基于循证的急诊疑似脓毒症患者集束化护理方案的构建及临床应用

Evidence-Based Development and Clinical Application of a Sepsis Bundle Care Protocol for Emergency Patients with Suspected Sepsis

摘要: 目的：应用基于循证的疑似脓毒症患者集束化护理方案以提高急诊疑似脓毒症患者护理质量。方法：采用循证护理方法系统检索并整合最佳实践证据，构建疑似脓毒症患者集束化护理方案。采用随机对照试验设计，将本院急诊EICU收治的130例疑似脓毒症患者随机分为观察组(n = 65)和对照组(n = 65)。观察组实施集束化护理方案，对照组采用常规护理。比较两组患者一般资料、临床指标(C反应蛋白、白细胞计数、肌酐、氧合指数)及临床预后指标(ICU住院时间、机械通气时间)。结果：观察组患者CPR、WBC、Cr以及PaO₂/FiO₂等临床指标明显优于对照组，差异有统计学意义(P < 0.05)；ICU住院时间及机械通气时间明显短于对照组，差异有统计学意义(P < 0.05)。1 h Bundle策略各项目达标率不一，执行率较高的是测量乳酸水平89.23% (116/130)，执行率较低的是应用广谱抗菌药物26.15% (34/130)；1 h Bundle策略总体达标率为11.54% (15/130)。结论：基于循证医学构建的集束化护理方案可有效改善急诊疑似脓毒症患者的炎症指标和器官功能，缩短ICU住院时间和机械通气时间，显著提升临床护理质量。

Abstract: Objective: To evaluate the impact of an evidence-based bundle of care protocol on improving nursing quality for emergency patients with suspected sepsis. Methods: A randomized controlled trial was conducted, involving 130 suspected sepsis patients in the emergency EICU. They were randomly assigned to an observation group (n = 65, receiving the bundle of care) and a control group (n = 65, receiving routine care). Clinical indicators (C-reactive protein, white blood cell count, creatinine, oxygenation index) and prognostic outcomes (ICU stay, mechanical ventilation duration) were compared. Results: The observation group showed significantly better clinical indicators (P < 0.05) and shorter ICU stay and mechanical ventilation time (P < 0.05) than the control group; The compliance rates for individual items in the 1 h Bundle strategy vary. The highest adherence was observed in lactate measurement at 89.23% (116/130), while the lowest was in the administration of broad-spectrum antibiotics at 26.15% (34/130). The overall compliance rate for the 1 h Bundle strategy was 11.54% (15/130). Conclusion: The evidence-based bundle of care protocol effectively improves inflammatory markers and organ function, reduces ICU stay and mechanical ventilation time, thus enhancing clinical nursing quality for suspected sepsis patients in the emergency setting.