骆艳妮 王春亚 李金娜

[摘要] 目的 探討应用集束化措施对ICU机械通气患者的效果，为临床治疗提供参考。 方法 选择2017年1月～2018年6月在西安交通大学第二附属医院ICU治疗的220例应用呼吸机辅助呼吸的重症患者，采用随机数字表法均分为对照组和观察组，每组各110例。对照组予以常规护理方案进行干预，观察组在此基础上同时予以集束化干预措施进行护理。比较两组患者机械通气时间、ICU住院时间、住院费用、病原菌检出数、呼吸机相关性肺炎发生率及患者满意度。 结果 观察组患者的机械通气时间、ICU住院时间、住院费用、病原菌检出数、呼吸机相关性肺炎发生率均低于对照组，且观察组患者满意率高于对照组，差异有统计学意义（P < 0.05）。 结论 集束化干预措施可有效缩短患者的机械通气时间和ICU住院时间，并能降低患者住院费用和呼吸机相关性肺炎发生率，同时可提高患者满意度。

[关键词] 集束化干预；呼吸机相关性肺炎；机械通气；重症加强护理病房；并发症

[中图分类号] R473.6 [文献标识码] A [文章编号] 1673-7210（2019）04（a）-0173-04

Effect of cluster intervention on mechanical ventilation patients in Intensive Care Unit

LUO Yanni1 WANG Chunya1 LI Jinna3 XIE Mei ZHAO Haining1 LI Hongling1

1.Department of Critical Care Medicine， the Second Affiliated Hospital of Xi′an Jiaotong University， Shaanxi Province， Xi′an 710004， China； 2.Department of Respiratory and Critical Care Medicine， the Second Affiliated Hospital of Xi′an Jiaotong University， Shaanxi Province， Xi′an 710004， China； 3.Department of Hospital Infection Management， the Second Affiliated Hospital of Xi'an Jiaotong University， Shaanxi Province， Xi′an 710004， China

[Abstract] Objective To explore the effect of clustering intervention on patients with mechanical ventilation， in order to provide a reference for clinical treatment. Methods From January 2017 to June 2018， in the Second Affiliated Hospital of Xi'an Jiaotong University， 220 patients with severe ventilator-assisted breathing in ICU were selected， according to random number table method， they were divided into control group and observation group， with 110 cases in each group. The control group was given routine nursing， in addition， the observation group was simultaneously treated with clustering intervention. The indicators included mechanical ventilation time， ICU hospitalization time， hospitalization cost， pathogen detection， VAP incidence and satisfaction rate of patients in two groups were compared. Results The mechanical ventilation time， ICU hospitalization time， hospitalization cost， the incidence of VAP and the total number of plants detected by the pathogen of the observation group were significantly lower than those of the control group， and the satisfaction rate was higher than that in the control group， the differences were statistically significant （P < 0.05）. Conclusion The results indicated that cluster intervention might reduce the mechanical ventilation time， ICU hospitalization time， the hospitalization cost and the incidence of ventilator-associated pneumonia， and improve patients′ satisfaction simultaneously.

[Key words] Cluster intervention； Ventilator-associated pneumonia； Mechanical ventilation； Intensive care unit； Complications

隨着临床医学知识及急救技术的不断发展，机械通气（mechanical ventilation，MV）已成为呼吸系统疾病和抢救危重患者的关键治疗措施之一。但是，机械通气过程中的常见并发症——呼吸机相关性肺炎（ventilator-associated pneumonia，VAP）具有发病率和致死率较高及预后不良等特征，严重影响患者生命，而且给家庭及社会造成巨大经济负担[1-3]。Mongodi等[4]的研究显示VAP发生率为43.1%，病死率为51.6%；Ramirez等[5]的研究显示VAP既增加患者病残率，又延长了患者的住院时间，并明显加重其家属的经济负担。为此，采取有效的护理干预措施，探索降低VAP发生率的干预方案已经成为当前研究热点。集束化干预……