标题：FMEA指导下的五色分层风险识别在EICU重症肺炎中的应用

      作者：李季，李春峰，任宛丽    李季，李春峰，任宛丽南阳医学高等专科学校第一附属医院EICU，河南 南阳 473058

      卷次： 2024年35卷4期

      【摘要】 目的 分析失效模式与效果分析(FMEA)指导下的五色分层风险识别在急诊重症监护室(EICU)重症肺炎患者中的应用效果。方法 回顾性选取2021年1月至2023年2月南阳医学高等专科学校第一附属医院EICU收治的120例重症肺炎患者，根据护理方法不同分为常规组和改进组各60例。常规组患者予以常规护理，改进组患者予以FMEA指导下的五色分层风险识别干预。比较两组患者的一般临床情况、并发症发生率及入EICU前、出EICU时血气指标[血氧饱和度(SpO2)、血氧分压(PaO2)、酸碱度(pH)、二氧化碳分压(PaCO2)]、急性生理与慢性健康评分(APACHEⅡ)、呼吸困难量表(mMRC)评分。结果 出 EICU时改进组患者的 SpO2、PaO2、pH分别为(92.33±5.56)%、(90.46±6.25) mmHg、7.32±0.19，明显高于常规组的(83.45±5.09)%、(84.65±6.08) mmHg、7.25±0.17，PaCO2为(58.25±4.16) mmHg，明显低于常规组的(66.43±4.47) mmHg，差异均有统计学意义(P<0.05)；改进组患者的EICU入住时间、呼吸机撤离时间、住院时间分别为(8.46±0.79) d、(5.95±1.03) d、(15.36±2.18) d，明显短于常规组的(10.35±1.27) d、(7.68±1.14) d、(18.45±2.24) d，差异均有统计学意义(P<0.05)；改进组患者的并发症总发生率为8.33%，明显低于常规组的 23.33%，差异有统计学意义(P<0.05)；出 EICU时改进组患者的APACHEⅡ、mMRC评分分别为(12.26±3.08)分、(1.88±0.28)分，明显低于常规组的 (17.48±3.45)分、(2.25±0.35)分，差异均有统计学意义 (P<0.05)。结论 FMEA指导下的五色分层风险识别能减少EICU重症肺炎患者并发症，改善呼吸状况与健康状况，且能改善重症肺炎患者血气指标，促进患者康复。
      【关键词】 重症肺炎；五色分层风险识别；失效模式与效果分析；并发症
      【中图分类号】 R473.6 【文献标识码】 A 【文章编号】 1003—6350（2024）04—0580—06

Application of five-color hierarchical risk identification under the guidance of failure mode and effects analysisin severe pneumonia in the Emergency Intensive Care Unit.
LI Ji, LI Chun-feng, REN Wan-li. Emergency IntensiveCare Unit, the First Affiliated Hospital of Nanyang Medical College, Nanyang 473058, Henan, CHINA
【Abstract】 Objective To analyze the application effect of five-color hierarchical risk identification under theguidance of failure mode and effects analysis (FMEA) in patients with severe pneumonia in Emergency Intensive CareUnit (EICU).Methods A total of 120 patients with severe pneumonia admitted to EICU of the First Affiliated Hospital ofNanyang Medical College from January 2021 to February 2023 were retrospectively selected. The patients were divided in-to a conventional group and an improved group according to different nursing methods, with 60 patients in each group. Thepatients in the conventional group received conventional nursing, and the patients in the improved group received five-col-or hierarchical risk identification intervention under the guidance of FMEA. The general clinical situation, incidence ofcomplications, as well as blood gas indicators [oxygen saturation (SpO2), partial pressure of oxygen (PaO2), pH, partial pres-sure of carbon dioxide (PaCO2)], acute physiological and chronic health score (APACHEⅡ), and dyspnea scale (mMRC)scores before entering EICU and after leaving EICU were compared between the two groups. Results At the time of leav-ing EICU, the SpO2, PaO2, and pH in the improved group were (92.33±5.56)%, (90.46±6.25) mmHg, and 7.32±0.19, re-spectively, which were significantly higher than (83.45±5.09)%, (84.65±6.08) mmHg, and 7.25±0.17 in the conventionalgroup, while the PaCO2 was (58.25±4.16) mmHg, significantly lower than (66.43±4.47) mmHg in the conventional group,with statistically significant differences (P<0.05). The length of stay in the EICU, the time of ventilator withdrawal, and thelength of hospital stay in the improved group were (8.46±0.79) d, (5.95±1.03) d, and (15.36±2.18) d, respectively, whichwere significantly shorter than (10.35±1.27) d, (7.68±1.14) d, and (18.45±2.24) d in the conventional group (P<0.05). Thetotal incidence of complications in the improved group was 8.33%, which was significantly lower than 23.33% in the con-ventional group (P<0.05). At the time of leaving EICU, the APACHEⅡ and mMRC scores in the improved group were(12.26±3.08) points and (1.88±0.28) points, respectively, which were significantly lower than (17.48±3.45) points and(2.25±0.35) points in the conventional group (P<0.05). Conclusion The five-color hierarchical risk identification underthe guidance of FMEA can reduce the complications of patients with severe pneumonia in EICU, improve the respiratorystatus, health status, and blood gas indicators, and thus promote recovery of the patients.
      【Key words】 Severe pneumonia; Five-color hierarchical risk identification; Failure mode and effect analysis;Complications