血液肿瘤患儿脓毒症预防策略的构建及实施

The development and application of sepsis prevention and management strategies in children with hematologic malignancies

目的:构建血液肿瘤患儿脓毒症预防管理策略,并评价实施效果。方法:选择2018年4—9月及2019年4—9月在某三级甲等医院血液肿瘤科病房发生发热性中性粒细胞减少症的患儿及同期护士作为研究对象,其中2018年4—9月的患儿为对照组,给予常规护理;2019年4—9月的患儿为实验组,实施血液肿瘤患儿脓毒症预防管理策略。比较两组患儿脓毒症和脓毒性休克发生率、发热至用药各阶段耗时、首剂抗生素及时使用达标率等方面的差异,比较两组护士在知识掌握等方面的差异。结果:实验组血液肿瘤患儿脓毒症发生率显著低于对照组(P<0.05),两组脓毒性休克发生率无统计学差异(P>0.05)。首剂抗生素及时使用达标率、护士操作考核合格率显著提升,发热至用药耗时、开医嘱至用药耗时显著降低(P<0.05),两组护士理论测验合格率无统计学差异(P>0.05)。结论:血液肿瘤患儿脓毒症预防管理策略能提高管理效率,改善临床结局,提升护理质量。

Objective:To construct and evaluate the sepsis prevention and management strategies in children with hematologic malignancies.Methods:Pediatric patients with hematologic malignancies who occurred febrile neutropenia in the department of hematology and oncology of one AAA Children's hospital were selected as subjects.The patients admitted from April to September 2018 and nurses in the same periods were included in the control group,and implemented with routine care.The patients admitted from April to September 2019 were included in the intervention group and performed the sepsis prevention and management strategies in children with hematologic malignancies.The rate of sepsis,sepsis shock,time of each step,rate of timely use of first antibiotics of patients,and knowledge level of nurses were compared between the two groups.Results:In intervention group,the rate of sepsis was decreased(P<0.05),while rate of septic shock was not statistically significant(P>0.05).The rate of timely use of first antibiotics of patients,and practice level of nurses were significantly increased;the time interval from fever to medication and from prescription to medication were significantly decreased(P<0.05),while knowledge level of nurses was not statistically significant(P>0.05).Conclusion:The sepsis prevention and management strategies in children with hematologic malignancies can effectively improve the management efficiency,clinical outcome and quality of care.