摘要
目的探讨依从性表格法实施呼吸机相关性肺炎(VAP)集束化管理方案的临床疗效。方法纳入2010年1月至2011年11月收住北京大学首钢医院重症医学科(ICU)行机械通气治疗超过48 h的患者共240例,前瞻性随机数字表法分成2组。表格组120例采用依从性表格法的方式实施VAP集束化管理方案,对照组120例采用日常医嘱的方式实施VAP集束化管理方案。比较两组患者的依从性达标率、VAP发生率、机械通气时间、住ICU时间、28 d病死率及ICU住院费用。结果与对照组比较,表格组患者的依从性达标率明显提高(81.6%比52.5%),VAP发生率明显降低(14.5例/1000机械通气日比36.2例/1000机械通气日),机械通气时间明显缩短(5 d比8 d),住ICU时间明显减少(8 d比13 d),28 d病死率明显降低(12.5%比28.3%),ICU住院费用明显降低(36 437元比58 942元),以上比较差异均有统计学意义(P均<0.05)。结论采用依从性表格法实施VAP集束化管理方案比采用日常医嘱的方式能够提高医护人员的依从性,降低VAP的发生率,缩短机械通气时间,缩短住ICU时间,降低病死率,节约住ICU费用。
Objective To investigate the effect of a real-time compliance dashboard to help reduce ventilator-associated pneumonia （VAP） with ventilator bundle. Methods 240 patients who were admitted into the intensive care unit （ICU） of Shougang Hospital of Peking University and had received mechanical ventilation （MV） for over 48 hours, between January 2010 and November 2011 ,were studied prospectively. The patients were divided into two groups by random number table,/e, a dashboard group （ n = 120） with implementation of a real-time compliance dashboard to help reduce VAP with ventilator bundle, and a control group （n = 120） with implementation of usually routine order to help reduce VAP with ventilator bundle. The success rate of ventilator bundle implementation, incidence of VAP, duration of MV, duration within ICU, mortality within 28 days, cost within ICU were compared between two groups. Results Compared with the control group, the success rate of ventilator bundle implementation obviously increased （81.6% vs. 52. 5% ） ,incidence of VAP （ 14. 5/1000 days of MV vs. 36. 2/1000 days of MV） ,duration of MV [5（4,7） days vs. 8 （6,11 ） days ], duration within ICU [ 8 （6,12） days vs. 13 （8,16） days ], mortality of 28 days （12. 6% vs. 28. 6% ） ,and cost within ICU （ 36,437 vs. 58,942） in the dashboard group obviously reduced （ P 〈 0. 05 ）. Conclusions Implementation of a real time compliance dashboard to help reduce VAP with ventilator bundle can obviously improve medical personnel compliance and reduce incidence of VAP, duration of MV,duration within ICU, mortality and cost in ICU than those of routine medical order to help reduce VAP with ventilator bundle.
出处
《中国呼吸与危重监护杂志》
CAS
2012年第4期358-361,共4页
Chinese Journal of Respiratory and Critical Care Medicine
