循证护理对机械通气患者呼吸机相关性肺炎发生的影响

目的 探讨循证护理在呼吸机相关性肺炎（VAP）中的实际临床效果.方法 将2011年1月-2013年6月在我科ICU住院治疗并行机械通气的160例患者随机分为观察组和对照组,其中观察组在常规护理措施的基础上进行循证护理,比较两者的有创通气时间、总通气时间、脱机时间,VAP的发生时间、发生率和病死率.结果 观察组有创通气时间、总通气时间、脱机时间以及VAP发生的时间分别为（3.3±0.6）,（10.3±3.8）,（2.6±4.3）,（9.2±2.8）d,显著低于或晚于对照组的（5.6±3.1）,（13.1±3.4）,（6.5±4.8）,（4.8±2.7）d,差异有统计学意义（t分别为2.58,2.63,2.86,2.79;P＜0.05）.而观察组VAP的发生率为16.9％,病死率为10.4％,显著低于对照组的48.1％,34.9％,且差异有统计学意义（x2分别为5.36,4.93;P ＜0.01）.结论 循证护理能显著缩短VAP患者的有创通气时间、总通气时间和脱机时间,能有效延缓和减少VAP的发生.

Effect of evidence-based nursing on ventilator-associated pneumonia in patients with mechanical ventilation

Objective To explore the clinical effect of evidence-based nursing in ventilator-associated pneumonia （VAP）.Methods One hundred and sixty patients with mechanical ventilation in our ICU from January 2011 to June 2013 were randomly divided into the observation group and the control group.The control group received the traditional nursing,and the observation group received evidence-based nursing on the basis of the routine nursing.The time of invasive ventilation,the duration of ventilation,the off-line time,the occurrence time of VAP,and the incidence and mortality rates of VAP were compared between two groups.Results The time of invasive ventilation,the duration of ventilation,the off-line time,the occurrence time of VAP in the observation group were respectively （3.3 ± 0.6）,（10.3 ± 3.8）,（2.6 ± 4.3）,（9.2 ± 2.8） d,and were significantly lower or later than （5.6 ± 3.1）,（13.1 ± 3.4）,（6.5 ± 4.8）,（4.8 ± 2.7） d in the control group,and the differences were statistically significant （t =2.58,2.63,2.86,2.79,respectively; P 〈0.05）.The incidence and mortality rates of VAP in the observation group were respectively 16.9% and 10.4%,and were significantly lower than 48.1% and 34.9% in the control group,and the differences were statistically significant （x2 =5.36,4.93,respectively; P 〈 0.01）.Conclusions Evidence-based nursing can significantly shorten the time of invasive ventilation,the duration of ventilation and the off-line time; and can also effectively delay and reduce the occurrence of VAP.