' clinical work tends to be 7 days. There were significant differences between different ICU regulations and the actual replacement time of nurses. The results of Case-control study showed that the patients in the observation group and the control group had age and inflammatory indexes before mechanical ventilation. There was no significant difference between the sputum positive rate during mechanical ventilation and the incidence of VAP during mechanical ventilation. Conclusion 1) the hospital should choose the appropriate way, strengthen the training of the ICU nurses' pipeline replacement time and related knowledge, and establish the safe pipeline replacement period suitable for their own environment, so as to reduce the workload of nurses and reduce the medical expenses. To promote the improvement of nursing service quality and to improve the quality of nursing service. The replacement of pipeline only when visible pollution or dysfunction in the naked eye does not affect the prognosis of patients, and it can obviously reduce the frequency of pipeline replacement, reduce the economic burden and manpower of patients, and improve the quality of nursing service. The consumption of material resources. It is recommended that the pipeline be replaced only if visible contamination or dysfunction is visible to the naked eye.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R47

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