项目管理在急性消化道大出血患者急救中的应用

Application of project management in the first aid for acute massive upper gastrointestinal hemorrhage

目的进一步提升护士对急性消化道大出血的急救技能，提高抢救成功率。方法2008年11—12月采用项目管理方法，对14名注册护士进行急性消化道大出血急救输液培训，评价培训前后9项知识点的掌握情况。抽取2006年9月至2008年10月进行抢救的急性消化道大出血患者84例作为对照组，2009年1月至2011年7月62例作为观察组，评价并比较两组患者的抢救效果。结果采用项目管理方法后，护士对选择建立深静脉置管时机、静脉通路选择、调节输液速度依据、羟乙基淀粉的作用及用量、补液开始前抽取血标本的意义和最佳补充血容量时限6项内容的掌握程度较培训前明显提高，差异均有统计学意义（t值分别为4．80，8．79，5．58，7．42，5．16，4．89；P均〈0．01）。观察组62例患者出血停止50例，生命体征稳定10例，死亡2例；对照组84例患者出血停止42例，生命体征稳定27例，死亡15例；两组抢救效果比较差异有统计学意义（χ^2=15．48，P〈0．01）。结论应用项目管理可显著提高护士临床急救能力，改善抢救效果。

Objective To improve first aid skills in acute massive upper gastrointestinal hemorrhage, and increase the successful rate of rescue. Methods Project management was used from November to December, 2008, 14 registered nurses were trained regarding fluid infusion for patients with acute massive upper gastrointestinal hemorrhage. 9 knowledge points was assessed before and after the training. To evaluate and compare the effectiveness of rescue between control group which included 84 patients rescued before the training from September 2006 to October 2008 and observation group which included 62 patients rescued after the training from January 2009 to July 2011. Results After the application of project management, 6 of 9 training contents, including timing of deep vein catheter, selection of venous channel, adjustment of infusion speed, effect and dosage of hetastarch, significance of blood specimen draw before infusion, as well as best time limit for blood volume supplementation, were significantly improved, and the differences were statistically significant （t = 4.80,8.79,5.58,7.42,5.16,4.89, respectively;P 〈 0.01 ）. In observation group, 50 of 62 patients＇ bleeding stopped, 10 patients vital signs were stable and 2 patients were dead, while in control group, 42 of 84 patients＇ bleeding stopped, 27 patients＇ vital signs were stable and 15 patients were dead, and the differences were statistically significant （ χ^2 = 15.48, P 〈 0.01 ）. Conclusions Project management is an effective method to improve nurses＇ skills for clinical first aid and the effectiveness of rescue.