集束化策略依从性对神经外科监护室机械通气患者呼吸机相关性肺炎发病率的影响

Impact of compliance with cluster bundled strategies on incidence of ventilator-associated pneumonia in patients undergoing mechanical ventilation in intensive care units of neurosurgery department

目的通过对神经外科监护室(NSICU)机械通气患者进行呼吸机集束化策略(VCB)干预,降低呼吸机相关性肺炎(VAP)的发生率。方法采取整群抽样前后对照的研究方法,对干预前(2015年5-7月)64例和干预后(2015年9月-2016年2月)121例患者VCB的依从率及VAP发生率进行比较,评价干预效果。结果干预组VAP发病率(5.42‰)小于对照组(26.67‰),差异有统计学意义(P<0.05);干预前后患者呼吸机使用率分别为17.64%和16.38%,差异无统计学意义;VCB整体依从率从干预前的11.11%提高到干预后的76.79%,干预后VCB中各项措施依从率也均高于干预前,差异均有统计学意义(P<0.01)。结论通过培训教育、信息反馈、晨交班提醒、定期督导、考核奖罚等综合措施,可提高VCB的依从性,降低VAP的发病率,但呼吸机使用率未见明显降低。

OBJECTIVE To take the ventilator cluster bundled （VCB） interventions to patients undergoing mechani- cal ventilation in neurosurgery intensive care unit （NSICU） so as to reduce the incidence of ventilator-associated pneumonia （VAP）. METHODS By means of eontrolled study before and after the cluster sampling, the rate of compliance with VCB and incidence of VAP were observed and compared before the intervention （64 cases, from May to Jul, 2015） and after the intervention （121 cases, from Sep 2015 to Feb 2016）, and the effects of the inter- ventions were evaluated. RESULTS The incidence of VAP of the intervention group was 5. 42‰, lower than 26.67‰ of the control group, and there was significant difference （P〈0.05）. The utilization rate of ventilators was 17.64% before the intervention, 16.38% after the intervention, and there was no significant difference. The overall rate of compliance with VCB was increased from 11.11% before the intervention to 76. 79% after the inter- vention ; the rates of compliance with the measures of VCB were higher after the intervention than before the inter- vention, and there was significant difference （P〈0.01）. CONCLUSION The comprehensive measures, such as training and education, information feedback, reminding on shift in the morning, regular supervision and guid- ance, performance evaluation and incentive measures, may improve the compliance with VCB and reduce the inci- dence of VAP, however, the utilization rate of ventilators is not remarkably reduced.