提高ICU护士对使用呼吸机患者抬高床头依从性的策略和效果

Strategies to improve nurses' compliance with head-of-bed elevation in ventilator patients in ICU

目的探讨在ICU施行集束干预措施降低呼吸机相关性肺炎（VAP）发生的过程中，能够提高护士对使用呼吸机患者抬高床头30-45。的依从性的策略．并评价临床效果。方法2012年1月至2013年3月，在对204例有创机械通气患者实施集束干预的过程中，通过对18名护士培训并改善工作条件、张贴宣传画等措施来提高护士对床头抬高的依从性，以便能够更好地实施集束干预策略，降低VAP的发生。结果床头抬高30-45。的依从性干预前（对照组）为21．5％，干预后（实验组）为47．6％，干预前后比较差异有统计学意义（P〈0．01）；干预前（对照组）VAP的发病率为26．3％。干预后（实验组）为15．5％。．干预前后比较差异无统计学意义（P〉0．05）。结论尽管干预后床头抬高的依从性有所提高，但对于VAP发病率的影响效果不显著。

Objective To explore the strategies of improving nurses＇ compliance on elevating the head of beds 30° to 45° in patients with ventilator in ICU. Methods Measures such as training the nurses,improving work con- ditions and putting up posters were implemented to increase nurses＇ eomplianee on elevating the head of beds. Results Nurses＇ compliance on elevating the head of beds increased from 21.5% and 47.6% after intercention（P〈0.01）; no significant difference was found in the incidence of ventilator-associated pneumonia（VAP） before and after intervention（26.3‰ versus 15.5‰. Conclusion Although nurses＇ compliance on elevating the head of beds increases after intervention,the compliance is still relatively low and the effect is not significant on reducing the incidence of VAP.