《俯卧位通气治疗核查单》的设计及在重度ARDS病人中的应用研究

Study on the design and application of prone positioning ventilation treatment checklist in patients with severe ARDS

目的:设计《俯卧位通气治疗核查单》,指导医护人员安全实施重度急性呼吸窘迫综合征(ARDS)病人俯卧位通气治疗。方法:通过俯卧位通气治疗的相关循证指引及查阅相关文献设计形成《俯卧位通气治疗核查单》,并选择2019年1月—2020年4月执行俯卧位通气的病人为观察组,应用设计的核查单;2017年8月—2018年12月执行俯卧位通气的病人为对照组,不应用核查单。对比该核查单使用前后俯卧位通气治疗操作耗时、皮肤损伤及非计划性拔管等并发症发生率和医护人员使用核查单的体会。结果:观察组和对照组病人完成俯卧位用时分别为(8.32±2.34)min和(10.40±4.12)min,两组差异有统计学意义(t=-2.097,P=0.042);两组病人由俯卧位翻身至仰卧位用时分别为(7.64±2.87)min和(10.31±4.08)min,差异有统计学意义(t=2.548,P=0.014);两组病人发生皮肤损伤发生率比较,观察组明显低于对照组(P=0.027);且所有使用过核查单的ICU医护人员对《俯卧位通气治疗核查单》在临床的使用均给予了肯定。结论:将核查单运用于重度ARDS病人俯卧位通气治疗,有助于规范俯卧位通气的操作,提高俯卧位通气治疗执行率和安全性,使俯卧位通气容易发起和维持。

Objective:To design a prone position ventilation treatment checklist,guiding medical staff to safely implement prone position ventilation treatment for patients with severe ARDS.Methods:The "Prone Position Ventilation Treatment Checklist" was designed and formed through the relevant evidence-based guidelines for prone position ventilation treatment and related literature review,and patients who performed prone position ventilation from January 2019 to April 2020 were selected as the observation group,which applied the designed checklist;the patients who performed prone position ventilation from August 2017 to December 2018 were the control group,and the checklist was not used.Comparing the time-consuming operation of prone position ventilation treatment before and after the use of the checklist,the occurrence of complications such as skin damage and unplanned extubation,and the application experience of medical staff.Results:The time required for the patients in the observation group and the control group to complete the prone position was(8.32±2.34)min and(10.40±4.12)min,respectively.The difference between the two groups was statistically significant(t=-2.097,P=0.042);The time required for the patient to change from the prone position to the supine position was(7.64±2.87)min and(10.31±4.08)min,respectively,and the difference was statistically significant(t=2.548,P=0.014);the incidence of skin injury in the two groups In comparison,the observation group was significantly lower than that in the control group(P=0.027);and all the ICU medical staff who had used the "Prone Ventilation Treatment Checklist" affirmed the clinical practicing.After being applied to the clinic,the operation time of prone position ventilation treatment is shortened while ensuring the safety of patients,reducing the occurrence of complications such as skin damage and unplanned extubation,and improving the work experience and acceptance of medical staff.Conclusion:Applying the checklist to the prone position ventilation treatment of severe ARDS patients will help standardize the operation of prone position ventilation,improve the implementation rate and safety of prone position ventilation treatment,and make it easier to initiate and maintain prone position ventilation.