集束化方案对降低危重症患者肠内营养相关误吸的效果研究

Effect of Care Bundles on Reducing Enteral Nutrition-Related Aspiration in Critically Ⅲ Patients

目的构建基于最佳证据的危重患者肠内营养相关误吸的集束化方案并评价其效果。方法构建基于循证的误吸管理集束化方案,通过临床审查以规范护士行为,比较应用方案前后误吸高危人群筛查率及发生率;通过对ICU护士进行方案培训,比较其对最佳证据的知晓度及执行情况。结果集束化方案应用后,误吸高危人群筛查率由20.39%提升为38.10%,误吸发生率由29.03%降至3.12%,差异均有统计学意义(均P<0.01);ICU护士对误吸的评估与识别、体位管理、气道管理、营养支持、镇静管理、口腔护理、药物预防等方面知识均较方案实施前有所提高,差异均有统计学意义(均P<0.05);ICU护士对集束化方案的各项执行率大于90%。结论基于循证最佳证据构建的集束化方案应用于临床,可有效降低危重症患者肠内营养误吸发生率、提升高危人群筛查率,值得临床推广使用。

Objective To construct the evidence-based care bundles for enteral nutrition-related aspiration in critically ill patients and evaluate its effectiveness.Methods The evidence-based care bundles for enteral nutrition-related aspiration in critically ill patients were constructed, which was used to standardize the behavior of nurses.The screening rate and incidence of aspiration in high-risk groups before and after the application of the program were compared. The nurses’ awareness and implementation of the best evidence were also compared through the program training for ICU nurses.Results After the care bundles were applied, the screening rate of high-risk groups of aspiration increased from 20.39% to 38.10%,and the incidence of aspiration decreased from 29.03% to 3.12%.The differences were statistically significant(all P<0.01).ICU nurses’ knowledge of assessment and identification of aspiration, body position management, airway management, nutritional support, sedation management, oral care and drug prevention were improved compared with those before implementing the program, the differences were statistically significant(all P<0.05).The implementation rate of ICU nurses on the care bundles was greater than 90%.Conclusions The application of the evidence-based care bundles can effectively reduce the incidence of enteral nutrition aspiration in critically ill patients and increase the screening rate of high-risk populations, which is worthy of clinical application.