龙苗　　贾叙锋　　邓海波　　黄象丽　　何平

[摘要] 目的 探討影响分析理论（FMEA）的护理干预在老年机械通气患者呼吸机相关性肺炎（VAP）预防中的价值。 方法 选取本院2017年2月至2019年3月收治的92例机械通气患者作为研究对象采用随机数表法分为观察组和对照组，每组各46例。对照组行常规护理干预预防VAP，观察组在FMEA指导下行护理干预预防VAP。比较两组机械通气期间VAP发生率，两组干预前后氧化应激反应及呼吸力学指标变化[丙二醛（MDA）、超氧化物歧化酶（SOD）、气道峰压（PIP）、气道阻力（AR）]，并比较两组机械通气时间及住院时间。 结果 观察组干预后VAP发生率为4.35%，显著低于对照组的19.57%，差异有统计学意义（P<0.05）。观察组干预后MDA、PIP、AR水平显著低于干预前及对照组干预后，差异有统计学意义（P<0.05）;观察组干预后SOD水平显著高于干预前及对照组干预后，差异有统计学意义（P<0.05）。观察组干预后机械通气时间及住院时间显著短于对照组，差异有统计学意义（P<0.05）。 结论 FMEA指导下行护理干预可降低VAP发生率，缩短老年患者机械通气时间及住院时间，具有较高的临床应用价值。

[关键词] 影响分析理论;老年;机械通气;呼吸机相关性肺炎

[中图分类号] R181.3          [文献标识码] B          [文章编号] 1673-9701（2021）11-0163-04

Value of failure model effectiveness analysis in preventing ventilator associated pneumonia in elderly patients with mechanical ventilation

LONG Miao1   JIA Xufeng2   DENG Haibo1   HUANG Xiangli1   HE Ping3

1.Department of Respiratory Medicine，the People′s Hospital of Jianyang City in Sichuan Province， Jianyang   641400，China; 2.Department of Orthopedics，the People′s Hospital of Jianyang City in Sichuan Province， Jianyang   641400， China; 3.Department of Nursing， the People′s Hospital of Jianyang City in Sichuan Province， Jianyang   641400， China

[Abstract] Objective To explore the value of nursing intervention based on failure model effectiveness analysis （FMEA） in preventing ventilator associated pneumonia（VAP） in elderly patients with mechanical ventilation. Methods A total of 92 patients with mechanical ventilation admitted to our hospital from February 2017 to March 2019 were selected as the research objects， and they were divided into the observation group and the control group according to the random number table method each group had 46 cases. The control group was treated with conventional nursing intervention to prevent VAP， while the observation group was treated with nursing intervention to prevent VAP under the guidance of FMEA. The incidence of VAP during mechanical ventilation was compared between the two groups. Meanwhile， the changes of oxidative stress reaction and respiratory mechanics indexes，malondialdehyde（MDA）， superoxide dismutase（SOD）， peak inspiratory pressure（PIP）， airway resistance（AR） before and after intervention were compared between the two groups. In addition， the time of mechanical ventilation and hospitalization in the hospi  were compared between the two groups. Results The incidence of VAP in the observation group was 4.35%， significantly lower than 19.57% in the control group， with statistically significant difference（P<0.05）. After the intervention， the levels of MDA，PIP and AR levels in the observation group were significantly lower than those in the control group before and after intervention， with statistically significant differences（P<0.05）. The SOD level in the observation group after intervention was significantly higher than that before intervention and that in the control group after intervention， with statistically significant difference（P<0.05）. After intervention，the time of mechanical ventilation and the hospitalization time in the observation group were significantly chorter than those in the control group， with statistically significant differences（P<0.05）. Conclusion Nursing intervention guided by FMEA can reduce the incidence of VAP， shorten the mechanical ventilation time and hospitalization time of elderly patients，which has high clinical application value.

[Key words] Failure model effectiveness analysis; The elderly; Mechanical Ventilation; Ventilator associated pneumonia

机械通气是治疗呼吸系统疾病的重要方式，能够辅助患者呼吸，达到抢救及治疗的目的，然而机械通气属于侵入性操作，患者通气治疗时易出现呼吸机相关性肺炎（Ventilator associated pneumonia，VAP）[1]。VAP发病后会对患者的病情缓解产生负面影响，会延长住院时间，增加患者的经济负担，严重者甚至会导致患者死亡，同时呼吸科收治的老年患者疾病危急，身体状况差，对侵入性操作的抵抗力弱，VAP的发生率较高，已成为医院感染的重点监护病房之一[2-3]。故障模式与影响分析理论（Failure model effectiveness analysis，FMEA）是一种前瞻性的分析方式，通过建立专项小组对某一程序、系统出现的问题及原因进行分析，制订相应的措施、方案预防问题的出现，达到降低系统风险的目的[4]。……