【摘要】 目的：探討兒科重癥監(jiān)護(hù)室（ICU）機(jī)械通氣鼻飼患兒實(shí)施預(yù)見(jiàn)性護(hù)理的應(yīng)用效果，為臨床提供指導(dǎo)。方法：選取筆者所在醫(yī)院兒科ICU機(jī)械通氣鼻飼患兒78例，隨機(jī)分為觀察組與對(duì)照組各39例。對(duì)照組實(shí)施常規(guī)護(hù)理，觀察組在此基礎(chǔ)上行預(yù)見(jiàn)性護(hù)理，比較兩組患兒鼻飼并發(fā)癥發(fā)生率、生活質(zhì)量、治療依從性與護(hù)理滿意度。結(jié)果：觀察組患兒鼻飼并發(fā)癥發(fā)生率低于對(duì)照組（10.26% vs 51.28%）；護(hù)理滿意度高于對(duì)照組，生活質(zhì)量評(píng)分及治療依從性?xún)?yōu)于對(duì)照組，差異均有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：對(duì)兒科ICU機(jī)械通氣鼻飼患兒施行預(yù)見(jiàn)性護(hù)理，能夠降低鼻飼并發(fā)癥發(fā)生率，提高患兒治療依從性、生活質(zhì)量，改善護(hù)患關(guān)系，值得臨床推廣。
　　【關(guān)鍵詞】 預(yù)見(jiàn)性護(hù)理； 兒科重癥監(jiān)護(hù)室； 機(jī)械通氣； 鼻飼
　　doi：10.14033/j.cnki.cfmr.2018.5.060 文獻(xiàn)標(biāo)識(shí)碼 B 文章編號(hào) 1674-6805（2018）05-0118-03
　　【Abstract】 Objective：To explore the pediatric intensive care unit（ICU） mechanical ventilation nasal feeding in children with the implementation of predictive care effect，to provide guidance for the clinical.Method：Seventy-eight children with pediatric ICU mechanical ventilation were randomly divided into the observation group and the control group（n=39）.The patients in the control group underwent routine care.The observation group was treated with predictive care on this basis.The incidence of nasal feeding complications，quality of life，treatment compliance and nursing satisfaction were compared between the two groups.Result：The incidence of nasal feeding complications in the observation group was lower than that in the control group（10.26% vs 51.28%），nursing satisfaction was higher than that of the control group，the quality of life score and the treatment compliance were better than the control group，the differences were statistically significant P<0.05）.Conclusion：The prospective nursing of children with pediatric ICU mechanical ventilation nasal feeding can reduce the risk of nasal feeding complications，improve the compliance of children with treatment，improve the quality of life and improve the nurse and patient relationship，and deserve clinical promotion.
　　【Key words】 Predictive care； Pediatric intensive care unit； Mechanical ventilation； Nasal feeding
　　First-author’s address：The First People’s Hospital of Qinzhou City，Qinzhou 535000，China
　　兒科重癥監(jiān)護(hù)室（ICU）機(jī)械通氣鼻飼患兒往往意識(shí)模糊，多處于睡眠或昏迷狀態(tài)，同時(shí)伴有不同程度的吞咽障礙，喪失進(jìn)食能力[1]。鼻飼是機(jī)械通氣患兒主要腸內(nèi)營(yíng)養(yǎng)支持方法，患兒所需的營(yíng)養(yǎng)物質(zhì)通過(guò)鼻導(dǎo)管注入胃中，無(wú)須主動(dòng)進(jìn)食、咀嚼，但是易導(dǎo)致嘔吐、腹瀉、吸入性肺炎等并發(fā)癥，降低患兒生活質(zhì)量，影響康復(fù)進(jìn)程，嚴(yán)重者危及患兒的生命[2]。本文在兒科ICU機(jī)械通氣鼻飼患兒實(shí)施預(yù)見(jiàn)性護(hù)理干預(yù)，效果滿意，現(xiàn)總結(jié)如下。
　　1 資料與方法
　　1.1 一般資料
　　選取2016年1-6月筆者所在醫(yī)院收治的行機(jī)械通氣行腸內(nèi)營(yíng)養(yǎng)的兒科ICU鼻飼患兒78例，均采用鼻飼方法。其中男42例，女36例；年齡0.3～8.5歲，平均（3.26±0.55）歲；病程1～3 d，平均（2.17±0.21）d；意識(shí)清晰18例，意識(shí)模糊26例，昏迷34例。采用隨機(jī)數(shù)表法分成對(duì)照組和觀察組各39例，兩組患兒年齡、性別、GCS評(píng)分和病因等比較，差異無(wú)統(tǒng)計(jì)學(xué)意義 （P>0.05）。
　　1.2 方法
　　鼻飼方法均應(yīng)用復(fù)爾凱胃管。對(duì)照組患兒實(shí)施常規(guī)護(hù)理。觀察組在此基礎(chǔ)上實(shí)施預(yù)見(jiàn)性護(hù)理，操作如下。
　　1.2.1 護(hù)理評(píng)估 成立預(yù)見(jiàn)分析小組，評(píng)估患者的病情、意識(shí)、胃腸道功能、GCS評(píng)分、吞咽反射、胃內(nèi)反流量及有無(wú)禁忌證等，初步評(píng)估高危風(fēng)險(xiǎn)事件，制定專(zhuān)項(xiàng)護(hù)理措施。

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