集束化管理措施对重症医学科呼吸机相关肺炎干预效果

Intervention effect of bundle management on ventilator-associated pneumonia in department of critical care medicine

目的探讨集束化管理降低重症医学科呼吸机相关肺炎(VAP)发病率的效果。方法选取2015年1月—2019年12月入住某院重症医学科行机械通气(MV)大于48 h的患者964例,根据入院时间及护理模式分为对照组(2015年1月—2016年12月)与干预组(2017年1月—2019年12月)。对照组采取常规护理管理措施,干预组在对照组基础上采取循环集束化管理模式,比较两组患者VAP发病率、住院期间病死率,以及MV患者多重耐药菌检出率、重症医学科多重耐药菌感染率。结果干预组665例患者,VAP发病率为12.95‰,住院期间病死率为4.06%;对照组299例患者,VAP发病率为25.79‰,住院期间病死率为10.37%,干预组患者VAP发病率及住院期间病死率均较对照组低(均P<0.05)。干预组患者多重耐药菌检出率低于对照组(12.77%VS 43.94%,P<0.05);干预组同期重症医学科患者多重耐药菌感染率低于对照组同期患者(0.52%VS 4.78%,P<0.05)。结论集束化管理措施可降低重症医学科VAP发病率、住院期间病死率,也可降低MV患者多重耐药菌检出率及感染率,值得临床推广应用。

Objective To analyze the effect of bundle management on ventilator-associated pneumonia(VAP) in department of critical care medicine. Methods From January 2015 to December 2019, 964 patients who were admitted in department of critical care medicine of a hospital and received mechanical ventilation(MV) for more than 48 hours were selected and divided into control group(January 2015-December 2016) and intervention group(January 2017-December 2019) according to admission time and nursing mode. Control group took routine nursing mana-gement measures, intervention group took cycle bundle management mode on the basis of control group. Incidence of VAP, mortality during hospitalization, detection rate of multidrug-resistant organism(MDRO) and infection rate of MDRO in department of critical care medicine were compared between two groups of patients. Results Among 665 patients in intervention group, incidence of VAP was 12.95 ‰, mortality during hospitalization was 4.06%;among 299 patients in control group, incidence of VAP was 25.79 ‰, mortality during hospitalization was 10.37%, incidence of VAP and mortality during hospitalization in intervention group were both lower than those in control group(both P<0.05). Detection rate of MDRO in intervention group was lower than that in control group(12.77% vs 43.94%, P<0.05);MDRO infection rates in patients in intervention group of department of critical care medicine was lower than that of control group during the same period(0.52% vs 4.78%, P<0.05).Conclusion Bundle management measures can reduce the incidence and mortality of VAP in department of critical care medicine, and can also reduce the detection rate and infection rate of MDRO in MV patients, which is worthy of clinical promotion and application.