ICU人工气道患者非计划性拔管危险因素及HFMEA的应用价值

目的探讨ICU人工气道患者非计划性拔管的危险因素及医疗失效模式与效应分析(HFMEA)的应用价值。方法选择2020年7月-9月在我院ICU治疗的气管插管患者100例为研究对象。根据是否发生非计划性拔管分为拔管组21例和未拔管组79例。收集患者一般资料与临床资料,采用单因素及多因素分析影响ICU人工气道患者非计划性拔管的危险因素。自2020年10月我科实施HFMEA,选择2020年10月~12月ICU气管插管患者100例,比较实施HFMEA前后非计划性拔管发生率。结果单因素分析结果显示,责任护士ICU工作年限、APACHEⅡ评分、置管天数、正确使用约束、镇静与躁动评分是发生非计划性拔管的相关因素(P<0.05)。多因素Logistic回归分析结果显示,责任护士ICU工作年限短、镇静与躁动评分高是非计划性拔管的独立危险因素,而正确使用约束是保护因素(P<0.05)。实施HFMEA后,非计划性拔管率显著低于实施HFMEA前(P<0.05)。结论ICU人工气道患者非计划性拔管率较高,责任护士经验缺乏、患者躁动、未正确使用约束等是非计划性拔管的高危因素。实施HFMEA后,非计划性拔管率显著下降。

Risk Factors of Unplanned Tube Drawing in Patients with Artificial Airway in ICU

Objective To discuss the risk factors of unplanned tube drawing in patients with artificial airway in ICU and application value of HFMEA.Methods 100 patients with tracheal intubation treated in ICU from July to September 2020 were selected as the study subjects.According to the occurrence of unplanned tube drawing,all cases were divided into the tube drawing group(21 cases)and the non-tube drawing group(79 cases).General and clinical data of patients were recorded.Univariate and multivariate analysis of risk factors were used to analyze the risk factors of unplanned tube drawing.Since October in 2020,HFMEA had been implemented in our department.100 cases from October to December 2020 were selected as the post-HFMEA group.The incidence of unplanned tube drawing before and after HFMEA was compared.Results Univariate analysis showed that:The ICU working life of responsible nurses was less than one year,high APACHE II score,more days of catheterization,improper use of restraint,high sedation and restlessness score were non-planned risk factors(P<0.05).Multivariate analysis showed that:short working lifeof responsible nurses,high sedation and agitation scores in ICU were independent risk factors for unplanned tube drawing,while correct use of restraint was protective factor(P<0.05).After the implementation of HFMEA,unplanned tube drawing rate was significantly lower than that before theimplementation of HFMEA(P<0.05).Conclusion The unplanned tube drawing rate of ICU patients with artificial airway is higher.Lack of experience of responsible nurses,restlessness of patients and lack of access restriction are high risk factors for unplanned tube drawingrate.For high-risk factors,the unplanned tube drawingrate decreased significantly after the implementation of HFMEA.