“解决问题，促进健康＂方法对提高ICU有创机械通气患者床头抬高依从性的效果

Effect of the ＂problem solving for better health＂ method on improving the compliance of raising thehead of bed of invasive mechanical ventilation patients in ICU

目的探讨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—7月“解决问题，促进健康”方法实施前在某院ICU行有创机械通气的78例患者为对照组，2012年10月—之013年5月“解决问题，促进健康”方法实施后在某院ICU行有创机械通气的119例患者为观察组，采用护士培训、改善工作条件、张贴宣传画等措施，评价两组护士对床头抬高的依从性，呼吸机相关性肺炎（VAP）的发生率。结果观察组18名护士对使用呼吸机患者床头抬高30～45°的依从性为55．2％，高于对照组的22．0％，差异有统计学意义（x2=237．4，P〈0．01）；观察组VAP的发病率为10．1％o，明显低于对照组的26．8％，差异有统计学意义（x2=5．11，P〈0．05）。结论干预后护士对使用呼吸机患者床头抬高的依从性增高，VAP发病率降低，对促进患者健康有重要的意义。

Objective To explore the strategies that can improve the nurses＇ compliance of raising the head of a bed for 30 -45 ° on mechanical ventilation patients and evaluate the clinical effect. Methods Before implementing ＂problem solving for better health （PSBH） ＂, 78 patients of invasive mechanical ventilation in ICU were included as the control group from January 2012 to July 2012. After implementing PSBH, 119 patients were included as the experimental group, from October 2012 to May 2013. By training the nurses, improving the working conditions and putting up posters, the compliance of nurses and the incidence of ventilator associated pneumonia from each group were compared. Results Nurses＇ compliance of raising the head of bed for 30 - 45° was 55.2% in experimental group, which was higher than that of control group （22.0%）. The difference was statistically significant （ X2 = 237.4, P 〈 0.01 ）. The incidence of ventilator associated pneumonia was 10.1%o in experimental group, which was lower than that of control group （26. 8%）. The difference was statistically significant （ X2 = 5. 11, P 〈 0. 05 ）. Conclusions After the PSBH intervention, the nurses ＇ compliance of raising the head of bed was increased, and the incidence of ventilator associated pneumonia was reduced. PSBH plays an important role in promoting the patients＇ health.