基于故障树理论和eCASH理念的ICU患者镇静镇痛管理策略

Construction and application of ICU sedative and analgesic management strategy based on Fault Tree Theory and eCASH(early Comfort using Analgesia,minimal Sedatives and maximal Humane care)concept

目的基于故障树理论构建ICU患者镇静镇痛管理策略,并进行应用。方法通过故障树分析法明确镇静镇痛的现存问题,基于eCASH镇静模式,构建了统一评估工具与方法、严密监测镇静效果与再评估、加强相关培训与考核、落实镇静镇痛护理措施、镇静镇痛追踪的综合管理策略,通过半年的临床应用,明确ICU镇静镇痛管理策略的效果。结果通过实施镇静镇痛综合管理策略,ICU机械通气患者浅镇静率达57.98%,谵妄发生率降至26.67%,平均机械通气时间由7.63 d降至6.57 d,ICU平均住院时间由8.94 d降至7.25 d,与实施前比较,差异有统计学意义(P<0.05)。结论在eCASH镇静镇痛管理原则指导下,基于故障树理论构建的ICU镇静镇痛管理策略,能有效改善机械通气患者的镇静镇痛效果。

Objective To construct an ICU sedative and analgesic management strategy based on Fault Tree Theory,and eCASH(early Comfort using Analgesia,minimal Sedatives and maximal Humane care)concept,and apply it into clinical practice.Methods We used Fault Tree Theory to figure out the existing problems of sedation and analgesic procedures.Then by referencing to eCASH concept,we established the ICU sedative and analgesic management strategy,which includes unified assessment tools and methods,close monitoring of sedative effect and reevaluation,trainings and exams,implementation of sedation and analgesia nursing measures,tracking the effects of sedation and analgesia.Later,we applied it into practice for six months.Results By the application of ICU sedative and analgesic management strategy,the light sedation rate increased to 57.98%,the incidence rate of delirium reduced to 26.67%,the average mechanical ventilation time descended from 7.63 days to 6.57 days,and the ICU average length of time reduced from 8.94 days to 7.25 days(P<0.05 for all).Conclusion With the guidance of eCASH concept,the ICU sedative and analgesic management strategy based on Fault Tree Theory can effectively improve the sedative and analgesic effect of patients undergoing mechanical ventilation.