集束化护理干预预防呼吸机相关性肺炎的效果及影响因素分析

Analysis of the effect and influencing factors of care bundle intervention on preventing ventilator-associated pneumonia

目的:探讨集束化护理干预对重症医学科机械通气患者呼吸机相关性肺炎(VAP)的预防效果及影响因素,为降低VAP的发生率提供理论依据。方法:对我院重症医学科2017年1月至2018年1月收治的247例机械通气患者进行集束化护理干预,采用单因素分析及二元Logistic回归分析护理干预的效果及相关影响因素。结果:247例机械通气患者中,发生VAP 45例,发生率为18.21%。年龄、是否存在意识障碍、是否气管切开、留置胃管、机械通气时间、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分、对护理干预依从性是患者发生VAP的影响因素(P<0.05),进一步分析显示,是否将患者床头抬高、是否对患者进行口腔护理、护理人员是否严格遵守无菌操作规程、是否定期清洁呼吸机管路、是否采用声门下吸引的气管导管,是患者发生VAP的影响因素(P<0.05)。结论:集束化护理干预措施下,影响重症医学科机械通气患者发生VAP的因素较多,应当进一步优化护理干预策略,以期降低VAP的发生率。

Objective: To investigate the preventive effect and influencing factors of care bundle intervention on ventilator-associated pneumonia(VAP) in patients treated with mechanical ventilation in critical care medicine department,and to provide intervention measures to reduce the incidence of VAP.Methods: The care bundle intervention strategy was applied to 247 patients receiving mechanical ventilation in our hospital from January 2017 to January 2018 in critical care medicine department, and the effects of nursing interventions and related influencing factors were analyzed by single factor analysis and binary logistic regression.Results: Among the 247 cases treated with mechanical ventilation, VAP occurred in 45 cases(18.21%).Age, disturbance of consciousness,tracheotomy,indwelling gastric tube,mechanical ventilation time,acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score and compliance with nursing intervention were the influencing factors of VAP(P<0.05).Further analysis showed that whether the patients sleep with the head of the bed elevated and oral care were given,nursing staff strictly adhere to the aseptic procedure and the ventilator line were cleaned regularly,and whether the endotracheal suction tube was used or not were the influencing factors of VAP(P<0.05).Conclusion: Many factors can influence the incidence of VAP in mechanical ventilation patients when care bundle intervention is conducted.The nursing intervention strategy should be further optimized to reduce the incidence of VAP.