摘要
目的探讨通过多准则决策分析法(MCDA)构建集束化干预策略,为神经重症患者早期拔除留置导尿管提供依据。方法检索文献并通过MCDA构建导尿管集束化干预策略,采用专家函询方式形成7个条目干预策略。采用便利抽样法选择神经重症患者122例为研究对象。选取2018年11月至2019年4月留置导尿管患者61例作为对照组,实施留置导尿管常规护理。选取2019年5—10月留置导尿管患者61例作为干预组,实施干预策略。比较2组患者拔管成功率、尿管留置天数及导尿管相关性泌尿系感染(CAUTI)发生率,并对干预组不同诊断患者留置导尿管相关指标进行分析。结果干预组留置尿管CAUTI发生率、成功拔除率、留置天数分别为39.3%(24/61)、32.79%(20/61)、17(14,22)d,对照组分别为59.0%(36/61)、8.19%(5/61)、21(15,27)d,2组比较差异有统计学意义(χ^(2)值为4.723、11.775,Z值为-9.211,P<0.05或0.01),达到早期拔除尿管的目的。在干预组的研究中,脑卒中患者尿管的留置时间在7~20 d,拔除导尿管的成功率最高为36.6%(15/41),与其他疾病比较差异有统计学意义(Z值为-2.448、-2.109,P<0.05)。结论MCDA构建导尿管拔除策略能够明显缩短神经重症患者尿管留置时间,提升早期拔管成功率,降低CAUTI率,为临床护理提供循证依据。
Objective To explore the establishment of a cluster intervention strategy by multi-criteria decision analysis(MCDA)to provide a basis for the early removal of indwelling catheters in severe neurological patients.Methods Through literature retrieval and MCDA,the catheter cluster intervention strategy was constructed,and the expert consultation was adopted to finally form 7 item cluster intervention strategies.The convenience sampling method was used to select 122 patients with severe neurological diseases as the research objects.A total of 61 patients with indwelling catheters from November 2018 to April 2019 were selected as the control group,and routine nursing care was performed according to indwelling catheters.A total of 61 patients with indwelling catheters from May 2019 to October 2019 were selected as the intervention group to compare the success rate of removing catheters,the number of days of indent catheters and the incidence of catheter-associated urinary tract infection(CAUTI)in the two groups,as well as to analyze the indicators related to indent catheters in the intervention group with different diagnoses.Results CAUTI incidence,successful catheter removal rate,indwelling days of catheter in the intervention group were 39.3%(24/61),32.79%(20/61),17(14,22)days,which were significantly higher than 59.0%(36/61),8.19%(5/61),21(15,27)days in the control group,and the difference was statistically significant(χ^(2) values were 4.723,11.775,Z value was-9.211,P<0.05 or 0.01);In the intervention group,stroke patients′indwelling time of catheter were 7-20 days,and the highest success rate of removing urinary catheters 36.6%(15/41),compared with other diseases,the difference was statistically significant(Z values were-2.448,-2.109,P<0.05).Conclusion MCDA construction of early catheter removal strategy can significantly shorten the indwelling time of the catheter in patients with severe neurological diseases,improve the success rate of early catheter extubation,reduce the CAUTI rate,to provide evidence-based
作者
张鑫
刘芳
龚立超
王晓英
Zhang Xin;Liu Fang;Gong Lichao;Wang Xiaoying(Department of Neurology,Xuanwu Hospital Capital Medical University,Beijing 100053,China)
出处
《中国实用护理杂志》
2021年第19期1446-1452,共7页
Chinese Journal of Practical Nursing
关键词
多准则决策法
集束化干预策略
拔除尿管
神经重症
Multi-criteria decision analysis
Bundled intervention strategy
Removing urinary catheters
Neurological intensive
