贾美云 李 哲 殷新新 施可可 刘艳红



集束化护理预防新生儿呼吸机相关性肺炎的效果观察

贾美云 李 哲 殷新新 施可可 刘艳红

【摘要】目的 探讨集束化护理在预防新生儿呼吸机相关性肺炎（VAP）的效果，为临床护理工作提供参考。方法 选取2013年1～12月收治NICU的96例机械通气≥48 h患者为干预组，患者均采取抬高床头30°～45°、密闭式吸痰、加强口咽部管理、严格洗手等集束化护理干预措施，选取2012年1～12月NICU收治的83例机械通气≥48 h患者为对照组，比较两组患者VAP发生率、住院时间及痰病原学检查结果。结果 与对照组相比，采用集束化护理方案后VAP发生率由15.67%降至7.29%，差异有统计学意义（P＜0.05）；机械通气时间由（8.0±3.5）d缩短至（5.0±2.5）d，差异有统计学意义（P＜0.05）；住院时间由（18.0±4.5）d缩短至（12.0±5.5）d，差异有统计学意义（P＜0.05）；两组患者病原菌均以革兰阴性菌为主，差异无统计学意义。结论 集束化护理对预防VAP有着重要的意义，加强对医护人员的培训，提高医护人员对集束化护理方案的依从性，持续有效的跟踪是降低VAP的关键。

【关键词】新生儿呼吸机相关性肺炎；集束化护理；机械通气

Objective To expore the effect of cluster care in preventing neonatal ventilator associated pneumonia （VAP） and provide reference for clinical treatment. Methods 96 patients with mechanical ventilation more than 48 h of NICU from January to December 2013 in our hospital were taken as intervention group，patients were taken up 30 to 45 degrees of the head，sputum suction closed to wash hands，in order to strengthen the management of oropharynx，strict cluster the nursing intervention measures，83 patients with mechanical ventilation more than 48 h from January to December 2012 were taken as control group，compared the VAP incidence，length of hospital stay and sputum etiology examination results. Results Compared with control group，the method of cluster nursing plan after the incidence of VAP decreased from 15.67% to 7.29%，the difference was statistically significant （P＜ 0.05）. Duration of mechanical ventilation by （8.0±3.5） d reduced to （5.0±2.5） d，the difference was statistically significant （P＜ 0.05）. Length of hospital stay by （18.0 ± 4.5） d to （12.0±5.5） d，the difference was statistically significant （P＜0.05）. Two groups of patients pathogenic bacteria were mainly gram-negative bacteria，there was no statistically significant difference. Conclusion Cluster nursing is of great significance to preventing VAP，and to strengthen the training of medical staff，improving the medical staff on cluster treatment compliance and quality tracking effectively is the key to reduce VAP.

【Key words】Neonatal ventilator correlation pneumonia，Cluster nursing，Mechanical ventilation

随着医学技术的发展，新生儿重症监护病房（Neonatal Intensive Care Unit，NICU）收治的危重症儿逐渐增多，使用机械通气的患儿也逐渐增加。机械通气是抢救成功危重儿的重要手段。目前随着呼吸机在NICU的广泛应用，危重新生儿的抢救成功率显著提高。但机械通气易并发呼吸机相关性肺炎（VAP），增加了新生儿院内感染率，延长了住院时间，增加了住院费用，严重感染甚至可能导致新生儿死亡。……