儿科体外膜肺氧合医护每日核查单的构建及效果评价

Construction and evaluation of daily checklist for pediatric extracorporeal membrane oxygenation

目的为了更好地提高儿科体外膜肺氧合(ECMO)临床结局和监护质量,临床医护团队设计了儿科ECMO应用期间的医护每日核查单用于临床并进行效果评价。方法基于临床共识和多中心ECMO患儿的结局指标构建每日核查表单,将2015年1月至2017年5月ECMO患儿27例为应用前组,2017年6月至2018年12月应用医护每日核查单的ECMO患儿51例为应用后组,比较2组患儿临床结局。结果78例患儿均使用的是静-动脉体外膜肺氧合(VA-ECMO)。应用后组院内病死率49.02%(25/51)显著低于应用前组的81.48%(22/27),差异有统计学意义(χ2=7.768,P=0.005)。应用前组患儿深静脉导管的感染率、压疮发生率以及入院期间体质量变化率分别为2/5、4/5、-2.70(-3.50^-2.05),应用后组分别为3.85%(1/26)、26.92%(7/26)、-0.09(-1.00~0.00),2组比较差异有统计学意义(χ2=4.505、5.161,Z=3.252,P<0.05或0.01)。结论VA-ECMO患儿使用每日核查表进行管理有助于临床追踪多脏器的进展,并通过临床目标值和细节的设定,便于团队的沟通,提升护理管理细节。

Objective To improve the clinical outcomes and critical care quality for pediatric extracorporeal membrane oxygenation (ECMO), the multidisciplinary team including doctors, nurses and respiratory therapist designed a daily checklist for patients with ECMO and evaluated the effect of the checklist. Methods A daily checklist for ECMO patients was designed based on the expert consensus and multi-centers relevant researches. ECMO patients from January 2015 and May 2017 in the pre-application group, while the other patients from June 2017 to December 2018 in the post-application group were compared in the clinical outcomes. Results All 78 pediatric patients used the venoarterial extracorporeal membrane oxygenation (VA-ECMO) including 27 patients in the pre-application group and the other 51 patients in the post-application group. The mortality rate was 49.02%(25/51) in the post-application group and 81.48%(22/27) in the pre-application group, the differences were significant (χ2=7.768, P=0.005). The rates of central line-associated bloodstream infection, pressure injury and the body weight change was 2/5, 4/5,-2.70(-3.50--2.05) in the pre-application group and 3.85%(1/26), 26.92%(7/26),-0.09(-1.00-0.00) in the post-application group,the differences were significant (χ2=4.505, 5.161, Z=3.252, P<0.05 or 0.01). Conclusions It is helpful for clinical staff to follow up the progress of the multiple organs when using the daily checklist, to facilitate team communication for, and to improve nursing management through setting the daily targets for individual VA-ECMO patients.