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目的探讨集束化(Bundle)护理对神经外科(NCU)重型颅脑疾病患者呼吸机相关性肺炎(VAP)的疗效。方法采用前瞻性随机-对照试验,对某院2009年3月1日～2011年7月1日入住的颅脑疾病患者,按照中华医学会呼吸病学分会制定的《医院获得性肺炎诊断和治疗指南》中VAP诊断标准,诊断为VAP的51例患者,随机分为试验组(Bundle治疗组31例)和常规组(对照组26例)。比较两组之间入住NCU的好转率、死亡率、入住时间以及费用。结果 (1)两组之间在年龄、性别、APACHEⅡ评分、诊断、合并症以及人工气道情况方面差异无统计学意义(P﹥0.05);(2)试验组好转率90.3%,对照组65.4%(P=0.027);(3)试验组死亡率6.5%,对照组30.8%(P=0.032);(4)试验组入住NCU的时间(12.16±5.14)d,对照组(16.54±4.80)d(P=0.002);(5)试验组入住NCU期间的总费用(6.0903±2.5323)万元,对照组(7.3019±1.8082)万元(P=0.046),差异有统计学意义。结论 Bundle护理明显提高重症颅脑疾病VAP患者的好转率,降低其死亡率,减少重症颅脑疾病VAP患者入住NCU时间及入住NCU的费用。
Objective To investigate the effect of Bundle nursing on ventilator-associated pneumonia (VAP) in patients with neurosurgical (NCU) severe craniocerebral disease. Methods A prospective randomized-controlled trial was conducted in a hospital from March 1, 2009 to July 1, 2011 admitted to patients with craniocerebral disease, according to the Chinese Medical Association Respiratory Disease Branch developed "hospital-acquired pneumonia diagnosis and treatment Fifty-one patients diagnosed with VAP who were diagnosed with VAP in the Guidelines were randomly divided into a test group (31 in the Bundle group) and a control group (26 in the control group). The rate of improvement, mortality, check-in time, and cost of staying in the NCU between the two groups were compared. Results (1) There was no significant difference in age, gender, APACHEⅡscore, diagnosis, comorbidities and artificial airway between the two groups (P> 0.05). (2) The rate of improvement was 90.3% in the experimental group and 65.4 (P = 0.027); (3) The mortality of the experimental group was 6.5% and that of the control group was 30.8% (P = 0.032); (4) The time for admission to the NCU was (12.16 ± 5.14) days in the experimental group and 16.54 ± 4.80 (P = 0.002); (5) The total cost during the period of NCU (6.0903 ± 2.5323) and control group (7.3019 ± 1.8082) yuan (P = 0.046) were significant difference between the two groups. Conclusion Bundle nursing significantly improves the rate of improvement of VAP patients with severe craniocerebral disease, reduces its mortality and reduces the time spent in NCU and the time spent in NCUs in VAP patients with severe craniocerebral disease.