VAP集束化护理方案实施缺陷的相关因素分析

Relative factors on implementation defect of bundle care program in ventilator-associated pneumonia

目的探讨气管插管患者VAP预防集束化护理方案实施缺陷的相关因素。方法收集2015年l-6月北京某三甲医院内科ICU收治的72例气管插管患者的临床资料，按照是否存在集束化护理方案实施缺陷分为两组，缺陷组30例和非缺陷组42例，分析发生实施缺陷的相关因素。结果缺陷组患者Glasgow评分为（10．70±3．91）分，高于非缺陷组，差异有统计学意义（t=2．434，P=0．017）；缺陷组CRRT应用比例占50％，高于非缺陷组，差异有统计学意义（X^2=6．429，P=0．011）；缺陷组的护患比为（0．46±0．03）分，低于非缺陷组，差异有统计学意义（t=-2．060，P=0．043）。多因素分析显示，Glasgow评分高、CRRT应用、护患比偏低是发生VAP预防集束化护理措施实施缺陷的危险因素（P〈0．05）。结论VAP集束化护理方案实施缺陷不仅受工作人员个人知信行影响，还有许多来自患者和环境中的客观因素，管王单者廊当以积极的杰序廊对．从而改善护理结局。

Objective To explore the relative factors on implementation defect of bundle care program in prevention of ventilator-associated pneumonia（VAP） in patients with endotracheal intubation. Methods The clinical data of 72 patients with endotracheal intuhation in medical intensive care unit（MICU） of a class m grade A hospital in Beijing from January 2015 to June 2015 were collected. They were divided into the group of defect（n=30） and the group of non-defect（n=42） according to the existence of implementation defect of bundle care program. The relative factors of implementation defect were analyzed. Results The score of Glasgow was （10.70 ± 3.91） in the group of defect, which was higher than that in the group of non-defect（t=2.434, P=0.017）. The proportion of application of CRRT was 50% in the group of defect higher than that in the group of non-defect（ X^2=-2.434, P=0.011）. The nurse-patient ratio was （0.46± 0.03） in the group of defect lower than that in the group of non-defect（t=2.060, P=0.043）. The multi-factor analysis showed the high score of Glasgow, application of CRRT and low nurse-patient ratio was the risk factors of the occurrence of implementation defect of bundle care program in prevention of VAP（P 〈 0.05）. Conclusions The implementation defect of bundle care program in precaution of VAP is affected not only by the knowledge-attitude-practice of staff, but also by many objective factors from patients and environment. The managers should reply with a positive attitude so as to improve nursing outcomes.