集束化护理措施对重型颅脑损伤呼吸机辅助通气患者VAP及压疮发生的影响研究

Study on the Effect of Clustered Nursing Measures on the Occurrence of VAP and Pressure Ulcers in Patients with Severe Head Injury and Ventilator Assisted Ventilation

目的研究集束化护理措施对重型颅脑损伤呼吸机辅助通气患者VAP及压疮发生的影响。方法方便选取2018年2月—2019年10月期间该院收治的106例重型颅脑损伤呼吸机辅助通气患者为研究对象,将其随机分为对照组(常规护理组)53例和观察组(集束化护理措施组)53例。比较两组的VAP及压疮发生率、护理前后的局部状态积分。结果观察组的VAP(护理3 d:0.00%,护理7 d:0.00%),与对照组同时期比差异有统计学意义(χ^2=4.157、5.248,P=0.041、0.022),压疮发生率(护理3 d:0.00%,护理7 d:1.89%),与对照组同时期比显著低于对照组,差异有统计学意义(χ^2=5.248、4.867,P=0.022、0.027),护理前两组的局部状态积分比较,差异无统计学意义(P>0.05),护理后不同时间观察组的局部状态积分[护理3 d红、肿分别为:(0.78±0.10)分、(0.91±0.10)分,护理7 d红、肿分别为:(0.35±0.06)分、(0.60±0.08)分]均显著优于对照组,差异有统计学意义(t=9.321、8.855、24.752、11.370,P<0.05)。结论集束化护理措施可有效控制重型颅脑损伤呼吸机辅助通气患者的VAP及压疮发生率。

Objective To study the effect of clustered nursing measures on the occurrence of VAP and pressure ulcers in patients with severe head injury and ventilator assisted ventilation.Methods From February 2018 to October 2019,106 patients with severe head injury ventilator assisted ventilation were convenient selected as the research objects,and they were randomly divided into a control group(routine care group),53 cases and an observation group(clustered nursing measures)53 cases.The incidence of VAP and pressure ulcers and the scores of local state before and after nursing were compared between the two groups.Results The VAP of the observation group(3 d nursing:0.00%,7 d nursing:0.00%),compared with the control group,the difference was statistically significant(χ^2=4.157,5.248,P=0.041,0.022),pressure sore incidence(3 d nursing:0.00%,nursing 7 d:1.89%,compared with the control group in the same period,it is significantly lower than the control group,the difference was statistically significant(χ^2=5.248,4.867,P=0.022,0.027),there was no statistically significant difference in the scores of local state(P>0.05).The scores of local state of the observation group at different times after nursing[red and swollen in 3 days of nursing:(0.78±0.10)points and(0.91±0.10)points,respectively,redness and swelling at 7 days of nursing was(0.35±0.06),(0.60±0.08)points,which was significantly better than the control group,the difference was statistically significant(t=9.321,8.855,24.752,11.370,P<0.05).Conclusion Cluster nursing measures can effectively control the incidence of VAP and pressure ulcers in patients with severe head injury with ventilator-assisted ventilation,and it is worthy of popularization and application in patients with severe head injury with ventilator-assisted ventilation.