儿科气管插管非计划性拔管现况调查与分析

目的:描述气管插管非计划性拔管在某儿科医院发生现状,分析其原因并探讨对策。方法:前瞻性研究,采用方便抽样法,使用自行设计的非计划性拔管登记表对2010年10月至2011年6月上海市某三级甲等儿科医院三个重症监护室留置气管插管的患儿进行调查。结果:本次调查共收集247例有效记录,其中27例(10.9%)共发生33次非计划性拔管,按例次计算得出非计划性拔管率为11.2%,按置管日计算拔管率为1.77次/100个置管日,新生儿组的重新置管率为66.7%,普通患儿组的重新置管率为88.9%。当班护士年资、护理人力配置、患儿年龄、肢体约束情况、镇静剂的使用为非计划性拔管的影响因素。结论:加强对护士的培训、提高年轻护士的评估和预见能力、增加护理人力配置、合理使用镇静剂、有效的肢体约束均可以减少非计划性拔管的发生。

The current status of unplanned extubation in pediatric intensive care units

Objectives： To describe the current status of unplanned extubation（UEX） in pediatric intensive care units（ICUs）, to analyze their causes and to explore the coutermeasures. Methods： A prospective study by convenience sampling was delivered and self-designed record form was used to investigate patients with tracheal intubation in three ICUs in a Grade Three Class A Children＇s hospital in Shanghai from October 2010 to May 2011. Results： Totally 247 patients were recorded effectively and 27 children （10：9%）underwent 33 UEXs. The UEX rate was 11.2% and 1.77 events per 100 intubation days. The reintubation rates of neonates and general patients was 66.7% and 88.9%, respectively. The risk factors of UEX were associated with working years of on duty nurses, nursing manpower, children＇s age, physical constrains and sedation usage. Conclusions： We should strengthen young nurses＇ training to improve their assessment and predictability abilities, increase nursing manpower, use sedation properly, and restrict body effectively to reduce UEX.