基于证据的集束化护理对心胸外科术后无创正压通气患者的影响

Evidence-based Bundle Nursing on the Non-invasive Positive Pressure Ventilation after Cardiothoracic Surgery

目的运用循证研究及质量持续改进的方法构建应用于心胸外科术后无创正压通气患者的集束化护理方案。方法便利抽样选取上海某三级甲等医院心胸外科重症监护室患者79例为研究对象,2012年6月至2013年6月为干预实施前组,应用常规护理模式为患者提供无创正压通气照护,共有患者38例;2013年6月至2014年6月为干预实施后组,应用基于证据的集束化护理,责任护士根据集束化护理方案与医生协同为患者提供无创正压通气照护。比较两组患者的相关临床指标。结果实施心胸外科术后患者无创正压通气的集束化护理方案后,患者的面罩漏气、恐惧焦虑心理、腹胀、误吸、鼻面部损伤以及口咽及呼吸道干燥等不良反应发生率显著下降;PaO_2、PaCO_2明显改善,而患者的住院时间、通气时间则显著降低,差异均有统计学意义(均P<0.05)。结论本次研究运用循证研究及质量持续改进的方法,构建并应用心胸外科术后患者无创正压通气的集束化护理方案,显著减少了无创正压通气患者的不良反应,提高了治疗效果,值得在临床推广运用。

Objective To use the evidence based methods and continuous quality improvement methods to construct the bundle nursing plan to cardiothoracic surgery patients with non-invasive positive pressure ventilation.Methods By convenience sampling,79 cases were selected.Patients admitted from June 2012 to June 2013 were applied with non-invasive positive pressure ventilation（before intervention implementation group,n=38）.Patients admitted from June 2013 to June 2014 were applied with evidence-based bundle nursing（after intervention implementation group）.Nurses according to the bundle nursing plan and cooperation with doctors to provided non-invasive positive pressure ventilation care to patients,the relevant clinical indexes of two groups were compared.Results After the implementation of non-invasive positive pressure ventilation bundle nursing plan,the incidence of mask leakage,fear and anxiety,abdominal distension,aspiration,facial injuries and oropharyngeal airway drying were significantly reduced.PaO_2 and PaCO_2 were significantly improved,the length of hospital stay and the ventilation time were significantly decreased（all P〈0.05）.Conclusions This study use the evidence-based method and quality continues improvement method to construct the non-invasive positive pressure ventilation bundle nursing plan for patient underwent cardiothoracic surgery,it can significantly reduce the adverse reaction of non-invasive positive pressure ventilation,improve the treatment effect,which is worth for clinical application.