摘要
目的探讨基于循证护理制定的呼吸机相关性肺炎(ventilator-associatedpneumonia,VAP)预防策略在成人心脏手术患者中的应用效果。方法回顾性分析2016年1月~2017年12月行体外循环心脏手术的成年患者。成立VAP循证小组,基于既往循证医学证据制定VAP风险评估表,对术后患者进行危险分层。同时进一步改良VAP集束化预防方案,并将其常规应用于高危患者。结果应用新的预防策略之后,VAP的发生率由8.1%(33/405)显著下降至4.6%(18/389)(P <0.05)。观察组患者的机械通气时间、ICU停留时间显著低于对照组(P <0.05),但是总住院日及病死率在两组间未有显著性差异(P> 0.05)。实施新的预防策略后护士对感控知识的掌握能力也有显著提升(P <0.05)。结论基于循证医学方法制定新的VAP预防策略,能够显著降低VAP的发生率、改善患者临床结局并提高护士的感控知识水平,值得在临床中进一步推广。
Objective To explore application effect of the prevention strategy of ventilator-associated pneumonia(VAP developed based on evidence-based nursing(EBN) in adult patients undergoing cardiac surgery. Methods Adult patients who underwent cardiac surgery with cardiopulmonary bypass in our department between January 2016 and December 2017 were retrospectively analyzed. A VAP evidence-based group was established to develop a VAP risk evaluation form based on previous data of evidence-based medicine and stratify the risks for postoperative patients. Meanwhile, the VAP prevention bundle protocol was further modified and applied to high-risk patients in a routine manner. The aforesaid prevention strategy of VAP and routine protocol of nursing and prevention were applied to patients admitted to our department after and before January 2017, respectively. Patients who adopted prevention strategy of VAP were included in the observation group, and patients who adopted routine protocol were included in the control group. Results After application of newly-established prevention strategy, the occurrence of VAP was significantly reduced from 8.1%(33/405) to 4.6%(18/389)(P < 0.05). The duration of mechanical ventilation and ICU length of stay(LOC) in the observation group were significantly lower than those in the control group(P < 0.05). There was no significant difference in the total LOC and mortality between the two groups. The nurses had significant improvement in mastering the knowledge of infection control after the implementation of newly-established prevention strategy(P < 0.05). Conclusion The newly-established prevention strategy of VAP based on evidence-based medical approach can markedly reduce the occurrence of VAP, improve the clinical outcomes of patients and raise the nurses’ abilities in mastering the knowledge of infection control, which deserves further promotion in clinical practice.
作者
刘小燕
刘雨杉
何思毅
Liu Xiaoyan;Liu Yushan;He Siyi(Department of Cardiothoracic Surgery,General Hospital of Western Theater Command of PLA,Chengdu,Sichuan,610083,China)
出处
《西南国防医药》
CAS
2020年第4期331-334,共4页
Medical Journal of National Defending Forces in Southwest China
基金
西部战区总医院青年科技创新人才项目资助(41732C11K)。
