成人心脏外科术后患者实施早期拔管策略效果观察与护理

Effect of early-phased extubation in patients of postoperative cardiac surgery and its nursing

目的探讨ICU护士主导实施的早期拔管策略在成人心脏外科术后机械通气患者中的应用效果及护理要点。方法回顾心脏术后经口气管插管入胸心外科ICU行机械通气治疗的156例患者的拔管情况,按照时间顺序分为传统组和干预组(早期拔管组),2组患者机械通气模式及参数、撤机方式、撤机后治疗护理等方法均相同,干预组是在传统组基础上以ICU护士主导实施综合早期拔管策略。观察撤机30 min 2组心率、呼吸、血压、PaO2/FiO2、PaCO2及拔管后无创正压通气(NPPV)例数、24 h再插管例数、拔管前机械通气时间及撤机时间等指标。结果撤机后30 min 2组患者心率、呼吸、血压、PaCO2及拔管后NPPV例数、24h再插管例数等指标无统计学差异(P>0.05),干预组PaO2/FiO2则较传统组显著改善(P<0.05),且干预组拔管前机械通气时间、撤机时间显著短于传统组(P<0.05)。结论 ICU护士实施的早期拔管策略对心脏外科术后撤机患者是安全的,能提高早期拔管成功率,减少机械通气并发症。

Objective To explore the effect of early - phased extubation in patients applying mechanic ventilation after cardiac surgery and the nursing measures in Intensive Care Unit （ICU）. Methods The 156 patients treated with mechanical ventilation through mouth to chest after cardiac surgery were were divided into conventional group and intervention group （early- phased extubation groups） according to time sequences. The mechanical ventilation models and parameters, ventilator weaning as well as treatment and nursing in the two groups were identical. Intervention group was given early- phased extubation on the basis of conventional group. Heart rate, breathing, PaO2/ FiO2 and PaCO2 were observed in 30 minutes after extubation. The number of patients of non- in- vasive positive pressure ventilation and reintubation within 24 hours were observed. Consequently, the difference was no statistically significant. Mechanical ventilation time and weaning time between two groups were compared. Results There were no statistical differences in HR, breathing, Pa- CO2, blood pressure after 30min extubation and the patient number using NPPV after extubation, the number reintubation within 24 hours between the two groups （P 〉0.05）. PaO2/FiO2 with the experimental groups was higher than the conventional group （P 〈 0.05）. Compared to the conven- tional groups, mechanical ventilation time and weaning time before early- phased extubation were significantly reduced （P 〈 0.05）. Conclusion Early - phased extubation applied by ICU nurses is secure for patients with ventilator weaning after cardiac surgery, which enables to increase the probability of successful extubation and to reduce the complications of mechanical ventilation.