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find Keyword "重症监护病房" 61 results
  • Current status and influencing factors of ventilator-associated pneumonia in comprehensive intensive care unit

    ObjectiveTo analyze the influencing factors of ventilator-associated pneumonia (VAP) in comprehensive intensive care units (ICUs) in a certain district of Shanghai, and to provide evidence for developing targeted measures to prevent and reduce the occurrence of VAP.MethodsThe target surveillance data of 1 567 inpatients with mechanical ventilation over 48 hours in comprehensive ICUs of 5 hospitals in the district from January 2015 to December 2017 were retrospectively analyzed to determine whether VAP occurred. The data were analyzed with SPSS 21.0 software to describe the occurrence of VAP in patients and to screen the influencing factors of VAP.ResultsThere were 133 cases of VAP in the 1 567 patients, with the incidence of 8.49% and the daily incidence of 6.01‰; the incidence of VAP decreased year by year from 2015 to 2017 (χ2trend=11.111, P=0.001). The mortality rate was 12.78% in VAP patients while was 7.25% in non-VAP patients; the difference was significant (χ2=5.223, P=0.022). A total of 203 pathogenic bacteria were detected in patients with VAP, mainly Gram-negative bacteria (153 strains, accounting for 75.37%). The most common pathogen was Pseudomonas aeruginosa. The single factor analysis showed that gender, age, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, the length of ICU stay, and the length of mechanical ventilation were the influencing factors of VAP (χ2=9.572, 5.237, 34.759, 48.558, 44.960, P<0.05). Multiple logistic regression analysis found that women [odds ratio (OR)=1.608, 95% confidence interval (CI) (1.104, 2.340), P=0.013], APACHE Ⅱ score >15 [OR=4.704, 95%CI (2.655, 8.335), P<0.001], the length of ICU stay >14 days [OR=2.012, 95%CI (1.188, 3.407), P=0.009], and the length of mechanical ventilation >7 days [OR=2.646, 95%CI (1.439, 4.863), P=0.002] were independent risk factors of VAP.ConclusionsNosocomial infection caused by mechanical ventilation in this area has a downward trend, and the mortality rate of patients with VAP is higher. For the patients treated with mechanical ventilation in ICU, we should actively treat the primary disease, shorten the length of ICU stay and the length of mechanical ventilation, and strictly control the indication of withdrawal, thereby reduce the occurrence of VAP.

    Release date:2019-08-15 01:20 Export PDF Favorites Scan
  • Study on critical illness rehabilitation

    With the continuous development of critical care medicine, the survival rate of critical ill patients continues to increase. However, the residual dysfunction will have a far-reaching impact on the burden on patients, families, and health-care systems, and will significantly increase the demand of the follow-up rehabilitation treatment. Critical illness rehabilitation intervenes patients who are still in the intensive care unit (ICU). It can prevent complications, functional deterioration and dysfunction, improve functional activity and quality of life, shorten the time of mechanical ventilation, the length of ICU stay and hospital stay, and also reduce medical expenses. Experts at home and abroad believe that early rehabilitation of critical ill patients is safe and effective. So rehabilitation should be involved in critical ill patients as early as possible. However, the promotion of this model is still limited by the setting of safety parameters, the ICU culture, the lack of critical rehabilitation professionals, and the physiological and mental cognitive status of patients. Rehabilitation treatment in ICU is constantly being practiced at home and abroad.

    Release date:2018-10-22 04:14 Export PDF Favorites Scan
  • 移动式床旁CT在神经重症监护病房的应用及护理

    目的探讨移动式床旁CT在神经重症监护病房(ICU)的应用及护理配合。 方法回顾分析2011年6月23日08:00-10月15日21:10使用移动式床旁CT行床旁CT检查的97例患者临床资料和检查过程中的护理。 结果移动式床旁CT的准确应用及时为医疗提供诊治依据,在患者病情变化时,在不增加风险的情况下了解颅内的病情并及时作出处理,减少对患者的转运,增加其安全性,对提高医护质量起到重要作用,本组97例患者均成功完成CT检查,未出现安全隐患。 结论在神经ICU使用移动式床旁式CT可以及时地发现患者出现的各种异常情况变化,有效地避免搬动患者外出检查所带来的各种风险。

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  • Evidence-based practice of oxygenation strategies therapy for intensive care unit adult patients with tracheal intubation after extubation

