ICU颈脊髓损伤患者床旁气管切开术核查单的编制与应用

Preparation and application of bedside tracheotomy checklist for patients with cervical spinal cord injury in ICU

目的探讨核查单在重症监护病房颈脊髓损伤患者行床旁气管切开术的应用效果。方法通过证据汇总和Delphi专家咨询编制核查单。选取2019年1月至2020年1月某三甲医院重症监护病房收治的颈脊髓损伤在气管插管条件下行气管切开术患者80例作为研究对象。一病区40例患者作为对照组,采用气管切开术常规护理配合措施;二病区40例患者作为观察组,采用基于核查单管理的气管切开术护理配合措施。比较两组患者气管切开术各阶段所用时间、术中出血量、一次性置管成功率、医护配合满意度等。结果观察组患者评估时间、用物准备时间、气管切开时间均明显短于对照组,术中出血量明显低于对照组,一次性置管成功率、医护配合满意度均明显高于对照组,差异均有统计学意义(P<0.05)。结论使用编制的核查单能缩短床旁气管切开术时间,减少术中出血量,提高置管成功率,同时能提高医护配合满意度。

Objective Investigate the effect of bedside tracheotomy in ICU patients with cervical spinal cord injury.Methods To compile verification list through evidence collection and Delphi expert consultation.From January 2019 to January 2020,80 patients with cervical spinal cord injury admitted to ICU of a third-grade first-class hospital were selected by convenience sampling method,and tracheotomy under tracheal intubation conditions was taken as the research object.The patients were divided into control group and observation group according to the way of coin flipping.40 patients in one ward were treated as the control group.In the second ward,40 patients were treated by tracheotomy based on verification sheet management.The two groups were compared:duration of tracheotomy at each stage,intraoperative blood loss,success rate of one-time catheterization,and satisfaction with medical care.Results In the observation group with verification sheet,the duration of tracheotomy at each stage was shorter(min)than that in the control group.The evaluation duration was(10.89±1.00<15.39±1.00),the preparation duration was(6.280±0.56<9.34±0.81),and the tracheotomy duration was(24.23±0.73<33.01±1.54),all P<0.05.The intraoperative blood loss in the observation group was 7.75ml less than that in the control group(P<0.05).The success rate of one-time catheterization was higher than that of the control group(97.5%vs.87.5%,P=0.025).Medical cooperation satisfaction was higher than that of the control group:doctors to nurses(99.44%vs.83.33%,P<0.05),nurses to doctors(93.75%vs.62.5%,P<0.05).Conclusion The time of bedside tracheotomy can be shortened,intraoperative blood loss can be reduced,the success rate of catheterization can be improved,and the satisfaction of medical care can be improved.