摘要
目的制订机械通气患儿镇痛镇静管理方案,并检验方案的实施效果。方法本研究是干预前后对比研究,采用方便抽样抽取2所三级甲等综合医院儿童重症监护病房(PICU)77例机械通气时间>24h的患儿为研究对象。方案实施前,护理人员严格遵医嘱执行镇痛镇静医嘱,定时进行舒适量表监测并记录。方案实施后,对所有患儿强化最大化人文关怀,医护人员共同制订每日镇静目标,护理人员根据舒适量表评分及戒断症状量表结果在一定范围内调节药物用量。结果方案实施前,患儿镇痛药物应用总量(吗啡当量)(18.51-4-13.34)mg/kg、咪达唑仑使用总量(26.29±13.58)mg/kg及时间(137-31±104.78)h、机械通气时间(174.00±90.17)h、住PICU时间(12.28±8.86)d,方案实施后,上述指标分别为(11.46±15.97)mg/kg、(12.01±10.06)mg/kg、(99.44±47.29)h、(111.15±58.82)h、(10.88±7.68)d,差异有统计学意义(t=O.743—2.595,P<0.05);方案实施后患儿戒断症状的发生率为4.88%(2,41),比方案实施前的19.44%(7/36)降低,差异有统计学意义(x=3.940,P<0.05);方案实施后护理人员镇静评估符合率93.33%(126/135),比方案实施前的83.67%(82,98)提高,差异有统计学意义(x^2=5.532,P<0.05)。结论方案以“早期镇痛,最小化镇静,最大化人陛关怀”为指导思想,力图达到镇静目标个体化、医护职责的明确化、医护沟通的连续化、药物选择及调节规范化、撤药流程程序化、评估记录常规化,并且将镇痛镇静管理列入科室护理质量管理重点项目之中,做到方案实施过程管理制度化。方案的实施提高了患儿的舒适程度,从而降低患儿应激状态、降低戒断症状和非计划性拔管的发生率,最终减少药物用量和机械通气时间。
Objective To develop a nurse-driven analgesia and sedation management plan and determine whether the protocol leads positive resuhs.MethodsThis was a before and after protocol implementation study in 2 pediatric intensive care units of 2 tertiary care hospitals.A total of 77 medical pediatric patients requiring mechanical ventilation with pediatric intensive care unit(PICU)length of stay for at least 24h were included.Prior to implementation of the protocol,analgesia and sedation was managed by the attending physician's order.Afterwards,post implementation,nurses managed analgesia and sedation following the protocol,including maximum human care,complying the same sedation objective,ordination of the speed according to Comfort Scale and Withdrawal Assessment Tool.Results Before the implementation of protocol,the amount of murphy equivalent was(18.51±13.34)mg/kg,the amount and time of Midazolam were(26.29±13.58)mg/kg and(137.31±104.78)h respectively, mechanical ventilation time was(174.00±90.17)h and time of PICU stay was(12.28±8.86)d;after the implementation of protocol the indexes were(11.46±15.97)mg/kg,(12.01±10.06)mg/kg,(99.44±47.29)h,(111.15±58.82)h,(10.88±7.68)d,and there were significant differences(t=-0.743-2.595,P< 0.05).The incidence of withdrawal after the implementation of protocol(19.44%,7/36)was significantly lower than that before the implementation of protocol(4.88%,2/41),and there was significant difference (X^2=3.940,P<0.05).The coincidence of sedation assessment of after the implementation of protocol was 93.33%(126/135),that of before the implementation of protocol was83.67%(82/98),and there was significant difference(X^2=5.532,P<0.05).ConclusionsThe plan takes"early analgesia,minimizing sedation,maximizing human concern"as tile guiding ideology,and strives to achieve the goal of sedation individualization,clarification of medical and nursing responsibilities,continuity of medical communication,standardization of drug selection and regulation,routinization of withdrawal procedures, routinization of evaluation records,and the management of analgesia and sedation is included in the department.In the key projects of nursing quality management,we should institutionalize the implementation process management.The implementation of the program improves the comfort level of children,thus reducing the stress state of children,reducing the incidence of withdrawal symptoms and unplanned extubation,and uhimately reducing drug consumption and mechanical ventilation time.
作者
亓秀梅
王芹
杨雪
张莉
张慧新
Qi Xiume;Wang Gin;Yang Xue;Zhang Li;Zhang Huixin(Department of Pediatrics,Shandong Provincial Qianfoshan Hospital,Jinan250014,China)
出处
《中国实用护理杂志》
2018年第34期2675-2682,共8页
Chinese Journal of Practical Nursing
基金
山东省医药卫生科技发展计划(2015WS0248).
关键词
机械通气
小儿
镇痛镇静
方案
Mechanical ventilation
Pediatric
Analgesia
Sedation
Protocol
