肝癌加速康复外科术中保温技术的循证实践  

Evidence-based practice of warming methods in enhanced recovery for liver cancer surgery

作　　者：周毅峰 杨继平 袁浩[2] 石泽亚[3] Zhou Yifeng;Yang Jiping;Yuan Hao;Shi Zeya(First Division of Operating Room,Hunan People′s Hospital,Changsha 410005,China)

机构地区：[1]湖南师范大学附属第一医院/湖南省人民医院手术一部,湖南长沙410005 [2]湖南师范大学附属第一医院/湖南省人民医院检验科,湖南长沙410005 [3]湖南师范大学附属第一医院/湖南省人民医院护理部,湖南长沙410005

出　　处：《护理学杂志》2019年第10期12-16,共5页Journal of Nursing Science

摘　　要：目的提炼加速康复外科术中保温技术的最佳证据并应用于肝癌手术患者,以预防低体温的发生,促进患者康复。方法遵循JBI临床证据应用模式,系统检索后纳入指南、系统评价、专家共识共12篇文献,总结最佳证据,制定8项审查指标。对47例肝癌手术患者及7名手术室护士开展基线审查,分析障碍因素,进行系统改进,并将证据应用于47例肝癌手术患者。比较证据应用前后护士对审查指标的执行率及患者术中体温维持情况与低体温、寒战发生率。结果证据应用后护士对7项审查指标的执行率显著高于证据应用前(均P<0.01);证据应用后患者术中体温显著高于证据应用前,低体温发生率由85.1%下降至27.7%(P<0.05,P<0.01)。结论基于最佳证据的保温技术用于肝癌患者加速康复外科手术,能维持患者术中体温,降低低体温发生率,加速患者术后康复。Objective To choose the best available evidence regarding patient warming in enhanced recovery after surgery(ERAS) program and apply in liver cancer surgery, thus to prevent hypothermia and promote recovery.Methods Following the JBI model of evidence-based healthcare, we retrieved 12 guidelines, systematic reviews and expert consensus regarding patient warming strategies for the management and/or prevention of hypothermia within the perioperative environment, then summarized best evidence from these literature and developed 8 audit indicators. The baseline audit was conducted on 47 patients and 7 nurses to identify barriers of patient warming within the perioperative environment, then improvement measures were made and implemented in 47 patients. Re-audit was also conducted to compare the implementation rates of audit indicators, body temperature of patients during surgery, and incidence rates of hypothermia and chills. Results The implementation rates of 7 audit indicators were significantly higher in re-audit compared with baseline audit(P〈0.01 for all). Body temperature of patients during surgery was significantly higher in re-audit, whereas incidence of hypothermia was decreased from 85.1% in baseline audit to 27.7% in re-audit(P〈0.05, P〈0.01). Conclusion Application of evidence-based warming methods in ERAS program for liver cancer patients can effectively maintain body temperature of patients in surgery, thus to prevent hypothermia and promote recovery of patients.

关 键 词：肝癌手术 加速康复外科 低体温 保温技术 循证实践 术中护理 

分 类 号：R472.3[医药卫生—护理学] R735.7[医药卫生—临床医学]