目标性镇静护理在重症肺炎患儿床旁肺泡灌洗术中的应用

Application of targeted sedation nursing for children with severe pneumonia in bedside bronchoscopy lung lavage

目的探讨目标性镇静护理在重症肺炎患儿床旁肺泡灌洗术中的应用效果。方法选取沈阳市某三级甲等医院儿科重症监护室2017年1月—9月40例重症肺炎行床旁肺泡灌洗术的患儿为观察组,实施目标性镇静护理;选取2016年1月—9月40例重症肺炎行床旁肺泡灌洗术的患儿为对照组,实施常规镇静护理。观察组根据Ramsay镇静评分标准,制订床旁肺泡灌洗术中各阶段的镇静目标:肺泡灌洗术前(T_2)、纤维支气管镜入声门时(T_3)、首次灌洗吸痰时(T_4)、肺泡灌洗术结束时(T_5)的目标Ramsay镇静评分值分别为4、5、5、4分。比较两组镇静治疗前(T_1)及床旁肺泡灌洗术各阶段(T_2～T_5)的Ramsay镇静评分分值,统计并记录以上各时刻患儿生命体征及术中不良反应的发生情况。结果两组在T_1时间点Ramsay镇静评分、生命体征差异无统计学意义(P>0.05);T_2～T_5时间点两组Ramsay镇静评分、生命体征差异具有统计学意义(P<0.05);观察组较对照组患儿术中不良反应发生率低,差异具有统计学意义(P<0.05)。结论实施目标性镇静护理,动态评估镇静效果,有利于维持患儿术中生命体征平稳,减少了由于镇静不足导致的不良反应。

Objective To explore the application effects of targeted sedation nursing for children with severe pneumonia in bedside bronchoscopy lung lavage, Methods From January to September 2016,in pediatric intensive care unit in a tertiary hospital in Shenyang,40 cases of children who underwent bedside alveolar lavage for severe pneumonia and received routine sedation nursing were selected as the control group. From January to September 2017 in the same hospital, 40 cases of children who received bedside alveolar lavage and targeted sedation nursing for severe pneumonia were selected as the observation group. Focused on the specific conditions of children with severe pneumonia, according to Ramsay sedation score, the individualized sedation target of each stage of bedside bronchoscopy lung lavage was identified! preoperative time of bedside bronchoscopy lung lavage(T2),the time of fiber bronchoscope into the glottis (T3), the first time of sputum suction lavage (T4), and postoperative time of alveolar lavage (T5), and the target Ramsay sedation score values were 4,5,5, and 4 points, respectively. By comparing the Ramsay sedation scores before (T1) and during (T2-T5) percutaneous alveolar lavage between two groups,the children's vital signs and the occurrence of intraoperative adverse reactions were recorded. Results There were no statistically significant differences in Ramsay sedative scores and vital signs between two groups at the time of T1 (P>0.05). The differences in Ramsay sedative scores and vital signs between two groups at T2-T5 were statistically significant (P< 0.05). The incidence of intraoperative adverse reactions was significantly low in the observation group (P<0.05). Conclusion Through targeted sedation nursing,the dynamic evaluation of sedative effects was achieved,the intraoperative vital signs in children maintained stable,and the occurrence of adverse reactions due to lack of sedation were preventatively reduced.