ICU患者气管插管非计划性拔管影响因素调查及防范措施效果评价

刘瑶　叶东花　郑益娇

[摘要] 目的 調查重症监护病房（Intensive care unit，ICU）患者非计划性拔管（unplanned extubation，UEX）的影响因素，并对相关防范措施进行效果评价。 方法 选取我院于2014年2月～2016年8月收治的ICU气管插管患者792例，按治疗时间和预防措施的不同，分为观察组和对照组。对照组394例于2014年2月～2015年7月行常规护理防范措施，观察组398例于2015年8月～2016年8月给予优化护理干预。总结ICU患者非计划性拔管的影响因素，并比较两组非计划性拔管的发生率。 结果 792例气管插管患者中发生UEX的有28例，其影响因素主要有导管固定不牢（7例）、肢体约束不当（4例）、护士操作不当（2例）和患者因意识状态异常或舒适度改变自行拔管（15例）；另外，夜晚和不使用镇静剂的UEX发生率（71.43%，64.29%）比白天、使用镇静剂的发生率（28.57%，35.71%）更高（P<0.05）。经Logistic回归分析发现：导管固定不牢、肢体约束不当、护士操作不当、患者自行拔管、夜间行气管插管、未使用镇静剂为UEX发生的影响因素。两组非计划性拔管率比较，观察组（1.76%）明显低于对照组（5.33%），且差异有统计学意义（P<0.05）。 结论 引起ICU患者非计划性拔管的因素主要有导管固定不牢、肢体约束不当、患者自行拔管等，同时夜间、不使用镇静剂时，UEX的发生率更高。对于以上原因，为降低非计划性拔管的发生率，规范护理操作，促使患者早日康复，采取有针对性的护理防范措施相比常规防范措施更加安全有效。

[关键词] ICU；UEX；影响因素；预防措施

[中图分类号] R472 [文献标识码] B [文章编号] 1673-9701（2017）11-0149-04

Investigation on the influencing factors of unplanned extubation of tracheal intubation in ICU patients and evaluation on the effect of preventive measures

LIU Yao1 YE Donghua1 ZHENG Yijiao2

1.ICU， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China； 2.Nursing Department， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To investigate the influencing factors of unplanned extubation （UEX） in intensive care unit （ICU） patients and evaluate the effect of corresponding preventive measures. Methods A total of 792 patients with ICU tracheal intubation who were enrolled in our hospital from February 2014 to August 2016 were selected. According to the treatment time and preventive measures， the patients were divided into the observation group and the control group. 394 patients in the control group from February 2014 to July 2015 were given routine nursing preventive measures， and 398 patients in the observation group were given optimal nursing interventions from August 2015 to August 2016. The influencing factors of unplanned extubation in ICU patients were summarized， and the incidence rate of unplanned extubation in both groups were compared. Results Of the 792 patients with tracheal intubation， 28 patients had UEX. The main factors were ustable catheter fixation （7 cases）， improper limb restriction （4 cases）， improper operation of nurses （2 cases） and patients' self-extubation（15 cases） due to abnormal state of consciousness or change of comfort； in addition， the incidence rate of UEX at night and without sedatives（71.43%， 64.29%） was higher than that during daytime and with sedatives （28.57%， 35.71%） （P<0.05）. According to the Logistic regression analysis： ustable catheter fixation， improper limb restriction， improper operation of nurses， patients' self-extubation， tracheal intubation during night time， lack of sedatives were influencing factors for UEX. The unplanned extubation rate of the two groups was compared， and the observation group （1.76%） was significantly lower than that in the control group （5.33%）. The difference was statistically significant（P<0.05）. Conclusion The factors that cause unplanned extubation in ICU patients are ustable catheter fixation， improper limb restriction， improper operation of nurses， patients' self-extubation， etc. At the same time， the incidence of UEX is higher when the intubation is performed during night time and without sedatives. For the above reasons， in order to reduce the incidence rate of unplanned extubation， standardize the nursing operation， and promote early recovery of patients， targeted preventive nursing measures are safer and more effective compared to routine preventive measures.

[Key words] ICU； UEX； Influencing factors； Preventive measures

非计划性拔管（Unplanned Extubation，UEX）也称意外拔管，是一种常见的ICU问题，指未经医护人员同意，患者擅自拔出插管或因医护人员操作不当导致插管意外脱落的情况[1]。研究[2]发现UEX可导致患者气道损伤，机体内分泌系统、呼吸系统、循环系统等发生紊乱；严重时可导致患者窒息、感染、延长住院天数、加重病情，甚者还会危及患者生命，从而引起医患纠纷[3]。我院通过对2014年2月～2016年8月期间收治的792例ICU气管插管患者进行非计划性拔管影响因素调查分析，取得了一定发现，现报道如下。

1 资料与方法

1.1 一般资料

选取我院2014年2月～2016年8月接诊的ICU气管插管患者792例作为研究对象，按预防措施及治疗时间的不同……