中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2009年
11期
660-663
,共4页
宋海晶%刘京涛%高素芹%莫嫣娉%刘芳%马朋林
宋海晶%劉京濤%高素芹%莫嫣娉%劉芳%馬朋林
송해정%류경도%고소근%막언빙%류방%마붕림
呼吸机集束化治疗%依从性%有效性%呼吸机相关性肺炎
呼吸機集束化治療%依從性%有效性%呼吸機相關性肺炎
호흡궤집속화치료%의종성%유효성%호흡궤상관성폐염
ventilator bundle%compliance%validity%ventilator associated pneumonia
目的 探讨呼吸机集束化治疗(Bundle)临床实施的依从性以及对呼吸机相关性肺炎(VAP)的预防作用.方法 采用单中心前后对照研究.将呼吸机Bundle 实施前1年(对照组)以及实施后2年(干预组)本院重症监护病房(ICU)收治的18～80岁、机械通气时间≥48 h的患者纳入本研究.观察干预组患者呼吸机Bundle治疗的达标率,以及两组患者的VAP发生率、机械通气时间和28 d病死率.结果 本研究中共入选患者237例,对照组71例,干预组166例.两组患者间性别、年龄、疾病种类以及急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分差异无统计学意义(P均>0.05);机械通气时间[对照组(5.9±5.6)d,干预组(5.2±6.1)d]、VAP发生率(对照组21.1%,干预组20.5%)以及28 d病死率(对照组16.9%,干预组19.8%)均未发生显著改变.干预组34.3%(57/166)的患者全部达到呼吸机Bundle 4项治疗目标要求;机械通气≤3 d、4～7 d、>7 d患者的达标率分别为62.5%(35/56)、22.1%(21/95)、6.7%(1/15).在Bundle 4项内容中,床头抬高≥30°达标率最差,为43.4%(72/166);每日唤醒加脱机试验、预防消化性溃疡及深静脉血栓形成3项措施的达标率相对较好[分别为92.2%(153/166)、88.0%(146/166)、83.1%(138/166)].结论 呼吸机Bundle较差的临床依从性是影响其有效性的重要因素.
目的 探討呼吸機集束化治療(Bundle)臨床實施的依從性以及對呼吸機相關性肺炎(VAP)的預防作用.方法 採用單中心前後對照研究.將呼吸機Bundle 實施前1年(對照組)以及實施後2年(榦預組)本院重癥鑑護病房(ICU)收治的18～80歲、機械通氣時間≥48 h的患者納入本研究.觀察榦預組患者呼吸機Bundle治療的達標率,以及兩組患者的VAP髮生率、機械通氣時間和28 d病死率.結果 本研究中共入選患者237例,對照組71例,榦預組166例.兩組患者間性彆、年齡、疾病種類以及急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分差異無統計學意義(P均>0.05);機械通氣時間[對照組(5.9±5.6)d,榦預組(5.2±6.1)d]、VAP髮生率(對照組21.1%,榦預組20.5%)以及28 d病死率(對照組16.9%,榦預組19.8%)均未髮生顯著改變.榦預組34.3%(57/166)的患者全部達到呼吸機Bundle 4項治療目標要求;機械通氣≤3 d、4～7 d、>7 d患者的達標率分彆為62.5%(35/56)、22.1%(21/95)、6.7%(1/15).在Bundle 4項內容中,床頭抬高≥30°達標率最差,為43.4%(72/166);每日喚醒加脫機試驗、預防消化性潰瘍及深靜脈血栓形成3項措施的達標率相對較好[分彆為92.2%(153/166)、88.0%(146/166)、83.1%(138/166)].結論 呼吸機Bundle較差的臨床依從性是影響其有效性的重要因素.
목적 탐토호흡궤집속화치료(Bundle)림상실시적의종성이급대호흡궤상관성폐염(VAP)적예방작용.방법 채용단중심전후대조연구.장호흡궤Bundle 실시전1년(대조조)이급실시후2년(간예조)본원중증감호병방(ICU)수치적18～80세、궤계통기시간≥48 h적환자납입본연구.관찰간예조환자호흡궤Bundle치료적체표솔,이급량조환자적VAP발생솔、궤계통기시간화28 d병사솔.결과 본연구중공입선환자237례,대조조71례,간예조166례.량조환자간성별、년령、질병충류이급급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분차이무통계학의의(P균>0.05);궤계통기시간[대조조(5.9±5.6)d,간예조(5.2±6.1)d]、VAP발생솔(대조조21.1%,간예조20.5%)이급28 d병사솔(대조조16.9%,간예조19.8%)균미발생현저개변.간예조34.3%(57/166)적환자전부체도호흡궤Bundle 4항치료목표요구;궤계통기≤3 d、4～7 d、>7 d환자적체표솔분별위62.5%(35/56)、22.1%(21/95)、6.7%(1/15).재Bundle 4항내용중,상두태고≥30°체표솔최차,위43.4%(72/166);매일환성가탈궤시험、예방소화성궤양급심정맥혈전형성3항조시적체표솔상대교호[분별위92.2%(153/166)、88.0%(146/166)、83.1%(138/166)].결론 호흡궤Bundle교차적림상의종성시영향기유효성적중요인소.
Objective To investigate the compliance of ventilator bundle implementation and its preventive effect on ventilator associated pneumonia (VAP). Methods A before and after design was used in this single center study. Patients aged from 18 to 80 years,with mechanical ventilation (MV) duration over 48 hours were recruited during 1 year before (control group) and 2 years after bundle implementation (intervention group). Measurements included the rate of successful ventilator bundle implementation in intervention group,incidence of VAP,duration of MV and mortality within 28 days in both groups. Results A total number of 237 patients,including 71 patients in control arm and 166 patients in intervention arm,were recruited in this study. There was no statistical significance in ratio of sex,mean age,category of diseases or mean acute physiology and chronic health evaluationⅡ (APACHEⅡ) score between two groups (all P>0.05). Significant changes were not found in MV duration [(5.9±5.6) days vs. (5.2±6.1) days],incidence of VAP (21.1% vs. 20.5%) and mortality within 28 days (16.9% vs. 19.8%) between control and intervention group as well. In intervention group,57 of 166 (34.3%) patients were successfully implemented all of four ventilator bundle items. The successful rate of ventilator bundle implementation were 62.5% (35/56),22.1% (21/95) and 6.7% (1/15) in patients received MV duration ≤3 days,47 days and >7 days respectively. Among the four items of the bundle,head of bed elevation ≥30°had the lowest successful rate [43.4% (72/166)]. But it was much better in the implementation of daily wake-up plus weaning,prevention of peptic ulcer and prevention of deep vein thrombosis formation [92.2% (153/166),88.0% (146/166) and 83.1% (138/166) respectively]. Conclusion The poor compliance of ventilator bundle is an important factor in impacting the efficacy of ventilator bundle.
