预防呼吸机相关性肺炎集束化护理方案的构建

Construction of a clustering solution to prevent the ventilator associated pneumonia

目的构建预防呼吸机相关性肺炎集束化护理方案,为ICU机械通气患者气道护理提供参考。方法以天津市护理质控中心制订的2016版《预防呼吸机相关性肺炎集束化护理策略》为基础,检索国内外文献,拟订气道管理方案;2019年10月—12月运用德尔菲法对17名专家进行2轮函询,征询专家意见,确定集束化护理方案。结果 2轮函询问卷的有效回收率均为100%,专家熟悉程度分别为0.92、0.96,权威系数为0.82、0.89;各级指标肯德尔和谐系数为0.088~0.485,均具有统计学意义(P<0.01)。最终形成包含10项策略、38条具体措施的集束化护理方案。结论该研究构建的预防呼吸机相关性肺炎集束化护理方案在原版策略的基础上,将预防"误吸"的理念更新为预防"微误吸",是一套科学、可靠、全面的方案,可为ICU临床护理实践提供参考。

Objective To construct a clustering solution for preventing the ventilator associated pneumonia(VAP)based on micro-aspiration,and to provide specific procedures for the airway care of mechanically ventilated patients in the intensive care unit. Methods Considering the 2016 version of "clustered nursing package for clinical strategies of preventing ventilator-associated pneumonia" by Tianjin Nursing Quality Control Center as the prototype,we formulated the airway management plans following evidence of domestic and foreign literature,and obtained expert opinions by the Delphi approach. Results 2 rounds of consultations have been taken from 17 experts from October to December 2019,and their positive coefficients were both 100%. The familiarity of the 2 rounds were 0.92 and 0.96,and the authoritative coefficients were 0.82 and 0.89. The coordination coefficients were 0.088 ~0.485,with variation the coefficients ranged from 0 to 0.239,all of which were statistically significant(P<0.01). Finally,a clustering plan with 10 strategies and 38 specific measures was constructed. Conclusion The clustering solution to prevent the VAP based on micro-aspiration was constructed in this research on the basis of the old package,but the concept of "aspiration" was updated to prevent "micro-aspiration". It was a scientific,reliable and practical program which would be beneficial for the clinical nursing in the intensive care unit.