进阶式核心因素思维在判断患者入住ICU时机的应用

Advanced Core Factors in Patients Admitted to ICU Time Thinking Judging Application

目的探讨进阶式思维(ATCA)判断患者入住ICU的标准的可行性。方法严格筛选入选病历,将患者随机分为3组。一组患者为实验组,采用进阶式思维评估患者,二组患者用APACHEⅡ评估患者,三组患者用APACHEⅢ评估患者。结果经回顾性分析及专家咨询,共18个特征指标进入核心因素思维变量。在三组患者中,精神混乱、呼吸衰竭、电解质紊乱、白细胞计数(WBC)>7.5×109/L、Cr<60μmol/L、腹胀、脉压差≥60 mm Hg、焦虑等10个指标实验组发生率低于二组与三组,差异有显著统计学意义(P<0.02)。结论进阶式思维分析可以指导护士建立临床护理思维,改善危重患者不良结局。

Objective To establish a judgment standard of ICU admission according to the main core factors of doctors and nurses（DNCA）. Methods Cases were selected strictly and divided into three groups randomly. The first group patiets as 3 experiment group were assessed with the main core factors of doctors and nurses. The second group patients were assessed with APACHEⅢ and the thirst group patients with APACHEⅡ. Results We found that 26 factors would cause the complications of ICU significantly. Multiple-factors analysis showed that the mental confusion, respiratory failure, electrolyte imbalance, white blood cell count（WBC） 7.5×10^9/L, Cr〈60 μ mol/L, abdominal distension,pulse pressure difference ≥60 mm Hg and anxiety can become the main core factors which were there the significant difference statistically（P〈0.05）. Conclusion The analysis of advanced thinking can help us identify heavy patients quickly,establishment of clinical care and guide the clinical thinking, enhance the practical ability.