摘要
目的探讨结构性防护综合护理(SPCN)在降低麻醉重症监护室(AICU)患者非计划性管道脱落(UEX)发生率及改善护理质量中的应用效果,为AICU管道护理提供循证依据。方法选取2022-06-01-2024-06-30河南省人民医院AICU收治的100例需≥2种生命支持管道的患者作为研究对象,按基线资料均衡原则分为对照组和观察组,每组各50例。对照组采用常规护理方案;观察组在常规护理基础上实施SPCN。t检验或χ^(2)检验比较2组患者的安全性、时效性及经济性指标。结果安全性方面,观察组UEX发生率(5.40‰)低于对照组(15.20‰),χ^(2)=6.724,P=0.010;气管插管脱落率(2.10%)低于对照组(8.60%),χ^(2)=4.317,P=0.038;导管相关并发症发生率(9.80‰)低于对照组(22.50‰),χ^(2)=7.892,P=0.005。皮肤压力性损伤例数(2例)少于对照组(7例),但差异无统计学意义,χ^(2)=1.565,P=0.165。时效性方面,观察组报警响应时间(18.70±6.80)s,短于对照组(45.30±12.50)s,t=13.210,P<0.001;导管复位耗时(3.20±1.50)min,短于对照组(8.50±2.20)min,t=15.333,P<0.001;夜间UEX发生率(2.30‰)低于对照组(9.80‰),χ^(2)=5.876,P=0.015。经济性方面,观察组日均耗材费用(41.21±10.17)元,高于对照组(35.95±8.83元),t=2.830,P=0.006;并发症处理费用(1.09±0.36)万元,低于对照组(2.31±0.60)万元,t=12.043,P<0.001;AICU住院时间(5.28±1.83)d,短于对照组(7.53±2.22)d,t=5.860,P<0.001;总住院费用(7.80±2.36)万元,低于对照组(10.57±3.55)万元,t=4.539,P<0.001。结论SPCN通过智能化分级管理、结构化固定体系及多学科协作,可有效降低AICU患者UEX发生率及相关并发症风险,提升护理响应效率,虽增加日均耗材费用,但能减少总医疗成本,对改善AICU管道护理质量及患者预后具有重要意义。
Objective To explore the application effect of structured protective comprehensive nursing(SPCN)in reducing the incidence of unplanned extubation(UEX)and improving nursing quality in patients in the anesthesia intensive care unit(AICU),so as to provide evidence-based basis for AICU pipeline care.Methods A total of 1o0 patients who were admitted to the AICU of Henan Provincial Peoples Hospital from June 1,2022 to June 30,2024 and required≥2 types of life-supporting catheters were selected as the research objects.They were divided into a control group and an observation group according to the principle of balanced baseline data,with 50 cases in each group.The control group received routine nursing,while the observation group implemented SPCN on the basis of routine nursing.The t-test or chi-square test was used to compare the safety,timeliness and economic indicators between the two groups.Results In terms of safety,the incidence of UEX in the observation group(5.40‰)was lower than that in the control group(15.20‰),χ^(2)=6.724,P=0.010;the endotracheal intubation extubation rate in the observation group(2.10%)was lower than that in the control group(8.60%),χ^(2)=4.317,P=0.038;the incidence of catheter-related complications in the observation group(9.80‰)was lower than that in the control group(22.50‰),χ^(2)=7.892,P=0.005.The number of cases of skin pressure injury in the observation group(2 cases)was less than that in the control group(7 cases),but the difference was not statistically significant,χ^(2)=1.565,P=0.165.In terms of timeliness,the alarm response time of the observation group(18.70±6.80)s was shorter than that of the control group(45.30±12.50)s,t=13.210,P<0.001;the catheter repositioning time of the observation group(3.20±1.50)min was shorter than that of the control group(8.50±2.20)min,t=15.333,P<0.001;the incidence of UEX at night in the observation group(2.30%o)was lower than that in the control group(9.80%o),χ^(2)=5.876,P=0.015.In terms of economy,the daily average consumable cost ofthe observation group(41.21±10.17)yuan was higher than that of the control group(35.95±8.83)yuan,t=2.830,P=0.006;the complication treatment cost of the observation group(10900±3600)yuan was lower than that of the control group(23100±6000)yuan,t=12.043,P<0.001;the AICU hospitalization time of the observation group(5.28±1.83)days was shorter than that of the control group(7.53±2.22)days,t=5.860,P<0.001;the total hospitalization cost of the observation group(78000±23600)yuan was lower than that of the control group(105700±35500)yuan,t=4.539,P<0.001.Conclusions Through intelligent hierarchical management,structured fixation system and multidisciplinary collaboration,SPCN can effectively reduce the incidence of UEX and the risk of related complications in AICU patients,and improve the efficiency of nursing response.Although it increases the daily average consumable cost,it can reduce the total medical cost,which is of great significance for improving the quality of AICU pipeline care and the prognosis of patients.
作者
马彩霞
翟胜楠
张惠怡
MA Caixia;ZHAI Shengnan;ZHANG Huiyi(Anesthesia Intensive Care Unit,Henan Provincial People's Hospital,Zhengzhou,Henan 45oo03,China)
出处
《社区医学杂志》
2025年第18期654-658,共5页
Journal Of Community Medicine
关键词
结构性防护综合护理
麻醉重症监护室
非计划性管道脱落
生命支持管道
护理质量
structured protective comprehensive nursing
anesthesia intensive care unit(AICU)
unplanned extubation
life-supporting catheters
nursing quality
