急性生理学和慢性健康状况评分联合诺顿评分在ICU患者护理中的应用

目的探讨急性生理学和慢性健康状况评分(acute physiology and chronic health evaluation,APACHEⅡ)联合诺顿压疮发生危险因素量化评估(又称NORTON评分)在ICU患者护理中应用的效果。方法便利抽样法选择2010年1月至2011年6月在杭州市第一人民医院ICU治疗的130例危重患者作为研究对象,按随机数字表法将其分为观察组(n=65)和对照组(n=65)。观察组患者每天进行动态APACHEⅡ及NORTON评分,并根据评分结果调整护理人员配置和实施护理对策;对照组患者按疾病种类实施常规护理。比较两组危重患者ICU住院时间、医疗费用、压疮发生率、患者或家属对护理工作的满意度、护士自身成就感、压力感及护士长对护理质量检查的满意度。结果观察组患者ICU住院时间、医疗费用、压疮发生率均明显低于对照组,且其对护理工作的满意度均高于对照组,差异均有统计学意义(均P<0.05)。观察组护士对自身的成就感以及护士长对其护理质量检查的满意度均高于对照组,压力感低于对照组,差异均有统计学意义(均P<0.05)。结论 APACHEⅡ评分及NORTON评分的联合应用有利于提高护士对疾病严重程度的评估能力,并指导护理人力的合理调配,提高护理质量及患者或家属的满意度,提高护士对自身的成就感以及护士长对护理质量检查的满意度,减轻护士的压力感。

Application of Acute Physiology and Chronic Health Evaluation and Norton Pressure Ulcer Risk Factors for Quantitative Assessment on Nursing of ICU Patients

Objective To explore the role of acute physiology and chronic health evaluation（APACHE Ⅱ） and Norton pressure ulcer risk factors for quantitative assessment（NORTON scale） in ICU patients.Methods From January 2010 to June 2011,130 ICU patients in the hospital were randomized into observation group（n=65） and control group（n=65）.Patients in the observation group were scored with APACHE Ⅱand NORTON scale everyday continually,and the corresponding nursing intervention projects were adopted according to APACHE Ⅱand NORTON scores.Routine nursing cares were used for the control group.The difference indexes of length of stay in ICU,cost,bedsore morbidity,rate of satisfaction in nurses and patients,nurse＇s own sense of accomplishment and pressure size and satisfaction of quality check for head nurse were compared between the observation group and the control group.Results The indexes of the observation group for length of stay in ICU,cost,bedsore morbidity were lower than those of the control group（P0.05）.The levels of satisfaction for patients and nurses in the observation group were higher than those in the control group（P0.05）.The level of the sense of accomplishment and satisfaction of quality check for head nurse in the observation group were higher than those in the control group.The sense of pressure of the observation group were significantly lower than those in the control group（P0.05）.Conclusion APACHE Ⅱ and NORTON scale helps nurse evaluate the severity of the disease,guide the rational deployment of the nursing workforce,implement the appropriate nursing interventions to improve quality of care and satisfaction of patients or families,improve the nurse＇s ownsense of accomplishment as well as the head nurse satisfaction,check the quality of care and reduce the sense of pressure for nurses.