Fei G, Wang F, Sun D, Ren Y W, Zhu L H, Hua J, Zhu Y P, Lyu G Z
Department of Burns and Plastic Surgery, Affiliated Hospital of Jiangnan University (Wuxi Third People's Hospital), Wuxi 214041, China.
Department of Critical Care, Zhongda Hospital Affiliated to Southeast University, Nanjing 210009, China.
Zhonghua Shao Shang Za Zhi. 2019 May 20;35(5):384-387. doi: 10.3760/cma.j.issn.1009-2587.2019.05.011.
To explore the application experience of integrated nursing mode in the treatment of extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident. On August 2nd, 2014, 35 extremely severe burn patients involved in the August 2nd Kunshan factory aluminum dust explosion accident were admitted to Wuxi Third People's Hospital, including 18 males and 17 females, aged 21-50 years. According to the characteristics of the wounded, the situation of the nursing staff, and the characteristics of the nursing work, the integrated nursing mode was constructed and implemented to improve overall nursing quality. The standardized management measures such as cluster management of facilities and equipments in wards, improving and unifying nursing system, standardized training, drawing up " Nurses Compulsory Reading" , optimizing nursing shift handover and so on were taken. Professional quality control groups such as continuous renal replacement therapy (CRRT) group, static therapy group, airway group, and burn group were established, and standardized writing nursing group, wound nursing group, psychological nursing group, and enteral nutrition nursing group were set up under burn group. The treatment outcomes of patients and effects of nursing management, nursing methods, and specialty nursing were recorded. Twenty-seven patients survived the shock period, infection period, and recovery period smoothly. The success rate of rescue was 77.14%. During the treatment, the ward was in good order. The implementation rate of disinfection and isolation system, the completion rate of shift handover, the standard rate of intravenous therapy, the implementation rate of bed head elevation, the correct rate of posture placement, and the success rate of CRRT were all 100%. Successful turn over of rotating bed without interruption of CRRT for 24 hours was implemented in two patients. In many cases, the single filter for hemodialysis continuously run for more than 72 hours. The airway mucosa of patients healed around 20 days after injury. No adverse nursing events such as tracheal cannula detachment/blockage, respiratory distress, atelectasis, lung consolidation, aspiration by mistake, rotating bed rollover, ear chondritis, nasal septal pressure ulcer, vacuum sealing drainage (VSD) catheter blockage, VSD dressing leakage, severe abdominal distension/diarrhea, non-planned extubation/blockage of various intravenous treatment catheters implanted into deep veins and arteries were observed. The integrated nursing mode significantly optimizes the nursing work process in the treatment of extremely severe mass burns, clarifies the duties of nursing staff, and improves the quality of nursing. This mode is worthy of taking reference by other burn treatment units.
探讨一体化护理模式在昆山工厂8·2铝粉尘爆炸事故极重度烧伤患者救治中的应用体会。2014年8月2日，昆山工厂8·2铝粉尘爆炸事故中的35例极重度烧伤患者被收治入无锡市第三人民医院，其中男18例，女17例，年龄21 - 50岁。根据伤员特点、护理人员情况及护理工作特点，构建并实施一体化护理模式以提高整体护理质量。采取了病房设施设备集群管理、完善并统一护理制度、规范培训并制定《护士必读》、优化护理交接班等标准化管理措施。成立了连续性肾脏替代治疗（CRRT）组、静脉治疗组、气道组、烧伤组等专业质量控制小组，烧伤组下设规范书写护理组、伤口护理组、心理护理组、肠内营养护理组。记录患者治疗转归及护理管理、护理方法、专科护理效果。结果27例患者顺利度过休克期、感染期及康复期，抢救成功率为77.14%。治疗期间，病房秩序良好，消毒隔离制度执行率、交接班完成率、静脉治疗规范率、床头抬高执行率、体位摆放正确率、CRRT成功率均达100%。2例患者实现旋转床成功翻身且CRRT不间断运行24小时。多例患者血液透析单一滤器连续运行超过72小时。患者气道黏膜伤后约20天愈合。未观察到气管插管脱出/堵塞、呼吸窘迫、肺不张、肺实变、误吸、旋转床翻身、耳软骨炎、鼻中隔压疮、封闭负压引流（VSD）导管堵塞、VSD敷料渗漏、严重腹胀/腹泻、各种深静脉及动脉植入式静脉治疗导管非计划性拔管/堵塞等不良护理事件。一体化护理模式显著优化了极重度群体烧伤救治中的护理工作流程，明确了护理人员职责，提高了护理质量，该模式值得其他烧伤治疗单位借鉴。
