廖莲清 刘爱群 梅永华 欧阳杰安 王红玲

【摘要】目的：探討人工气道风险防范综合管理对老年患者气管插管意外拔管事件发生率的影响。方法 选取2018年6月至2018年12月我院收治的接受气管插管人工气道的34例患者为对照组，实施常规风险防范管理；选取2019年1月至2019年6月我院ICU进行气管插管人工气道的患者42例作为观察组，实施失效模式和效果分析（FMEA）模式进行风险防范管理，比较两组患者的共同风险系数（RPN）和意外拔管事件发生率。结果 对照组患者的意外拔管事件发生率显著高于观察组（P<0.05），对照组患者的意外拔管的诱发因素中体位不正、缺乏风险评估、缺乏健康宣传及医护经验缺乏比例均高于观察组。对照组患者在缺乏健康宣传、缺乏防范措施、缺乏风险评估、患者依从差及插管固定不当的失效模式RPN得分均显著高于观察组，以上差异具有统计学意义（P<0.05）。结论 实施人工气道风险防范联合FMEA管理可以显著降低意外拔管事件发生率，具有重要的临床推广价值。

【关键词】人工气道；气管插管；FMEA；RPN；意外拔管

[中图分类号]R472.9 [文献标识码]A [文章编号]2096-5249（2021）13-0167-02

Study on risk prevention of endotracheal intubation by artificial airway management

LIAO Lian-qing， LIU Ai-qun， MEI Yong-hua， OUYANG Jie-an， WANG Hong-ling （The Third Affiliated Hospital Of Guangdong Medical University， Guangzhou Guangdong 528318， China）

[Abstract] Objective： To investigate the effect of comprehensive management of artificial airway risk prevention on the incidence of accidental tracheal extubation in elderly patients. Methods： From June 2018 to December 2018， 34 patients undergoing endotracheal intubation and artificial airway treatment in our hospital were selected as the control group， and routine risk prevention management was performed. The ICU in our hospital was selected from January 2019 to June 2019. 42 patients with tracheal intubation and artificial airway were used as observation group， and failure mode and effect analysis （FMEA） mode were implemented for risk prevention management. The common risk coefficient （RPN） and the incidence of accidental extubation were compared between the two groups of patients. Results： The incidence of accidental extubation in patients in the control group was significantly higher than that in the observation group （P<0.05）， The predisposing factors of accidental extubation in the control group were higher than those in the observation group， including misposture， lack of risk assessment， lack of health promotion and lack of medical experience. The patients in the control group had a failure mode RPN of lack of health promotion， lack of precautions， lack of risk assessment， poor patient compliance， and improper intubation fixation. The scores were significantly higher than those in the observation group， the above differences were statistically significant （P<0.05）. Conclusion： The implementation of artificial airway risk prevention combined with FMEA management can significantly reduce the incidence of accidental extubation and has important clinical promotion value.

[Key words] Artificial airway； Tracheal intubation； FMEA； RPN； Accidental Extubation

在ICU危重患者治疗中，为保障和维持患者正常的呼吸功能，目前常选择实施气管插管方式保障气道通畅[1]。气管插管是一种侵入性置管，其在保障呼吸通畅的同时还会诱发一定的呼吸道刺激问题，导致患者接受气管插管治疗中身体会做出自我保护反应而意外拔管，在出现意外拔管事件后，若未得到及时补救容易危害患者生命安全[2]。……