周玲玲，赵慧莉

(上海交通大学医学院附属新华医院，上海 200092)

集束化护理预防老年患者呼吸机相关性肺炎的作用

周玲玲，赵慧莉

(上海交通大学医学院附属新华医院，上海 200092)

目的探讨集束化护理干预策略对预防老年患者呼吸机相关性肺炎(ventilator-associated pneumonia，VAP)的作用。方法选择2011年1—12月入住上海交通大学医学院附属新华医院重症监护室(ICU)接受人工气道和机械通气＞48h的老年患者99例，按制订的集束化护理措施进行护理，包括抬高床头、每日唤醒计划、消化性溃疡的预防和深静脉血栓(DVT)的预防。另选2010年1—12月在我院ICU接受人工气道和机械通气＞48h的老年患者98例为对照组，按ICU护理措施进行护理。比较两组患者VAP的发生率、机械通气时间、入住ICU的时间和病死率等。结果集束化组VAP的发生率较对照组显著下降，差异有统计学意义(P＜0.01);在机械通气时间、入住ICU时间和病死率方面与对照组比较，差异有统计学意义(P＜0.05)。结论集束化护理干预策略能有效预防和降低老年患者VAP的发生，减少患者机械通气的时间及各种不良反应的发生，有助于促进患者早日康复。

老年患者;呼吸机相关性肺炎;集束化护理

Abstract:ObjectiveTo investigate the clinical effect of a care bundle in preventing ventilator-associated pneumonia(VAP)in the elderly patients.MethodsA retrospective study was conducted.197elderly patients with mechanical ventilation＞48h admitted in intensive care units(ICUs)during January 2010to December 2011in our hospital were selected.The patients in 2010(n=99)were enrolled in the experimental group，and those in 2010were enrolled in the control group(n=98).The control group only received the routine nursing，while the experimental group received a ventilator care bundle besides the routine nursing，which included raising the head of bed，daily sedation interruption，peptic ulcer prevention，and deep vein thrombosis prevention.The morbidity of VAP，mechanical ventilation time，hospital stay in ICU and mortality were compared.ResultsThe morbidity of VAP in the experimental group significantly decreased than that in the control group compared to the control group(P＜0.01).Moreover，the mechanical ventilation time，hospital stay in ICU，and mortality reduced significantly(P＜0.05).ConclusionThe care bundle can effectively prevent and in the experimental group reduce the occurrence of VAP in the elderly patients，reduce mechanical ventilation time and complications，and promote their recovery.

Key Words:Elderly patient;Ventilator-associated pneumonia;Care bundle

集束化护理又称为集束化干预或捆绑式干预，是 指当患者在难以避免的风险下进行治疗时，由医护人员提供的一系列安全有效的护理干预的集合［1］。其目的在于为患者提供尽量优化的医疗服务。一个集束化护理方案通常包括3～6个元素，每个元素都获得循证医学证据支持，共同执行的效果优于单一元素执行［2］。……