    Objective To evaluate and summarize the relevant evidence of oxygenation strategies with tracheal intubation after extubation for adult in intensive care unit (ICU), and to provide evidence-based practice for the development of scientific and effective strategies tracheal intubation after extubation for ICU adult patients. Methods Evidence-based databases, related guideline websites, association websites and original databases were searched by computer for literature about oxygenation strategies with tracheal intubation after extubation for ICU adults patients was extracted. The retrieval time was from the establishment of the databases to May 2023. Two researchers trained in evidence-based practice evaluated the quality of the included literature and extracted evidence from the literature that met the quality evaluation criteria. Results A total of 18 articles were included, including 7 guidelines, 4 clinical decisions, 2 expert consensus, 4 systematic reviews and 1 randomized controlled trial. A total of 22 pieces of best evidence were formed, including 7 aspects of basic principles, evaluation, selection, parameter setting, withdrawal, effect evaluation and precautions. ConclusionThe medical staff should select the best evidence based on the actual clinical situation and the patient’s own needs, and adjust the oxygenation strategies to reduce the rate of tracheal intubation and improve the prognosis of patients.

    Release date:2024-09-23 01:22 Export PDF Favorites Scan
  • Effect of Interventions on Ventilator-associated Pneumonia in Patients with Tumor in Intensive Care Unit

    ObjectiveTo investigate the causes of ventilator-associated pneumonia (VAP) in patients with tumor in Intensive Care Unit (ICU), and take effective intervention measures to reduce the incidence of VAP. MethodsThe targeted monitoring was conducted for the ICU patients who underwent the mechanical ventilation for over 48 hours from January 2013 to December 2014. Then the conventional nursing measures where adopted in 2013 without any field intervention measure implemented. While the prevention and control method was conducted in 2014 and the causes of VAP was valued and anyzed. ResultsAfter adopting intervention measures, the thousand-day rate of VAP decreased from 8.71‰ before the interventions to 2.30‰ after the interventions. The utilization rate of ventilators increased from 63% to 72% after the interventions were taken in 2014. The constituent ratio of the multidrug-resistant bacteria among the isolated pathogens in each year presented a downward trend. ConclusionVAP is common in ICU patients. It is necessary to reach preventive measures and designated position and ventilator management so as to prevent the occurrence of new nosocomial infection.

    Release date:2016-11-23 05:46 Export PDF Favorites Scan
  • 巴林特小组在重症监护病房护理工作中的应用

    目的 探讨巴林特小组在重症监护病房护理中的应用效果。 方法 2015 年 6 月在心理卫生中心协助下成立巴林特小组,按流程开展活动,报告人汇报案例,组长与成员协助分析梳理,采用倾听、提问、回答等方式,最后进行总结。对 1 例典型病例进行详细分析。 结果 在典型案例中,汇报人在巴林特小组组长与成员的引导下主动表述其感受,能换位思考患者情况,不良情绪得到逐渐缓解,认识得到提高,并在之后的护患沟通中体现良好的持续影响,取得了患者的信任与理解。 结论 通过巴林特小组的活动,能搭建相互支持、交流、学习的平台,提高护士自我觉察、倾听、观察和沟通能力,促进护士个人成长,改善职业倦怠,和谐护患关系。

    Release date:2017-04-19 10:17 Export PDF Favorites Scan
  • 重症医学科构建外周静脉置入中心静脉导管医护一体的工作模式探讨

    目的在重症医学科(ICU)开展外周静脉置入中心静脉导管(PICC)医护一体合作的工作模式,以提高PICC置管的成功率,解决重症患者置管的相关问题,降低导管相关性血流感染(CRBSI)发生率。 方法选择2010年4月-2012年3月入住ICU的置入PICC的患者229例,按照入住日期单双数分为对照组和试验组,比较两组CRBSI的发生率和PICC置管成功率。 结果试验组CRBSI发生率明显低于对照组;且试验组的PICC置管成功率明显高于对照组,差异均有统计学意义(P<0.01)。 结论ICU构建PICC医护一体的工作模式,能显著提高重症患者PICC置管成功率和安全性,降低CRBSI发生率,减少了重症患者反复静脉穿刺的痛苦,保护患者外周静脉,提高护理质量及工作效率。

