摘要
目的调查山东省二级和三级综合医院重症监护病房(ICU)护士的腹内压(IAP)临床监测管理及认知情况,分析当前存在的问题,为制订IAP监测标准与流程以及对不同级别医院开展针对性培训提供参考。方法采用滚雪球抽样法,于2022年9月28日至11月10日对来自山东省62家二级和三级综合医院的1049名护士的一般资料、IAP监测管理现状及IAP监测认知现状进行调查,分析当前存在的问题。结果调查结果显示,共650名护士(62.0%)进行过IAP监测操作,其中有612名(94.2%)选择经膀胱监测,三级医院护士比例均高于二级医院护士〔IAP监测操作:73.4%(460/627)比45.0%(190/422),经膀胱监测:96.7%(445/460)比87.9%(167/190),均P<0.05〕。在对IAP监测管理情况的比较中,二级医院护士对清醒患者在操作前做好教育与解释说明、IAP测量时“0”点参考位置、关注向膀胱内注入生理盐水的温度、关注读数的时机以及标记参考“0”点这5个方面优于三级医院护士(均P<0.05),三级医院护士向膀胱内注入生理盐水的量优于二级医院护士(P<0.05);二级和三级医院护士在如何处理呼气末正压(PEEP)对IAP造成的影响方面差异亦有统计学意义(P<0.05);但目前对因病情无法断开呼吸机或将PEEP调至“0”的患者尚无科学的经膀胱测量IAP的方法。在对IAP监测认知情况的比较中,二级和三级医院ICU护士IAP认知总体得分为7(6,9)分,三级医院护士得分高于二级医院护士〔分:8(6,10)比7(6,9),P<0.05〕。结论山东省二级和三级综合医院ICU护士IAP监测的开展率有待提高,管理及认知情况存在差异,护理管理者应提高对IAP监测的重视程度,针对护士情况开展系统化、规范化的培训。
Objective To investigate the management and knowledge of intra-abdominal pressure(IAP)monitoring among intensive care unit(ICU)nurses in secondary and tertiary general hospitals in Shandong Province,analyze the current problems,and provide reference for the development of standards and procedures for IAP monitoring and the development of targeted training for hospitals at different levels.Methods A snowball sampling method was used to investigate the general information,current status of IAP monitoring management and knowledge of 1049 nurses from 62 secondary and tertiary general hospitals in Shandong Province from September 28 to November 10,2022 to analyze the current problems.Results Results of the survery show a total of 650 nurses(62.0%)had performed IAP monitoring,of which 612(94.2%)chose bladder monitoring,with a higher proportion of nurses in tertiary hospitals than in secondary hospitals[IAP monitoring operations:73.4%(460/627)vs.45.0%(190/422),bladder monitoring:96.7%(445/460)vs.87.9%(167/190),both P<0.05].In the comparison of the management of IAP monitoring,the nurses in secondary hospitals did better than the nurses in tertiary hospitals in 5 aspects:"education and explanatory to the awake patients before the procedure""the body position of the zero reference""attention to the temperature of saline injected into the bladder""attention to the timing of the measurement"and"marking the zero reference"(all P<0.05),while the volume of saline injected into the bladder by the nurses of the tertiary hospitals outperformed the nurses of the secondary hospitals.There was also a statistically significant difference between the nurses of secondary and tertiary hospitals in how they handled the impact of positive end-expiratory pressure(PEEP)on IAP(P<0.05).However,there is no scientific method for measuring IAP in patients who are unable to disconnect the ventilator or adjust PEEP to"0".In the comparison of knowledge about IAP monitoring,the overall score was 7(6,9),and nurses in tertiary hospitals scored higher than nurses in secondary hospitals[scores:8(6,10)vs.7(6,9),P<0.05].Conclusions IAP monitoring can be further promoted in Shandong Province,and the status of management and knowledge of IAP monitoring differs among ICU nurses in secondary and tertiary hospitals.Nursing managers should pay more attention to IAP monitoring and organize systematic and standardized training for nurses.
作者
陈凤致
张继承
刘备备
邰子健
王启
刘红丽
白雪
Chen Fengzhi;Zhang Jicheng;Liu Beibei;Tai Zijian;Wang Qi;Liu Hongli;Bai Xue(Department of Critical Care Medicine,Shandong Provincial Hospital Affiliated to Shandong First Medical University,Jinan 250021,Shandong,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2023年第3期358-363,共6页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
黎介寿肠道屏障研究基金(Z-2017-24-2009)。
关键词
重症监护病房
腹内压监测
现状调查
Intensive care unit
Intra-abdominal pressure monitoring
Investigation of current status
