抬高机械通气患者床头医嘱执行情况的调查_王兰芳

抬高机械通气患者床头医嘱执行情况的调查

王兰芳,童小华,卢　谨,郑春美,吴志英

【摘要】　目的　调查抬高机械通气患者床头医嘱的执行情况,了解护理人员落实患者床头抬高30°～45°的准确性。方法　由专门培训的护士在观察日的9:00、15:00、21:00、3:00四个时点,使用自制量角器,对29例机械通气患者共测量1894例次床头抬高的角度,并按0°、1°～19°、20°～29°、30°～45°进行分类统计,同时将护士自查估计角度与研究人员所测结果进行比较。结果　在总计1894例次的测量中,床头抬高大于0°的共662例次,占测量总次数的34.95%;日间(9:00,15:00)床头抬高402次,夜间(21:00,3:00)床头抬高260次,两时段相比差异有统计学意义。床头准确抬高30°～45°的共311例次,占测量总次数的16.42%,但护士自查评估认为床头准确抬高30°～45°的有581例次,两者比较差异有统计学意义(P <0.01)。结论　机械通气患者的床头抬高现状未能达到美国疾病预防与控制中心预防指南的推荐要求,护士对抬高床头30°～45°的重要性认识不足及对实际抬高角度判断有偏差是其主要原因。 【关键词】　体位;机械通气;执行;呼吸相关性肺炎

【中图分类号】　R197.323 【文献标志码】　A 【文章编号】　1008-9993(2010)4B -0585-03

C linical Investigation on Compliance and Accuracy of Head -of -bed Elevation in Patients with Mechanical Ventilation

Wang Lan -fang ,Tong Xiao -hua ,Lu Jin ,Zheng Chun -mei ,Wu Zhi -y ing (ICU ,Zhejiang Provincial H o spital

of T raditio nal Chinese Medicine ,H angzhou 310006,China )

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Abstract 】　Objective To investigate the applica tion status of head -o f -bed elevation in patients w ith me -

chanical ventilatio n and identify the accuracy of nurses in adapting the elevatio n angle to 30°-45°.Methods The nurses were trained to use the self -angla r measurem ent tool to measure 1894cases o f the ang le of bed elevation at four points (9:00AM ,3:00PM ,9:00PM ,3:00AM )in 29patients with mechanical ventila -tions .The ang le of bed elevatio ns (0°、1°-19°、20°-29°、30°-45°)w ere classified statistically .The differences o f self -examination and evaluatio n form s betw een untrained nurses and researchers w ere com -pared .Results Of 1894cases of bed elevation angle m easurement ,the elev ated bed angles over 0°w ere ob -served in 662cases (34.95%).Significant differences w ere observed in the elev ation num bers be tw een day -time (9A M ,3PM ;402times )and nig httime (9PM ,3AM ;260times );Sig nificant differences we re o bse rved between the elevated bed angles of 30°-45°observed in 311cases (16.42%)and those (30°-45°)in 581cases detected by nurses 'self -examination and assessment (P <0.01).C onclusion Head -of -bed elev ation in patients w ith mechanical ventilatio n failed to meet clinical requirements of the preventio n g uidelines offerd by centers fo r disease control and prevention (CDC )of the United States m ainly due to the lack of full aw areness of importance of elevating the bed 30°-45°deg rees and the judg ement biases o n the actual elevation ang le of a deviatio n of nur ses .

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Key words 】　posture ;mechanical ventilation ;co mpliance ;ventilato r associated pneumonia

[Nurs J Chin PLA ,2010,27(4B ):585-586,624]

作者简介:310006杭州,浙江省中医院ICU 作者简介:王兰芳,本科,主管护师,主要从事ICU 临床护理与研究

呼吸机相关性肺炎(ventilato r associated pneu -m onia ,VA P )是指施行人工机械通气(mechanical

ventilatio n ,M V )治疗48h 以上并发,或原有肺部感染行M V 治疗48h 以上再发,并经病原学证实的一种医源性的肺部感染(多为细菌性肺炎)

[1]

。VAP

是IC U 的常见并发症,亦是导致患者死亡的重要原因。VAP 在M V 患者中的发生率为9%～69%,病死率为25%～76%;M V 每增加1d ,发生VAP 的危

险性增加1%～3%[2-3]。患者一旦发生VAP ,易造成

脱机困难、住院时间延长、住院费用增加,严重者危及患者生命[4]。美国疾病预防与控制中心发布了有关VAP 的预防指南[5],建议在没有医学禁忌的情况下,将床头抬高30°～45°作为预防VAP 的推荐方法。多