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  • 霍桑效应对重症监护病房手卫生依从性的影响研究

    目的 探索霍桑效应对重症监护病房(Intensive Care Unit,ICU)医护人员手卫生依从性的影响。 方法 2014 年 10 月—12 月科室根据世界卫生组织手卫生调查方法,采用现场直接观察法和隐蔽式观察法,分别对 ICU 122 名护士、12 名医生、4 名保洁、14 名工人的手卫生情况进行明访和暗访,并将明访和暗访监测到的手卫生时机的洗手执行情况进行对比分析;2015 年 1 月研究者对中国知网数据库中所报道的手卫生依从性调查的文章进行了文献回顾,检索关键词为“手卫生”“依从性”,对搜索获取到的文献进行分析。 结果 ICU 医护人员手卫生依从性明访、暗访结果分别为 70.05%(1 275/1 820)和 57.28%(1 023/1 786),差异有统计学意义(P<0.001)。对中国知网数据库中检索到的 62 篇核心期刊的研究方法采用明访的居多,其中明访 36 篇,暗访 24 篇,明暗访相结合的 2 篇;仅有 3 篇提及霍桑效应,其中 2 篇采取了避免霍桑效应的措施;手卫生依从性<50% 的文献占总文献的 25.8%,依从性在 50%~80% 的文献占总文献的 46.8%,依从性在 80%~90% 的文献占总文献的 12.9%,依从性>90% 的文献占总文献的 14.5%。 结论 ICU 医护人员手卫生依从性可能受霍桑效应影响,因此在进行手卫生依从性的调查时要避免霍桑效应,以取得真实的调查结果。

    Release date:2017-06-22 02:01 Export PDF Favorites Scan
  • Study on the safety of ventilator support for critical patients in hyperbaric oxygen chamber

    ObjectiveTo explore the safety of ventilator support in hyperbaric oxygen chamber and the prevention of related complications.MethodsFrom July 2016 to December 2018, there were 127 intensive care unit patients underwent hyperbaric oxygen therapy with ventilator. Medical professionals in hyperbaric medicine or intensive care medicine were arranged to accompany the patients in the treatment process, to observe the patients’ condition changes closely, monitor their heart rate, respiration, blood pressure, and oxygen saturation, and perform sputum suction at any time if needed and monitor the airway peak pressure change to prevent pneumothorax.ResultsDuring the process of hyperbaric oxygen therapy, 13 patients (10.24%) were treated with analgesia/sedation for patient-ventilator asynchrony, 4 patients (3.15%) exited the champer emergently for acute left heart failure, 3 patients (2.36%) had epileptic seizures, 3 patients (2.36%) had aspiration, and 1 patient (0.79%) had breath and cardiac arrest. After emergency treatment, all the patients returned to the ward safely.ConclusionDuring the treatment of hyperbaric oxygen therapy for intensive care unit patients with ventilator, the accompany of qualified professionals in hyperbaric medicine or intensive care medicine in the hyperbaric oxygen chamber can treat the patients’ symptoms timely and reduce the risk greatly.

    Release date:2020-06-25 07:43 Export PDF Favorites Scan
  • Study on the Risk Factors for Intensive Care Unit Nosocomial Infection in a First-class Hospital in Wuxi

    ObjectiveTo identify the risk factors of Intensive Care Unit (ICU) nosocomial infection in ICU ward in a first-class hospital in Wuxi, and discuss the effective control measures, in order to provide evidence for making strategies in preventing and controlling nosocomial infection. MethodsAccording to the principle of random sampling and with the use of case-control study, a sample of 100 nosocomial infection patients were selected randomly from January 2012 to December 2014 as survey group, and another 100 patients without nosocomial infection as control group. The data were input using EpiData 2.0, and SPSS 13.0 was used for statistical analysis; t-test and χ2 test were conducted, and the risk factors were analyzed using multi-variate logistic regression model. The significant level of P-value was 0.05. ResultsBased on the results of univariate analysis, there were 13 risk factors for ICU nosocomial infection, including diabetes mellitus, hypoproteinemia, being bedridden, surgical operation, immunosuppression, glucocorticoids, organ transplantation, tracheal intubation, length of hospitalization, length of mechanical ventilation, length of central venous catheter, length of urinary catheter, and length of nasogastric tube indwelling. Multi-variate logistic analysis indicated that hospitalization of 7 days or longer[OR=1.106, 95%CI (1.025, 1.096), P=0.001], diabetes mellitus[OR=2.770, 95%CI (1.068, 7.186), P=0.036], surgical operation[OR=7.524, 95%CI (2.352, 24.063), P=0.001], mechanical ventilation of 7 days or longer[OR=1.222, 95%CI (1.116, 1.339), P<0.001], and nasogastric tube indwelling of 7 days or longer[OR=1.110, 95%CI (1.035, 1.190), P=0.003] were considered as independent risk factors for ICU nosocomial infection. ConclusionHospitalization of 7 days or longer, diabetes mellitus, surgical operation, tracheal intubation of 7 days or longer, and gastric intubation of 7 days or longer are the major risk factors for nosocomial infection in ICU ward. Advanced intervention and comprehensive prevention measures are helpful to reduce the nosocomial infection rate and ensure the safety of medical treatment.

    Release date:2016-10-02 04:54 Export PDF Favorites Scan
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