西北地区医院临床应用呼吸机相关情况的调查分析

Analysis of the clinically application of ventilator of hospitals in northwest of China

目的调查西北地区二级以上医院临床应用呼吸机的相关情况及问题,旨在为本地区呼吸机操作相关人员长期培训方案的制定提供参考依据。方法以参加2012年12月西京医院呼吸与危重症医学科举办的西北地区无创呼吸机培训班的全体学员作为调查对象,采用问卷调查的形式进行。结果收回有效调查问卷81份,三甲医院、三乙医院、二甲医院、二乙医院的人员分别占45.5%、11.3%、39.5%、3.7%。①在呼吸机参数的调节人员方面:70%的医院由医生单独调节,1.2%的医院由护士调节,24.6%的医院由两者共同调节;②在机械通气的认识方面:14.8%只是为了满足家属尽心;38.2%认为只能短期缓解病情,远期意义不大;20.9%认为花费大,总体效果不佳;4.9%的认为使用呼吸机会增加患者痛苦;80.2%认为早期使用呼吸机,有效改善了病情;③在无创呼吸机使用过程中常见的并发症方面:按照被调查者的经验,发生率从高至低依次是排痰不利(70.3%)、腹胀(58%)、误吸(25.9%)、面部压疮(24.7%)、血压不稳(8.6%)及气胸(12.3%);④在使用无创呼吸机过程中的镇静方面:8.6%常规给予镇静,11.1%为大多数时候镇静,25.9%偶尔镇静,38.3%从不镇静;⑤在无创呼吸机使用过程中存在的困惑方面:61.7%对呼吸机的结构及原理不清楚,67.9%对使用无创呼吸机的适应证和时机把握不准,75.3%对参数的调节没有把握,53.1%对无创通气过程中排出二氧化碳的原理不清楚。结论西北地区二级以上医院的呼吸机操作人员中,大多数能够认识到呼吸机在治疗呼吸衰竭中的重要作用,但总体上对呼吸机的结构与原理、适应证及参数调节等相关知识欠缺,在应用无创呼吸机的过程中并发症发生率高。本调查资料将为本地区呼吸机操作人员培训计划的制定提供重要参考。

Objective To understand the relevant circumstances and issues of clinical ventilator application of hospitals upper than or equal to second-class in China＇s northwest.It provides a reference for developing a long-term training program for local ventilator operators.Methods Trainees （all from Northwest of China） were collected from Non-invasive ventilator training courses which is hold by department of pulmonary and critical care medicine,Xijing Hospital in December,2012.We adopt the form of the questionnaire in this survey.Results Finally,81 qualified questionnaires were collected.Respondents were composed of upper first-class hospital （45.5%）,middle first-class hospital （11.3%）,upper second-class hospital （39.5%） and middle second-class hospital （3.7%）.①Operator of Adjusting ventilator：Doctors take on this work （70%）; Nurses take on this work （1.2%）.Both of doctors and nurses take this work （24.6%）;②Knowledge of mechanical ventilation （MV）：The purpose of using MV only to meet the families＇ request （14.8%）; doctors thought using MV just could retard the disease in short-term,but in long-term,it is meaningless （38.2%） ; doctors thought MV was expensive,and the overall results was so poor （20.9%） ;doctors thought using MV increased the opportunity of breathing pain （4.9%） ; doctors thought use the breathing machines in early time,can improve the patients＇ condition （80.2%） ; ③ Complication of using Non-invasive ventilation （according to the experience of the respondents,from high to low）：the incidence followed by expectoration unfavorable （70.3%） ; abdominal distension （58%） ; aspiration （25.9%） ; facial pressure ulcers （24.7%） ; unstable blood pressure （8.6%） ; pneumothorax （12.3%） ; ④Sedation of using Non-invasive ventilation：8.6% routinely given sedation,11.1% for most of the time sedation,25.9% occasionally sedation,38.3% never.⑤The confusion of non-invasive ventilator：operator was not clear about the structure and principle of the ventilator（61.7%） ; operator was not grasp the exact indications and timing of using non-invasive ventilator（67.9%） ; operator was not sure of the parameter adjustment（75.3%） ; operator was unclear of the non-invasive ventilation principle of carbon dioxide emitted （53.1%）.Conclusions Most of the ventilator operators of hospitals upper than or equal to second-class of China＇s Northwest regions could recognize the important role of ventilator in respiratory failure curing,but they lack of the knowledge about the structure and principle of the ventilator,parameter adjustment and so on.And there were higher level of complications during the non-invasive ventilation clinically.The information will provide an important reference of the ventilator operator training program development locally.