ICU机械通气患者撤机后呼吸肌训练的循证实践

Evidence-Based Practice of Respiratory Muscle Training on Patients Withdrawn from Mechanical Ventilation in the ICU

目的将重症监护病房(intensive care unit,ICU)机械通气患者撤机后呼吸肌训练的最佳证据应用于临床实践并评价其效果。方法运用循证护理的方法,将获取的最佳证据应用于临床,比较循证实践前后上海市某三级甲等医院ICU机械通气患者撤机后肺功能、再插管率以及ICU住院时间,以及护士对ICU机械通气患者撤机后呼吸肌训练知识问卷得分和各个审查指标的执行情况。结果证据应用后,ICU机械通气撤机患者呼气峰流速及第1 s用力呼吸容积均有所改善,撤机后ICU住院时间缩短,护士的知识问卷得分以及对审查指标的执行率有所提高(均P<0.05)。结论开展基于最佳证据的循证实践,能够有效改善ICU机械通气撤机患者的肺功能,提高ICU护士对相关知识的掌握程度,缩短证据与临床实践的差距,从而提高护理质量。

Objective To apply the best evidence of respiratory muscle training for patients with mechanical ventilation in ICU after machine withdrawal to the clinical practice and to evaluate its effects.Methods An evidence-based nursing approach was used to apply the best evidence obtained to the clinical practice and to compare the pulmonary function,re-intubation rate,length of stay in ICU,nurses’scores on a questionnaire on their knowledge of respiratory muscle training of patients in the ICU after machine withdrawal and the implementation of each review index before and after evidence-based practice in a tertiary A hospital in Shanghai.Results After the application of the evidence,there was an improvement in PEF and FEV1 in mechanically ventilated patients in the ICU who were withdrawn from the machine,a reduction in the length of stay in the ICU after withdrawal,and an improvement in nurses’score on the knowledge questionnaire as well as in their implementation of the review indexes(all P<0.05).Conclusions Carrying out evidence-based practice based on the best evidence can effectively improve the lung function of ICU patients withdrawn from mechanical ventilation,increase ICU nurses’master of relevant knowledge,and shorten the gap between evidence and clinical practice,thus improving nursing quality.