54例老年COPD患者拔气管导管失败原因回顾性分析及护理对策

Retrospective Analysis and Nursing Countermeasures of 54 Elderly Patients Failed to Extubate Endotracheal Tube with COPD

目的探讨老年COPD使用呼吸机的患者中出现拔管失败的原因并回顾性分析和提出护理对策。方法采用回顾性分析的方法,选取2016年8月至2019年4月我科收治的621例老年COPD患者需要气管插管呼吸机辅助呼吸的,其中54例患者出现了拔管失败的不良结局。分析其一般资料、病情资料、拔管前处置情况,插管发生的时间及当班护士的资料。运用构成比及频数进行描述分析,使用χ2检验,以P<0.05表示有统计学意义。结果大于80岁、合并共病和Ⅱ型呼吸衰竭的COPD患者发生重插管率对比其所在分组差异有统计学意义,P<0.05;低年资和初级职称护士与高年资中高级职称护士相比,发生重插管率差异没有统计学意义,P>0.05;APN各班次相比,重插管发生率差异没有统计学意义,P>0.05,但A班发生重插管例数较多。结论数据表明老年COPD患者中出现重插管的重点人群指明了临床护理工作的方向;插管前应使用静脉用药和雾化吸入药物缓解患者症状;经过严格培训的低年资和低职称护士可一定程度弥补临床经验的不足,缩小与高年资和高级职称护士的差距;护理管理者及护理人员可以考虑在重点时段及重点班次加强人员配置,并重视重点人群的拔管,从而降低护理人员的平均工作负荷,减少拔管失败出现重插管发生率。

Objective To explore the causes of extubation failure in elderly patients with COPD using ventilator,and to retrospectively analyze and put forward nursing countermeasures.Methods A retrospective analysis was used to select 621 elderly patients with COPD who needed tracheal intubation and ventilator-assisted breathing from August 2016 to April 2019 inour department.Fifty-four of them had adverse outcomes of extubation failure.The general information,the condition information,the disposal before extubation,the time of intubation and the data of nurses on duty were analyzed.Component ratio and frequency were used for descriptive analysis.Chi-square test was used to show statistical significance with P<0.05.Results The incidence of re-intubation in COPD patients over 80 years old with comorbidity and typeⅡrespiratory failure was significantly higher than that in their respective groups(P<0.05);there was no significant difference in the incidence of re-intubation between junior nurses and senior nurses(P>0.05);there was no significant difference in the incidence of re-intubation between APN time period.There was no significant difference in the incidence of re-intubation(P>0.05),but there were more cases of re-intubation in 8:01-16:00.Conclusion The data show that the key population of elderly patients with COPD who have re-intubation points out the direction of clinical nursing work;intravenous drug use and aerosol inhalation should be used before intubation to alleviate symptoms of patients;junior and junior nurses with strict training can make up for the shortage of clinical experience to a certain extent,reduce and senior and senior nurses.Nursing managers and nurses can consider strengthening staffing in key periods and shifts,and attaching importance to extubation of key groups,so as to reduce the average workload of nurses and the incidence of re-intubation in failure of extubation.