循证思维在序贯机械通气治疗患者拔管时机选择中的应用研究

Applied study on effect of evidence-based nursing on the decision of extubation in patients with sequential mechanical ventilation

目的 探讨用循证护理思维方法对序贯机械通气治疗患者拔管时机选择和安全拔管的作用。方法 针对68例COPD伴严重呼吸衰竭患者在序贯机械通气治疗护理中存在的问题，进行系统文献检索，求证研究领域的实症，以最佳论据指导临床护理实践，从而实施最佳的护理方案。结果 68例病人在序贯机械通气过程中均在适合时机安全拔管，呼吸机相关性肺炎（VAP）0例，从有创机械通气过渡到无创机械通气拔管成功68例，有创机械通气3～5d后尚需面罩机械通气的时间为7±5d，住院时间14．1±3．1d。结论 循证护理的实施能有效提高COPD伴严重呼吸衰竭进行序贯机械通气治疗的疗效，促进患者早日康复，提高整体护理水平。

Objective To evaluate the effect of evidence based nursing on the decision and safety of extubation for patients with sequential mechanical ventilation. Methods Based on the problems of nursing care in 68 patients with chronic obstructive pulmonary disease （COPD） with severe respiratory failure requiring sequential mechanical ventilation, related documents were investigated by literature searches systematically, the optimal plan was made and practiced in the light of the best documents. Results All cases were extubated successfully in proper time during the process of sequential mechanical ventilation, the incidence of ventilator associated pneumonia （VAP） was 0/68. The duration of face mask mechanical ventilation was （7±5） days followed the invasive mechanical ventilation which the duration was 3-5 days, the duration of hospital stay was （14.1±3.1） days. Conclusions In CODP patients with severe respiratory failure requiring sequential mechanical ventilation, applying of evidence-based nursing improved the efficacy of sequential mechanical ventilation and the level of holistic nursing.