ICU 人工气道非计划性拔管风险评估及措施落实的探讨

摘要

Objective To explore the implementation of risk assessment and prevention measurement for artificial air-way management by ICU nurses. Methods A cross sectional study was designed to investigating the risk assessing awareness and current condition of artificial airway management in 1 1 9 general ICU nurses from 1 0 hospitals,by revealing tubes distribution in ICU patients and questionnaire survey. Results For the patients from 1 0 hospitals general ICU,74.7% were with an artifi-cial airway,and from which 85.53% were considered as high risk intubation.UEX (Unplanned Extubation)most likely happen in oral tracheal intubation;Underdosing sedation and analgesics was the primary risk factor lead to UEX;Passive position chan-ging also was the highest risk nursing operation causing UEX;Effective fixation and proper sedation and analgesics were consid-ered as the primary measure to prevent UEX. Conclusion According to this analysis,we may provide effective data,design risk appraisal form and nursing guide for artificial airway management,and improve scientificity and availability of nursing.%目的：了解 ICU 护士对人工气道风险评估意识及预防措施的落实情况，为护理管理者规范人工气道风险评估及落实措施提供依据。方法采用横断面调查，得出广州市10家医院综合 ICU 患者管道分布情况，结合问卷调查方式，对该10家医院119名综合 ICU 护士进行人工气道风险评估的认知及管道现状进行调查。结果该10家医院综合 ICU 患者人工气道带管率达74.7％，占高危管道的85.53％；护士问卷调查结果：认为经口气管插管为人工气道最易发生非计划性拔管的插管方式；镇静镇痛不到位是发生 UEX 的首要高危因素；为患者翻身是最易导致人工气道发生 UEX 的护理操作；最主要的预防措施是有效固定及合理的镇静镇痛等。结论可依据本调查分析结果，为护理管理者提供有效数据，制定人工气道风险评估单及护理措施落实指引，从而提高护理工作的科学性及有效性。