危重症患者非计划性拔管的相关因素分析

Related factors and nursing intervention of unplanned extubation for critically ill patients in ICU

目的探讨危重症患者非计划性拔管的相关因素,并对其护理干预措施进行总结,推广应用至ICU危重症患者以降低其非计划拔管率。方法将2019年10月至2020年10月肿瘤相关科室收治的100例危重症PICC置管患者作为研究群体。研究时间为30 d,其中按照治疗需求进行常规拔管70例,非计划性拔管30例,分析PICC非计划性拔管的影响因素,针对分析结果给予对应的护理措施。结果30例非计划性拔管患者拔管原因:堵管无法再通、自行拔管、可疑性感染、皮肤过敏、脱出、渗血、股静脉置管侧下肢血栓。单因素分析显示,非计划性拔管患者受自身原因、导管原因、操作以及维护等原因影响(P<0.05)。Logistic多因素回归分析显示,年龄、体温变化、血管状态、APACHEⅡ评分等因素与患者非计划性拔管之间存在密切关联性(P<0.05)。经对应护理干预,30例患者均未发生静脉炎、血栓、穿刺点感染等并发症。结论自身原因、导管原因、操作以及维护是影响危重症患者非计划性拔管的单因素,而受年龄、体温变化、血管状态、APACHEⅡ评分为影响危重症患者非计划性拔管的多因素,给予对应的护理措施能够有效降低非计划性拔管患者的发生几率,以及拔管后并发症发生几率,通过此项研究,旨在将成功经验推广至ICU患者。

Objective To investigate the related factors and intervention of unplanned extubation for critically ill patients in ICU,so as to reduce the unplanned extubation rate.Methods One hundred critically ill patients who underwent PICC catheterization in ICU of our hospital from October 2019 to October 2020 were enrolled in the study,of whom,70 cases underwent routine extubation according to the treatment needs,and 30 cases underwent unplanned extubation,with the observation duration being 30 days.The influencing factors on unplanned extubation of PICC were analyzed,and corresponding nursing measures were performed according to the analysis results.Results The reasons for the unplanned extubation were as follows:catheter obstruction could not be recanalized,self-extubation,suspected infection,skin allergy,prolapse,bleeding,lower limb thrombosis in femoral vein catheterization side.The univariate analysis showed that patients with unplanned extubation were affected by their own reasons,catheter reasons,operation and maintenance reasons(P<0.05).Logistic multifactor regression analysis showed that patient’s age,the changes of temperature and state of blood vessels,and APACHEⅡscores were closely correlated with the unplanned extubation(P<0.05).After corresponding nursing intervention,no complications including phlebitis,thrombosis and puncture site infection were found in the 30 patients.Conclusion The reason itself,catheters cause,operation and maintenance are single factor affecting unplanned extubation for critically ill patients in ICU,and patient’s age,and changes of temperature,state of blood vessels,APACHEⅡscores are multiple factors affecting unplanned extubation for the patients.To perform corresponding nursing measures can effectively reduce the risk of unplanned extubation and reduce the incidence of complications after extubation.