摘要目的 了解神经外科监护室(NSICU)护士执行预防胃内容物误吸指南的现状,分析其对患者误吸结局的影响.方法 采用方便抽样法,于2016年6月—2017年1月选取北京市2所三级综合医院NSICU作为调查场所,对2个NSICU预防胃内容物误吸的护理现状进行调查,并分析其与患者误吸结局的关系.使用SPSS 21.0软件对数据进行统计分析.结果 定时评估鼻饲管路位置、使用复方氯已定进行口腔护理、每6小时抽吸胃内残余已经成为NSICU的护理常规;但仅有1/4的床头抬高角度达到了指南要求,55.9%的人工气道气囊压力仍处于较低水平.误吸患者与非误吸患者的床头抬高角度、气囊压力、肠内营养速度3项指标差异均具有统计学意义(χ2值分别为13.848、41.093、33.011;P<0.001).结论 预防误吸的指南内容在不断增加和更新,但临床实施中仍与指南存在差距.本研究提示实际临床工作中护理人员应严格执行和细化指南推荐的措施,以期降低胃内容物误吸的发生率.

abstractsObjective To investigate the guidelines implementation status of preventing gastric aspiration by Neurosurgery Intensive Care Unit (NSICU) nurses, and analyze its effects on gastric aspiration outcomes. Methods Using convenient sampling method, two NSICU of Class Ⅲ hospitals in Beijing from June 2016 to January 2017 were selected to investigate the nursing status of preventing gastric aspiration and analyze its relationship with gastric aspiration outcomes. SPSS 21.0 software was used to analyze the data. Results NSICU nursing routine included assessing the nasal feeding tube position, using the compound chlorhexidine in oral care, and assessing gastric residual volumes (GRVs) per 6 hours. However, only a quarter of bedside elevation angle met the guidelines requirements; 55.9% of the cuff pressure was at a low level. There were statistically significant differences in bedside elevation angle, cuff pressure and enteral nutrition velocity in the comparison of aspiration and non-aspiration patients (χ2=13.848,41.093,33.011;P< 0.001). Conclusions Although guidelines for the prevention of gastric aspiration are being constantly added and updated, a gap between the clinical practice and the guidelines exists. This study suggests that the recommended measures should be more rigorous and detailed in practical clinical work to reduce the incidence of gastric aspiration.