集束化护理管理在急救气管插管患者中的应用

Application of the cluster nursing management in the emergency endotracheal incubation

目的：探讨集束化护理管理在急救气管插管中应用的效果。方法选择180例有急救气管插管指征的患者，按照就诊时间分为实验组和对照组，每组各90例。对照组采用传统护理管理方法，实验组采用集束化护理管理方法，比较两组患者在插管前准备时间、插管次数、插管前后指脉氧饱和度（ SpO2）以及插管并发症发生率等方面有无差异。结果两组共22例患者最终改用其他通气方法，其中实验组14例，对照组8例。实验组患者插管前准备时间为（179．5±36．0）s，对照组为（317．4±56．0）s，两组比较差异有统计学意义（t ＝19．65，P＜0．01）。实验组1次及2次插管成功率分别为53．9％，32.9％，高于对照组（34．1％，21．9％），差异有统计学意义（χ2值分别为3．972，4．497；P＜0．05）。实验组患者SpO2在开始插管时和确认导管进入声门时分别为（88．0±9．9）％，（85．0±11．3）％，均高于对照组[（78．9±14．0）％，（72．1±14．4）％]，差异均有统计学意义（t值分别为5．036，6．687；P＜0．01）。实验组插管导致牙齿松动脱落、软组织损伤出血的发生率低于对照组，差异有统计学意义（χ^2值分别为4.378，4．304；P＜0．05）。结论集束化护理管理能缩短急救气管插管前准备时间，提高插管成功率，预防插管过程中患者指脉氧饱和度的降低，减少插管并发症的发生。

Objective To explore the effect of the cluster nursing management in the emergency endotracheal incubation .Methods One hundred and eighty patients with emergency endotracheal incubation were chosen and divided into the control group and the experimental group according the admission time , each with 90 cases.The control group received the routine nursing , and the experimental group received the cluster nursing management .The preparation time of incubation , the number of incubation , the pulse oxygen saturation （ SpO2 ） before and after the incubation and the incidence rate of complication were compared between two groups.Results Twenty-two patients including 14 cases in the experimental group and 8 cases in the control group finally changed to the other ventilation ways .The preparation time of incubation was （179.5 ±36.0） s in the experimental group, and was （317.4 ±56.0） s in the control group, and the difference was statistically significant （t=19.65,P〈0.01）.The success rate of one and double intubation were respectively 53.9%, 32.9%in the experimental group, and were higher than 34.1%, 21.9% in the control group, and the differences were statistically significant （χ^2 =3.972,4.497, respectively; P〈0.05）.The SpO2 before and after the incubation were respectively （88.0 ±9.9）,（85.0 ±11.3）% in the experimental group, and were （78.9 ±14.0）,（72.1 ±14.4）% in the control group, and the differences were statistically significant （t=5.036,6.687, respectively;P〈0.01）.The differences were found in the incidences of complication including loose teeth loss and soft tissue injury bleeding between two groups （χ2 =4.378,4.304, respectively;P〈0.05）. Conclusions The cluster nursing management can shorten the preparation time of incubation , and increase the success rate of intubation , and prevent the reduction of SpO 2 during the intubation , and decrease the incidence of intubation complication .