临床儿科杂志 ›› 2015, Vol. 33 ›› Issue (5): 445-.doi: 10.3969 j.issn.1000-3606.2015.05.012

• 综合报道 • 上一篇    下一篇

综合干预策略降低新生儿呼吸机相关性肺炎的效果评估

疏恒,韦红,李洁,张传龙,许琼   

  1. 安徽医科大学附属六安医院新生儿重症监护室( 安徽六安 237005)
  • 收稿日期:2015-05-15 出版日期:2015-05-15 发布日期:2015-05-15
  • 通讯作者: 韦红 E-mail:weihong82134@sina.com
  • 基金资助:
    安徽省卫生计生委科研计划项目妇儿课题(No.14FR008)

Clinical practice of multidimensional strategy to reduce neonatal ventilator-associated pneumonia

SHU Heng, WEI Hong, LI Jie, ZHANG Chuanlong, XU Qiong   

  1. Department of Neonatal Intensive Care Unit, Liuan Affiliated Hospital of Anhui University, Liuan 237005, Anhui, China
  • Received:2015-05-15 Online:2015-05-15 Published:2015-05-15

摘要: 目的 探讨综合干预策略对降低新生儿呼吸机相关性肺炎(VAP)的临床效果。方法 选取2012年10月至2014年9月住院治疗、行有创机械通气(MV)≥48 h的新生儿为研究对象,其中2012年10月至2013年9月收治并采取经验性防治措施的患儿为对照组,2013年10月至2014年9月收治并采取综合干预策略的患儿为干预组。综合干预策略包括集束化策略,教育培训,对实施过程、结果的监测及反馈。对干预前后各措施实施情况进行量化评价,并比较VAP发生率。结果 相对于对照组,干预组手卫生依从性提升17.0%,吸痰操作、口腔护理、冷凝水及时清除、床头抬高以及抑酸剂使用的合格率分别提升11.4%、14.7%、18.2%、37.5%和56.3%,差异有统计学意义(χ2=36.47~294.36,P均<0.01);但抗生素使用合格率干预后仅为66.1%,与对照组(55.8%)的差异无统计学意义(P>0.05)。对照组和干预组的VAP发生率分别为41.7/1 000呼吸机使用日和19.7/1 000呼吸机使用日,差异有统计学意义(P<0.05);两组呼吸机使用率的差异无统计学意义(P>0.05)。结论 运用综合干预策略可有效降低VAP发生率。

Abstract:  Objective  To investigate the interventional effect of multidimensional strategy to reduce the incidence of neonatal ventilator-associated pneumonia. Methods The patients who were admitted to the NICU department and received mechanical ventilation (MV) for more than 48 hours from October 2012 to September 2014 were recruited. The control group received the experienced interventions from October 2012 to September 2013, neonates from October 2013 to September 2014 were recruited as the intervention group receiving multidimensional controlling strategy, including bundle care, education, process and outcome surveillance and feedback on the practices. The compliance of before-after implementation of interventions were quantitatively evaluated,and the rate of VAP was compared between the two groups. Results The compliance rate of hand hygiene and the qualified rate of sputum suction, oral care, drain condensation from ventilator circuit, semi-recumbent position, and preventing of stress-ulcers were increased 17.0%, 11.4%, 14.7%, 18.2%, 37.5% and 56.3% respectively after implementation of multidimensional strategy, and had statistical difference (χ2=36.47-294.36,P<0.01). But the qualified rate of antibiotic use only was 66.1% in the post-VAP bundle phases, and showed no statistical difference before and after(P>0.05). The VAP rate was 41.7 cases per 1000 MV-days during control group and 19.7 cases per 1000 MV-days during intervention group, had statistical significance (P<0.05). But the rate of ventilator application showed no statistical difference between two group (P>0.05).Conclusion The multidimensional strategy can effectively prevent the incidence of VAP.