摘要
目的探讨坡度调整床垫在儿科重症监护病房(PICU)机械通气患儿体位管理中的应用效果,以寻求临床中PICU机械通气患儿维持有效体位的方法。方法采用类实验研究方法。以便利抽样法选取2022年1月1日至12月31日湖南省儿童医院PICU收治的机械通气患儿为研究对象,按随机数字表法分为对照组和试验组,每组21例;对照组使用医院统一的儿童病床和传统体位管理方法,试验组采用适于人体工学的坡度调整床垫进行体位管理;比较2组患儿的舒适度、机械通气时间、PICU住院时间、体位下滑和非计划性脱管不良事件以及血气分析指标情况。结果2组最终各纳入21例。对照组男10例,女11例,年龄(31.43±27.01)个月。试验组男11例,女10例,年龄(24.57±24.20)个月。试验组在使用第24、72小时的舒适度评分分别是(13.57±0.93)、(12.52±0.60)分;对照组分别是(16.05±1.72)、(15.81±1.66)分,2组比较差异均有统计学意义(t=5.82,8.52,均P<0.05)。试验组机械通气时间为(5.43±2.48)d、PICU住院时间为(9.29±3.04)d、体位下滑次数为(7.52±2.06)次,优于对照组的(8.52±4.65)d、(12.71±6.76)d、(14.95±6.86)次,差异均有统计学意义(t=2.69、2.12、4.75,均P<0.05)。试验组非计划性脱管0例次,对照组4例次,差异有统计学意义(χ^(2)=5.97,P<0.05)。血气分析中,第2天对照组的PaCO 2为(56.90±6.77)mmHg(1 mmHg=0.133 kPa),试验组为(48.67±8.13)mmHg;第3天,对照组的PaO 2、氧合指数、PaCO 2为(91.19±16.27)、(278.19±71.54)、(51.62±4.73)mmHg,试验组为(110.43±21.73)、(347.33±90.95)、(40.24±5.57)mmHg,2组比较差异均有统计学意义(t值为7.50~51.00,均P<0.05)。2组血气分析的时间交互、组间交互、时间与组间交互效用比较,差异均有统计学意义(F值为3.62~66.38,均P<0.05)。结论坡度调整床垫在PICU机械通气患儿中能维持有效体位,改善患儿舒适度,缩短PICU住院时间和机械通气时间,明显减少体位下滑情况,降低非计划性脱管不良事件风险发生,通过改善换气和通气障碍来提升血气分析指标,该用具可作为体位管理的一种优化选择,有望有效提升护理质量。
Objective To explore the application effect of slope adjustment mattresses in the position management of pediatric intensive care unit(PICU)mechanically ventilated children,in order to seek methods for maintaining effective posture in clinical practice.MethodsThis was a quasi-experimental study.In this study,the mechanically ventilated children in PICU of Hunan Children′s Hospital from January 1 to December 31,2022 were selected by convenient sampling method and divided into control group(n=21)and experimental group(n=21)according to random number table.Children in control group used the hospital bed and the traditional posture management,and children in experimental group used the slope adjustment mattress for posture management.The comfort scores,mechanical ventilation time,PICU length of stay,postural decline,unplanned extubation and blood gas analysis index were compared between the two groups.ResultsThere were 21 cases were admitted in each group ultimately.In the control group,there were 10 males and 11 females,the age was(31.43±27.01)months.There were 11 males and 10 females in the experimental group,the age was(24.57±24.20)months.The comfort scores of the experimental group were(13.57±0.93)and(12.52±0.60)points at the 24 hour and 72 hour respectively;while the comfort scores of the control group were(16.05±1.72)and(15.81±1.66)points at the 24 hour and 72 hour respectively.There were significant differences between the two groups(t=5.82,8.52,both P<0.05).The mechanical ventilation time was(5.43±2.48)d,the PICU length of stay was(9.29±3.04)d,and the number of postural decline was(7.52±2.06)times in the experimental group which was superior to control group(8.52±4.65)d,(12.71±6.76)d,(14.95±6.86)times,the differences were significant(t=2.69,2.12,4.75,all P<0.05).There were 0 case of unplanned extubation in the experimental group and 4 cases of unplanned extubation in the control group.The difference was significant(χ2=5.97,P<0.05).For blood gas analysis,PaCO 2 on the second day were(56.90±6.77)mmHg(1 mmHg=0.133 kPa)in the control group,and(48.67±8.13)mmHg in the experimental group;PaO 2,oxygenation index,PaCO 2 on the third day were(91.19±16.27),(278.19±71.54),(51.62±4.73)mmHg in the control group,and(110.43±21.73),(347.33±90.95),(40.24±5.57)mmHg in the experimental group,the differences were significant(t values were 7.50-51.00,all P<0.05).There were significant differences about blood gas analysis of time interaction,inter-group interaction,time and inter-group interaction were compared between the two groups(F values were 3.62-66.38,all P<0.05).ConclusionsSlope adjustment mattresses can maintain effective posture,improve comfort,shorten PICU hospital stay and mechanical ventilation time,significantly reduce posture decline and the risk of unplanned tube withdrawal adverse events in PICU mechanically ventilated children.Improving ventilation and ventilation disorders to enhance blood gas analysis indicators.This appliance can be used as an optimized choice for posture management and expected to effectively improve the quality of nursing care.
作者
刘琼洁
张新萍
彭丹
刘美华
刘花艳
Liu Qiongjie;Zhang Xinping;Peng Dan;Liu Meihua;Liu Huayan(Department of PICUl,Hunan Children's Hospital,Changsha 410007,China;Department of Health Care Center,Hunan Children's Hospital,Changsha 410007,China;Department of Respiratory,Hunan Children's Hospital,Changsha 410007,China)
出处
《中国实用护理杂志》
2024年第13期984-991,共8页
Chinese Journal of Practical Nursing
基金
湖南省科学技术厅创新项目(2021SK50506)。
关键词
重症监护病房
新生儿
通气机
机械
坡度调整床垫
体位管理
Intensive care unit,neonatal
Ventilators,mechanical
Slope adjustment mattress
Position management
