ICU患者经口气管插管自行拔管影响因素调查及综合护理措施

Investigation on the influencing factors of self-extubation of oral tracheal intubation in ICU patients and comprehensive nursing measures

目的 调查ICU患者经口气管插管自行拔管影响因素,研究综合护理措施。方法随机选取我院重症医学科2014年7月~2016年6月收治的ICU经口气管插管患者705例,将其分为对照组与实验组。对照组352例,行常规护理,实验组353例,在常规护理的基础上行综合护理。统计ICU患者经口气管插管自行拔管影响因素,比较护理后两组患者自行拔管率与死亡率、护理满意度评分。结果在对ICU经口气管插管自行拔管单因素影响分析中,患者自行拔管时间、气管插管构建方式、患者拔管方式及患者病情均是影响ICU患者经口气管插管自行拔管的单因素。实验组自行拔管率(1.70%)、死亡率(12.7%)均显著低于对照组(5.40%、25.3%),差异显著(P<0.05)。实验组护理满意度评分均高于对照组,差异显著(P<0.05)。结论 ICU患者经口气管插管自行拔管影响因素主要为约束不当、患者自行吐管、患者躁动等,临床上应对其实施综合护理,以降低自行拔管率、死亡率,提高患者的护理满意度。

Objective To investigate the influencing factors of self-extubation of oral tracheal intubation in ICU pa- tients, and to explore the comprehensive nursing measures. Methods 705 patients who were admitted to the Department of Critical Care Medicine in our hospital and were given oral tracheal intubation from July 2014 to June 2016 were ran- domly selected. The patients were divided into the control group and the experimental group. 352 cases in the control group were given routine nursing care, and 353 cases in the experimental group were given comprehensive nursing care on the basis of routine nursing care. The influencing factors of self-extubation of oral tracheal intubation were statisti- cally analyzed in ICU patients, and the self-extubation rate, mortality rate and nursing satisfaction score were compared between the two groups after the nursing care. Results In the single factor analysis of self-extubation of oral tracheal intubation in ICU patients, the self-extubation time, construction method of tracheal intubation, patients＂ extubation method and patients＂ conditions were all single factors affecting the self-extubation of oral tracheal intubation in ICU patients; the spontaneous extubation rate（1.70%） and death rate（12.7%） in the experimental group were significantly lower than those in the control group（5.40%, 25.3%）, and the differences were significant（P〈0.05）; the score of satisfac- tion towards nursing in the experimental group was significantly higher than that in the control group, and the differ- ence was significant （P〈0.05）. Conclusion The influencing factors of self-extubation of oral tracheal intubation in ICU patients are mainly improper restraint, patients＂ self-tube discharge, and patients＂ restlessness. The implementation of comprehensive nursing care should be carried out clinically to reduce the self-extubation rate and mortality rate, and improve the satisfaction towards nursing care in the patients.