护士主导的程序化撤机在重症监护室有创机械通气患者中的应用效果评价

doi:10.19983/j.issn.2096-8493.20260082

摘要/Abstract

摘要：

目的: 比较护士主导的程序化撤机方案与传统撤机方案在重症监护室(intensive care unit, ICU)有创机械通气患者中的应用效果,为临床撤机实践提供依据。方法: 选择2025年1—9月在复旦大学附属青浦医院急诊ICU及外科ICU收治的采用有创机械通气治疗的120例患者,分为观察组和对照组各60例。对照组采用传统撤机方案,观察组实施护士主导的程序化撤机方案[包括每日撤机筛查、3分钟自主呼吸试验(spontaneous breathing trial, SBT)、自主呼吸试验、医护合作撤机拔管、拔管后护士的处理及观察等]。比较两组患者每日撤机筛查率、平均机械通气时间、撤机失败率和ICU滞留时间。结果: 观察组每日撤机筛查率的M(Q₁,Q₃)为100.0%(100.0%,100.0%),高于对照组的66.7%(50.0%,75.0%);患者机械通气时间为(73.4±24.8)h,短于对照组的(82.2±23.1)h;ICU滞留时间为(4.9±1.4)d,短于对照组的(5.8±1.6)d,差异均有统计学意义(Z=9.222,P<0.001;t=1.999,P=0.048;t=3.305,P=0.001)。观察组撤机失败率为1.7%(1/60),与对照组撤机的失败率(3.3%,2/60)比较,差异无统计学意义(χ²=0.342,P=0.559)。结论: 护士主导的程序化撤机可缩短ICU有创机械通气患者撤机时间、平均机械通气时间和ICU滞留时间,但对撤机失败率无影响,总体具有临床推广价值。

关键词: 护士, 通气机, 机械, 对比研究

Abstract:

Objective: To compare the application effects of a nurse-led protocolized weaning program with conventional weaning program in intensive care unit (ICU) patients receiving invasive mechanical ventilation, and to provide evidence for clinical weaning practice. Methods: A total of 120 patients receiving invasive mechanical ventilation and admitted to the Emergency ICU and Surgical ICU of Qingpu Hospital Affiliated to Fudan University from January to September 2025 were enrolled and divided into an observation group and a control group, with 60 cases in each group. The control group received conventional weaning, while the observation group received a nurse-led protocolized nursing program (including daily weaning screening, 3-minute spontaneous breathing trial, spontaneous breathing trial, physician-nurse collaborative weaning and extubation, and post-extubation nursing management and monitoring). The daily weaning screening rate, mean duration of mechanical ventilation, weaning failure rate, and ICU length of stay were compared between the two groups. Results: The median (Q₁,Q₃) daily weaning screening rate in the observation group was 100.0% (100.0%, 100.0%), which was higher than that in the control group (66.7% (50.0%, 75.0%)). The duration of mechanical ventilation in the observation group was (73.4±24.8) h, shorter than that in the control group ((82.2±23.1) h). The ICU length of stay in the observation group was (4.9±1.4) d, shorter than that in the control group ((5.8±1.6) d). All differences were statistically significant (Z=9.222, P<0.001; t=1.999, P=0.048; t=3.305, P=0.001). The weaning failure rate was 1.7% (1/60) in the observation group and 3.3% (2/60) in the control group, with no statistically significant difference (χ²=0.342, P=0.559). Conclusion: The nurse-led protocolized weaning can shorten the weaning time, mean duration of mechanical ventilation, and ICU length of stay in patients receiving invasive mechanical ventilation, but has no effect on the weaning failure rate. Overall, it has clinical application value.

Key words: Nurses, Ventilators, mechanical, Comparative study

中图分类号:

R473.5

夏丽芳, 范志文, 张惟, 金伟魏. 护士主导的程序化撤机在重症监护室有创机械通气患者中的应用效果评价[J]. 结核与肺部疾病杂志, 2026, 7(3): 308-313. doi: 10.19983/j.issn.2096-8493.20260082

Xia Lifang, Fan Zhiwen, Zhang Wei, Jin Weiwei. Evaluation of the application effect of nurse-led protocol-based weaning in patients with invasive mechanical ventilation in the intensive care unit[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(3): 308-313. doi: 10.19983/j.issn.2096-8493.20260082

图/表 3

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指标	对照组(60例)	观察组(60例)	统计检验值	P值
年龄(岁,$\bar{x}$±s)	68.4±15.1	70.1±15.5	t=-0.608	0.544
性别[例(构成比,%)]			χ²=0.320	0.572
男性	36(60.0)	39(65.0)
女性	24(40.0)	21(35.0)
疾病种类[例(发生率,%)]			χ²=1.933	0.586
腹部手术	21(35.0)	24(40.0)
重症肺炎	13(21.7)	10(16.7)
创伤	15(25.0)	17(28.3)
脓毒性休克	11(18.3)	9(15.0)
APACHE Ⅱ评分(分,$\bar{x}$±s)	16.3±3.7	15.2±3.0	t=1.803	0.074
氧合指数($\bar{x}$±s)	182.3±21.3	185.1±21.7	t=-0.903	0.368