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程序化脱机方案在呼吸内科重症监护病房机械通气患者脱机过程中的临床实践 被引量:8

A clinical practice of protocol-directed weaning from mechanical ventilation in a respiratory intensive care unit
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摘要 目的实施有利于机械通气患者脱机的方法,缩短机械通气时间,促进患者早日康复。方法选择华中科技大学同济医学院附属同济医院呼吸内科重症监护病房(RICU)的机械通气患者为研究对象,将2018年1—11月入院的患者设为对照组,使用基于医生经验判断的脱机方法脱机。2019年同期在院的患者设为观察组,实施程序化脱机方案,比较两组患者的脱机成功率、撤机时间、总机械通气时间、RICU住院时间、总住院时间和脱机后24h内再行机械通气的发生率。结果程序化脱机方案提高了成功脱机率(29.8%vs 53.22%),缩短了撤机时间(9.14h vs 3.64h),降低了总机械通气时间(9.43 d vs 5.88 d)和RICU住院日(39.50 d vs 16.06 d)。两组患者在死亡率(25.5%vs 20.97%)、脱机后24 h内再行机械通气发生率(21.43%vs 3.03%)以及总住院日(43.50 vs27.06)方面的差异无统计学意义(P>0.05)。结论程序化脱机方案可以改善患者照护结局,在没有或者缺乏专职的呼吸治疗师的情况下,可以考虑将程序化脱机方案交由接受了培训的护士来实施。 Objective To implement a nurse-led weaning protocol in mechanically ventilated patients,shorten the time of mechanical ventilation(MV),and promote early recovery of patients.Methods Patients on MV from January to November 2018 in the Respiratory medicine intensive care unit(RICU)of a tertiary hospital in central China were included as the historical control group,and patients in the same period in 2019 were included as the intervention group.The rate of successfully weaning,weaning time,total mechanical ventilation time,RICU length of stay(LOS),hospital LOS,and the incidence of mechanical ventilation within 24 hours after weaning,were measured both groups.Results The nurse-led weaning protocol increased the successful weaning rate(29.8%vs 53.22%,P=0.014),shortened the weaning time(9.14h vs 3.64 h,P<0.001),and reduced the total mechanical ventilation time(9.43 day vs 5.88 day,P=0.045)and RICU LOS(39.50 day vs 16.06 day,P=0.030).There were no statistical significance(P>0.05)between the two groups on mortality(25.5%vs 20.97%,P=0.575),the incidence of mechanical ventilation within 24 hours after weaning(21.43%vs 3.03%,P=0.073),and the hospital LOS(43.50 vs 27.06,P=0.134).Conclusion A protocol for weaning from MV driven by RICU nurses decreased the duration of MV and ICU LOS in mechanically ventilated patients without adverse effects and was worth recommending.
作者 杨建国 何细飞 黄菊九 徐素琴 郑佳 刘春锋 赵豫鄂 郑娜 Yang Jianguo;He Xifei;Huang Jujiu;Xu Suqin;Zheng Jia;Liu Chunfeng;Zhao Yu'e;Zheng Na(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,430030)
出处 《护士进修杂志》 2021年第14期1281-1286,共6页 Journal of Nurses Training
关键词 机械通气 呼吸机脱机 程序化脱机 自主呼吸试验 撤机时间 Mechanical ventilation Ventilator weaning Weaning protocol Spontaneous breathing trial Weaning duration
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