综合干预策略预防新生儿呼吸机相关性肺炎的临床观察

Clinical Observation of Prevention Neonatal Ventilator Associated Pneumonia in Comprehensive Intervention Strategy

目的探讨综合干预策略对预防新生儿呼吸机相关性肺炎(ventilator associated pneumonia,VAP)的临床效果。方法回顾性的选取广东省河源市龙川县妇幼保健院2014年3月至2016年2月住院治疗,行有创机械通气(mechanical ventilation MV)≥48 h的新生儿纳入研究对象,以2014年3月至2015年2月为干预前期,采取经验性防治措施,所收治患儿例为对照组;以2015年3月至2016年2月为干预期,采取综合干预策略,具体明确各自职责及分工,并量化评价干预前后各主要干预措施包括:手卫生依从性,吸痰操作、口腔护理、冷凝水及时清除、比较干预前后两组VAP发生率。结果实施综合干预策略后,各主要干预措施依从性及合格率较干预前组均有不同程度提升。其中手卫生依从性从72.5%提升至92.6%,差异显著(X^2=294.36,P<0.01)。护理人员负责部分:如吸痰操作、口腔护理、冷凝水及时清除干预后较前分别提升12.5%、13.84%、19.12%,差异均有统计学意义(X^2=36.47~82.2,P<0.01);VAP的发生率由41.25%下降至18.75%,X^2=4.97,P<0.05,差异有显著意义。结论综合干预策略运用临床可有效降低VAP发生率,而其具体实施需要整个NICU团队,包括医师、护士、实习生和院感专职人员观念的转变和共同努力,强调综合有效的管理才能达到降低VAP的目标。

Objective To discuss clinical effect of prevention neonatal ventilator associated pneumonia in comprehensive invention strategy. Methods The newborn babies who mechanical ventilation more than 48 hours from maternal and child care services center of I.ongchuan county between March 2014 and February 2015 were chose as research objects, early intervention period was between March 2014 and February 2015, experience prevention measures were taken, the patients were treated as the control group; intervention period was between March 2015 and February 2016, comprehensive intervention strategy was taken, the main intervention measures included： hand hygiene compliance, suctioning operation, oral nursing and condensated water remover, the rate of VAP incidence was compared. Results After comprehensive intervention strategy, the compliance and the rate of pass were improved, hand hygiene compliance increased from 72.5% to 92.6%, the difference were significant（X＇-=294.36,P 〈 0.01）. The nurses were responsible for： suctioning operation, oral nursing and condensated water remover, which were increased to 12.5%, 13.84%, 19.12%, respectively, the difference was significant （X^2=36.47-82.2,P 〈0.01）; the rate of VAP incidence were decreased from 41.25% to 18.75% （X^2=4.97,P 〈0.05）, the difference was significant. Conclusion Comprehensive intervention strategy can decrease the rate of VAP incidence, NICU groups are needed, including the concept transfer and effort of doctors, nurses and trainee, we should emphasis on effective management to decrease VAP.