集束化护理预防神经外科气管切开患者肺部感染的研究

Effect of cluster care on prevention of pulmonary infections in neurosurgery department patients undergoing tracheotomy

目的研究集束化护理方案预防神经外科气管切开患者肺部感染的效果,规范人工气道管理护理操作行为。方法 2010年3月-2012年2月收集神经外科重症昏迷气管切开患者,其中采用传统气道管理方法者设为对照组,共103例,采用集束化护理干预者设为观察组,共106例;集束化护理方案包括:抬高床头30～45°,持续点滴泵入气道湿化法,按需吸痰,使用负压吸引式牙刷为昏迷患者刷牙等,比较两组肺部感染率、气管切开期间住院总费用、气管切开时间及痰病原学检查结果。结果观察组肺部感染发生率为21.69%,对照组为40.78%,差异有统计学意义(P<0.01);观察组气管切开期间总住院费用为(7168.43±110.26)元,对照组为(9388.63±120.82)元,差异有统计学意义(P<0.01);观察组入住ICU时间为(9.31±6.20)d,对照组为(10.53±7.28)d;观察组气管切开时间为(33.80±5.90)d,对照组为(44.23±9.23)d,差异有统计学意义(P<0.01);观察组多药耐药菌检出率为39.13%,对照组为54.76%。结论集束化护理能有效预防和降低神经外科重症昏迷气管切开患者肺部感染的发生,缩短患者气管切开时间,降低住院费用。

OBECTIVE To explore the effect of cluster nursing programs on prevention of pulmonary infections in the neurosurgery department patients undergoing tracheotomy so as to standardize the nursing behavior of artificial airways. METHODS The eases of severe coma , who were treated in the neurosurgery department from Mar 2010 to Feb 2012, were enrolled in the study, then 103 cases who were treated with conventional airway nursing were assigned as the control group, and 106 cases who adopted cluster nursing were set as the observation group the cluster nursing programs included the 30-45°elevation of bed head, airway humidification through continuous drip infusion, sputum aspiration on demand, and use of vacuum suction toothbrush, then the incidence of pulmonary infections, total hospitalization cost, and duration of traeheotomy were compared between the two groups, and the result of sputum culture of pathogens was observed. RESULTS The incidence rate of pulmonary infections was 21.69% in the observation group, 40. 78% in the control group, the difference was statistically significant （P〈0.01） ; the total hospitalization coat during the tracheotomy was （7168.43± 110.26） yuan in the observation group, （9388.63±120.82）yuan in the control group, the difference was statistically significant（P〈0.01）; the duration of ICU stay was （9.31±6.20）d in the observation group, （10.53±7.28）d in the control group; the duration of tracheotomy was （33.80±5.90）d in the observation group, （44.23±9.23）d in the control group, the difference was statistically significant（P〈0.01） ; the detection rate of multidrug-resistant bacteria was 39.13% in the observation group, 54.76% in the control group. CONCLUSION The cluster nursing can effectively prevent the pulmonary infections in the severe coma patients undergoing tracheotomy, shorten the duration of tracheotomy, and cut the hospitalization cost.