气管内插管非计划拔管的护理因素和预后分析

Nursing factors and prognostic analysis Of unplanned extubation Of mechanical ventilation patients

目的探讨非计划拔管成功与失败的相关护理因素及其与预后的相关性 ,寻求改善预后的措施。方法回顾分析近 5年我们医院ICU中机械通气病人发生非计划拔管的护理临床资料。结果 1 6 5 6例机械通气病人中发生非计划拔管 1 1 6例 (7% ) ,病人自行拔管 90例 (77.5 % ) ,意外脱管 2 6例 (2 2 .4 % ) ,其中 6 2例发生在撤机过程中 ,5 4例发生在完全机械通气状况下。非计划拔管组与对照组在年龄、性别、插管途经、原发病情况、APACHEⅡ评分 ,急性呼衰原因和并发脏器衰竭等无显著差异 (P >0 .0 5 )。非计划拔管失败组与成功组和对照组比较 ,机械通气时间、住ICU时间和住院时间明显延长 ,死亡率无显著差异。结论机械通气病人发生非计划拔管可延长机械通气时间、住ICU时间和住院的时间 ,但不增加死亡率。拔管成功与否取决于拔管当时病人的通气状况。而护理人员对机械通气的病人更需要持续严密监护 。

Objeoctive Discussing the related nursing factors to success & failure of unplanned extubation and it's redationShip to prognosis,so to search the managements to improve prognosis.Methods Reviewing the clinical date of unplanned extubation in our ICU in the recent 5years.Results There are 116(7%)unplanned extubation unexpected 62 patients extubated in the course of weaning and 54 patients extubated in the state of completely mechanical ventilation.There isn't apparent difference between the unplanned extubation group and the contrast group in age?sex?intubation route?primary disease?APACHE Ⅱ scole?the cruse of acuterespiration failure?organ failure?mechanical ventilat period?ICU period and total hospital period are prolonged in the unplanned exmbation group.There isn't apparent difference in mortality between two groups.Conclusions Unplanned extubation of mechanical ventilation patient can prolong mechanical ventilation period?ICU period and total hospital period,but it doesn't increase mortality.Whether unplanned extubation succsseed or not depends on mechanical ventilation condition at that time.The nursing strategy should mornit patient on venilation on more closely and consistantly,helping patient improve realization of weaning and extubation.