某三级甲等医院模拟肺细菌污染现况调查

目的：调查某三级甲等医院各科模拟肺细菌污染状况并进行分析,以减少院内感染率。方法将9个科室的14个模拟肺分别进行内口及外口采样,进行细菌培养鉴定。同时调查各科模拟肺管理、存放环境、使用频率、呼吸机管道消毒方法及呼吸机使用过程中是否存在脱机时连接模拟肺等情况。结果调查样本中有6个模拟肺内口、2个模拟肺外口检测出致病菌,以铜绿假单胞菌、金黄色葡萄球菌、少动鞘氨醇单胞菌、念珠地丝菌等为主。各科均未建立规范的模拟肺管理及消毒制度,导致模拟肺存放不规范。结论模拟肺细菌污染率高,消毒及管理不规范,临床管理者应采取针对性措施,以减少患者院内感染的发生。     

Combination of ventilator care bundle and regular oral care with chlorhexidine was associated with reduction in ventilator associated pneumonia

BackgroundVentilator associated pneumonia (VAP) is an important source of morbidity and mortality in patients receiving mechanical ventilation. VAP is associated with prolongation of mechanical ventilation, ICU and hospital stay and increases in costs.MethodsQuality improvement project. Mechanically ventilated patients received oral care every 8 h with chlorhexidine 2%. A formal process was developed to evaluate compliance with the following ventilator bundle initiatives: head of the bed elevation to 30–45°, daily sedation vacation and assess the readiness to extubate, providing peptic ulcer disease prophylaxis and providing deep vein thrombosis prophylaxis (unless contraindicated).ResultsThe rate of VAP before starting the project, in the first 6 months of year 1431H, was 16.2 cases/1000 ventilator days. Six month after inception of the quality improvement project, the VAP rates decreased to 5.6 cases/1000 ventilator days at the end of 1431H, and at the end of 1432H, it was 5.5 cases/1000 ventilator days. This leads to significant reduction in mortality (adjusted according to APACHE II) from 23.4% to 19.1% (p value 0.024) and the length of stay in ICU from 9.7 to 6.5 days (p value 0.00002).ConclusionThe combination of regular oral hygiene with chlorhexidine 2% and rigorous implementation of ventilator care bundle was associated with significant reduction in VAP rate in mechanically ventilated patients. This has led to reduction in length of stay in ICU from 9.7 to 6.5 days and reduction in mortality from 23.4% to 19.1%.     

不同呼吸机湿化管道系统在老年机械通气患者中的应用效果对比

目的:探讨不同呼吸机湿化管道系统在老年机械通气患者中的应用效果。方法:选取老年机械通气患者140例,随机分为3组,其中A组(n=43)使用MR410型湿化管道系统,B组(n=47)使用MR730型湿化管道系统,C组(n=50)采用MR 850型一次性双加热式、自动加水加湿湿化管道系统。观察3组湿化效果、并发症发生情况、通气时间及管道护理情况。结果:C组湿化效果适中比例最高,其次为B组,A组最低,3组间差异有统计学意义(P<0.01)。C组无导管痰痂和气道痉挛的发生,A组发生率最高,3组间差异有统计学意义(P<0.01)。C组通气时间、管道总更换次数、呼吸机管道护理时数均低于A、B组,差异有统计学意义(P<0.01)。结论:使用MR850型一次性双加热式、自动加水加湿湿化管道系统湿化效果最好,能降低并发症发生率,缩短通气时间和护理工作量。     

探讨慢性阻塞性肺疾病行无创呼吸机治疗的临床护理

目的探讨慢性阻塞性肺疾病行无创呼吸机治疗的临床护理。方法通过对2012年6月至2013年10月在我院进行住院治疗慢性阻塞性肺病的52例患者,进行无创呼吸机治疗,及相应的护理措施。观察患者治疗前后的生理指标的变化情况。结果治疗后患者的Pa O2较治疗前明显提高,具有显著性差异(P<0.05),治疗后Pa CO2、RR明显降低,具有显著差异(P<0.05)说明其具有统计学意义。结论针对慢性阻塞性肺疾病行无创呼吸机治疗患者给予全面有效的护理,可以提高患者的生活质量,减轻患者痛苦,改善预后。     

