多维度评估在早产儿NCPAP治疗下鼻中隔皮肤损伤中的应用效果

摘要

目的 缩短早产儿经鼻持续气道正压通气(NCPAP)治疗时间,减少鼻中隔皮肤的损伤,提高救护质量.方法 选取2014年2月—2016年9月在新生儿科进行NCPAP治疗的早产儿72例,观察组和对照组各36例,对照组采用常规护理方法,观察组结合多维度立体式评估干预,运用品管圈展开质量改进,采用特性要因图分析NCPAP治疗下早产儿鼻中隔皮肤损伤的原因,采用因果关联分析及临床检查方法找出真因,针对5个真因,制定改进方案.比较多维度评估法应用前后,两组早产儿应用NCPAP治疗的时长、鼻中隔皮肤损伤发生数量、程度,平均住院日,责任护士干预下拔管率,患儿体重平稳增长情况.结果 制定早期撤机标准流程和疼痛管理计划,采用水胶体敷料联合管路固定带固定法,早产儿NCPAP治疗的时间时长由(44.2±18.4)h降至(32.3±11.7)h,差异有统计学意义(t=2.173,P=0.003);Ⅰ度皮肤损伤发生率由41.7%降至11.1%,(χ2=-3.092,P=0.003);Ⅱ度皮肤损伤发生率由16.7%降至2.8%,差异有统计学意义(χ2=-2.017,P=0.048);护士干预下撤机率由58.3%降至13.9%,差异有统计学意义(χ2=4.366,P=0.000),平均住院时间由(189.1±52.8)h降至(170.9±42.4)h,差异有统计学意义(t=3.014,P=0.003);患儿体重增长从58.3%提高至88.9%,差异有统计学意义(χ2=3.092,P=0.003).结论 多维度评估干预可有效减少NCPAP治疗下早产儿鼻中隔皮肤损伤问题的发生.%Objective To improve the nursing quality and optimize services by shortening the treatment time of nasal continuous positive airway pressure (NCPAP), and decreasing the incidence of nasal septum injury. Methods Totally 72 prematures treated with NCPAP in neonate department from February 2014 to September 2016 were selected and divided into the observation group and the control group, with 26 cases in each group. Patients in the control group received routine nursing method, while patients in the observation group received multi-dimension evaluation intervention. We used quality control circle to improve the quality, used cause-and-effect diagram to analyze the cause of nasal septum injury of prematures under the treatment of NCPAP, and used correlation analysis and clinical examination to find out the root cause. Targeted at 5 root causes, the improvement project was made. The treatment time of prematures, the number of cases of nasal septum injury and its degree, the average hospitalization time, the decannulation rate under the duty nurses' intervention, the increasing situation of prematures' weight in two groups before and after the application of multi-dimension evaluation were compared.Results Early machine withdrawal standard process and pain management plan were made, and hydrocolloid dressing combined with piping belt fixation method was used. The treatment time of NCPAP in prematures decreased from (44.2±18.4) h to (32.3±11.7) h (t=2.173,P=0.003); the incidence rate of Ⅰskin injury decreased from 41.7% to 11.1% (χ2=-3.092,P=0.003); the incidence rate of Ⅱskin injury decreased from 16.7% to 2.8% (χ2=-2.017,P=0.048); the machine withdrawal rate under nurses' intervention decreased from 58.3% to 13.9% (χ2=4.366,P=0.000); the average hospitalization time decreased from (189.1±52.8) h to (170.9±42.4) h (t=3.014,P=0.003); the increasing weight of prematures reduced from 58.3% to 88.9% (χ2=3.092,P=0.003); and the comparison between two groups had significant difference (P<0.05).Conclusions Multi-dimension evaluation can significantly decrease the occurrence of premature's nasal septum injuries.