集束化干预策略对高原ICU机械通气患者呼吸机相关性肺炎的预防效果

Application effect of cluster intervention strategy in preventing ventilator-associated pneumonia in ICU patients with mechanical ventilation at high altitudea

目的探讨实施集束化干预策略对预防高原ICU机械通气患者呼吸机相关性肺炎(VAP)的效果,为高原地区VAP预防策略提供依据。方法选取青海省人民医院ICU行机械通气的患者作为研究对象,其中2017年4至12月入院未实施集束化护理策略的418例患者为对照组,2018年2至10月入院实施集束化干预策略的437例患者为观察组。比较2组患者的机械通气时间、ICU住院时间、VAP发生率、误吸发生率、气囊压力监测情况及2组医务人员手卫生依从性情况。结果观察组机械通气时间及ICU住院时间均显著短于对照组,2组间比较差异有统计学意义[机械通气时间:(5.94±4.17)d vs(9.72±5.66)d,t=11.14,P<0.001;ICU住院时间:(9.63±6.41)d vs(14.48±8.30)d,t=9.55,P<0.001];VAP及误吸发生率均少于对照组,2组间比较差异有统计学意义(VAP发生率:3.4%和8.1%,χ^(2)=9.39,P=0.001;误吸发生率:0.7%vs 2.2%,χ^(2)=4.82,P=0.030);气囊压力监测达标率高于对照组,2组间比较差异有统计学意义(96.4%vs 61.7%,χ^(2)=2.50,P<0.001)。观察组医务人员手卫生依从性高于对照组,2组间比较差异有统计学意义(79.0%vs 48.5%,χ^(2)=4.76,P<0.001)。结论集束化干预策略可有效缩短机械通气时间、ICU住院时间,减少高原地区VAP及误吸的发生率,提高气囊压力监测达标率及医护人员手卫生依从性,值得临床应用。

Objective To explore the application effect of cluster intervention strategy in preventing ventilator-associated pneumonia(VAP)in ICU patients with mechanical ventilation at high altitude,and to provide basis for VAP prevention strategy at high altitude.Methods 418 patients with mechanical ventilation in ICU of Qinghai Provincial People's Hospital from April to December 2017 were selected as the control group,and 437 patients with cluster intervention strategy from February to October 2018 were selected as the observation group.The duration of mechanical ventilation,length of ICU stay,incidence of VAP,incidence of aspiration,monitoring of air bag pressure,and hand hygiene compliance of medical staff in the two groups were compared.Results The mechanical ventilation time and ICU hospitalization time in the observation group were significantly less than those in the control group,the differences between the two groups were statistically significant[mechanical ventilation time:(5.94±4.17)d vs(9.72±5.66)d,t=11.14,P<0.001;ICU hospitalization time:(9.63±6.41)d vs(14.48±8.3)d,t=9.55,P<0.001];the incidence of VAP in the observation group was less than that in the control group,the difference between the two groups was statistically significant(3.4%vs 8.1%,χ^(2)=9.39,P=0.002);the incidence of aspiration in the observation group was significantly less than that in the control group,the difference between the two groups was statistically significant(0.7%vs 2.2%,χ^(2)=4.82,P=0.030);the qualified rate of artificial airway balloon pressure management in the observation group was higher than that in the control group,the difference between the two groups was statistically significant(96.4%vs 61.7%,χ^(2)=2.50,P<0.001);the hand hygiene compliance was higher than that in the control group,the difference between the two groups was statistically significant(79.0%vs 48.5%,χ^(2)=4.76,P<0.001).Conclusion Cluster intervention strategy can effectively reduce mechanical ventilation time,ICU hospitalization time,the incidence of VAP and aspiration in plateau area,improve the qualified rate of artificial airway balloon management and hand hygiene compliance of medical staff,which is worthy of clinical application.