CAJ | 학술논문

目的分析机械通气患儿意外拔管的原因,探讨有效干预对策.方法将我院儿科重症监护病房(PICU)2013年5月至2014年2月收治的气管插管行常规护理的患儿148例设为对照组,2014年3～12月收治的气管插管实施干预的患儿152例设为观察组,对其发生意外拔管的次数、人工气道方式和发生的原因及干预对策进行回顾性分析.结果对照组总带管日283 d,脱管19例次,脱管率6.7％;观察组总带管日253 d,脱管8例次,脱管率3.2％,2组比较差异有统计学意义,x2=5.25,P＜0.05.患儿意识状况异常是造成计划外拔管的主要原因,导管固定不牢占第二位因素,其次为患儿舒适度改变,护理操作不当致气管插管过短过浅等均可导致意外拔管.结论优化护理干预对策,对建立人工气道的患儿应高度重视意外拔管的预防干预,适度镇静、肢体约束、正确固定气管套管及呼吸机管道是有效的护理对策.
목적 분석궤계통기환인의외발관적원인,탐토유효간예대책.방법 장아원인과중증감호병방(PICU)2013년5월지2014년2월수치적기관삽관행상규호리적환인148례설위대조조,2014년3～12월수치적기관삽관실시간예적환인152례설위관찰조,대기발생의외발관적차수、인공기도방식화발생적원인급간예대책진행회고성분석.결과 대조조총대관일283 d,탈관19례차,탈관솔6.7％;관찰조총대관일253 d,탈관8례차,탈관솔3.2％,2조비교차이유통계학의의,x2=5.25,P＜0.05.환인의식상황이상시조성계화외발관적주요원인,도관고정불뢰점제이위인소,기차위환인서괄도개변,호리조작불당치기관삽관과단과천등균가도치의외발관.결론 우화호리간예대책,대건립인공기도적환인응고도중시의외발관적예방간예,괄도진정、지체약속、정학고정기관투관급호흡궤관도시유효적호리대책.
Objective To analyze the reasons for accidental extubation in infants during mechanical ventilation and to explore effective intervention countermeasures.Methods A total of 148 infants with accidental extubation from May 2013 to February 2014 who given routine nursing care were selected as control group.Another 152 infants with accidental extubation in pediatric intensive care unit (PICU) who given optimization nursing care from March to December 2014 were selected as observation group.Retrospective analysis of accidental extubation,artificial airway way and intervention care were conducted.Results The total intratracheal tube time was 283 d in control group and 253 d in observation group.Nineteen cases (6.7％) suffered accidental exudation in control group and that of 8 cases(3.2％) in observation group,and there was significant difference between two groups,x2=5.25,P＜0.05.The primary reason of unplanned extubation was that infants with unconsciousness,the second cause was the improper catheter fixed.The third cause was the patient's comfort level and so on the improper nursing operation leading to accidental extubation too short or too shallow.Conclusion Infants given mechanical ventilation should pay more attention to the intervention of accidental extubation,appropriate calm,physical constraints and correct fixed pipeline.