Care practices for patients requiring mechanical ventilation more than seven days in Swedish intensive care units: A national survey

ObjectiveTo identify care practices in Swedish intensive care units specific to patients requiring mechanical ventilation for >7 days.Research MethodologyWe conducted a national cross-sectional survey inviting all adult Swedish ICUs (n = 79). Nurse managers were invited by email to complete a questionnaire by telephone. The questionnaire included seven domains: ventilator weaning, mobilisation, communication, nutrition, symptom assessment, psychosocial support and organisational characteristics.ResultsWe received responses from 77 units (response rate, 97%). Weaning protocols were available in 42 (55%) units, 52 (68%) used individualised weaning strategies and 50 (65%) involved physicians and nurses in collaborative decision making. In 48 units (62%), early mobilisation was prioritised using bed cycling but only 26 (34%) units had mobilisation protocols. Most of the intensive care units (74, 96%) had nutrition protocols but only 2 (3%) had dedicated dieticians. Delirium screening tools were available in 49 (64%) ICUs, 3 (4%) assessed anxiety and none assessed dyspnoea. Nineteen (25%) units employed a primary nursing model and 11 (14%) indicated person-centred care policies. Regular case conferences, including family participation, were held by 39 (51%) units.ConclusionWe found that an individualised approach to ventilator weaning, decided by physicians and nurses in collaboration, was the predominant approach, although weaning protocols were available in some intensive care units. Most units prioritised early mobilisation, though few used protocols. Nutritional protocols were widely adopted, as few units had a dedicated dietician.     

孟鲁司特钠治疗儿童呼吸道合胞病毒毛细支气管炎的临床评价

目的 评价孟鲁司特钠在呼吸道合胞病毒(RSV)感染的儿童毛细支气管炎治疗中的应用价值。方法 120 例确诊RSV 感染性毛细支气管炎的患儿随机分为2 组,对照组和治疗组各60 例。对照组采用常规疗法,治疗组在对照组基础上加用孟鲁司特钠5 mg/次、口服1 次/d,比较治疗7 d 后两组的疗效及预后。结果 治疗组患儿的咳嗽消失时间、喘憋消失时间、呼吸困难消失时间、肺部湿罗音消失时间、住院时间均显著的低于对照组(P< 0.01)。治疗第3、7 天两组患儿的尿白三烯E4(LTE4)、血清半胱氨酸白三烯(CysLTS)、血氧饱和度(TcSaO2)均较治疗前显著好转(P< 0.05),且治疗组优于对照组(P< 0.05)。治疗第7 天治疗组患儿的临床有效率为95%,显著高于对照组的83.33%(P< 0.05);治疗组的复发率为3.33%,显著低于对照组的13.33%(P< 0.05)。结论 孟鲁司特钠结合常规疗法治疗RSV 毛细支气管炎具有缩短治疗时间、尽快缓解临床症状,改善LTE4、CysLTS 炎症因子的作用,从而有效提高临床疗效。     

长期机械通气的老年患者撤机的影响因素分析

目的 筛选老年患者长期机械通气(PMV)的影响因素。方法 收集154例肺部感染或慢性阻塞性肺疾病(COPD)急性加重患者，在机械通气(简称通气)前及撤机或通气21d时的各项指标。结果 单因素分析结果表明：年龄、是否卧床、白细胞数、中性粒细胞比例、肺泡动脉血氧分压差[P（A-a）O2]、尿素氮、肌酐、上消化道出血、心率、血压，短期通气组撤机时或PMV组通气21d时上述指标及心功能、意识状态为PMV的影响因素。多因素分析结果表明：与PMV相关的独立因素为年龄、通气21d时P（A-a）O2及心功能；年龄≥82．0岁、通气21d时P（A-a）O2≥95．0mmHg、心功能≥3级为PMV的危险因素。随后检验8例PMV患者，同时满足3项指标判定PMV的准确性为87．5％。结论 年龄、通气21d时P（A-a）O2及心功能为影响PMV的独立因素。