肺癌围手术期静脉血栓预防最佳证据的应用及效果评价  

Summary and application of the best evidence for prevention of venous thrombosis in perioperative period of lung cancer patients

作　　者：王丽婷 李惠玲[1] 赵杰[2] Wang Liting;Li Huiling;Zhao Jie(School of Nursing,Suzhou University,Suzhou 215006,China;Department of Nursing,Affiliated Hospital of Jiangnan University,Wuxi 214062,China)

机构地区：[1]苏州大学护理学院,215006 [2]江南大学附属医院护理部,无锡214062

出　　处：《中国实用护理杂志》2021年第13期1009-1016,共8页Chinese Journal of Practical Nursing

摘　　要：目的促进最佳证据在胸外科肺癌手术患者静脉血栓预防过程中的应用,降低静脉血栓的发生率。方法检索、筛选肺癌围手术期静脉血栓栓塞症预防相关高质量文献指南,提炼证据,结合临床背景通过专家论证会议生成护理策略并以此为依据制订临床审查指标。以i-PARIHS循证框架为理论框架,通过建立核心小组、排除现有障碍、教育培训、质控等方式将证据高效应用于临床,采用现场观察、查阅病历等方法收集数据,从系统、护士、患者3个层面评价证据应用的效果。结果系统层面:科室建立了肺癌患者围手术期静脉血栓栓塞症预防的规范及流程,改良了血栓风险评估工具,制作了宣教材料,将血栓预防纳入质控范围,在充分考虑到人力、物资的情况下,优化了组织环境。护士层面:证据应用后护士静脉血栓栓塞症预防知、信、行问卷得分及总分分别为(17.6±1.8)、(17.4±1.8)、(18.8±1.2)、(53.8±2.9)分,较证据应用前的(12.0±2.9)、(14.5±2.8)、(11.6±2.7)、(38.3±5.1)分有所提高,差异有统计学意义(t值为-11.40~-3.90,均P<0.05)。患者层面:证据应用前静脉血栓栓塞症发生率为4.7%(19/403),证据应用后静脉血栓栓塞症发生率为0(0/118),两者比较差异有统计学意义(χ2值为5.774,P<0.05)。结论基于循证构建的肺癌围手术期静脉血栓预防最佳证据具有科学性,将其应用于临床可有效优化系统组织环境、规范护理行为、提高护理质量、减少肺癌手术患者静脉血栓的发生。Objective To promote the application of the best evidence in the prevention of venous thrombosis in patients with lung cancer in thoracic surgery,so as to improve the nursing management,elevate the nursing quality and reduce the incidence of venous thrombosis.Methods High quality literature guidelines related to perioperative venous thromboembolism prevention of lung cancer were searched and screened,and the evidence was extracted.Combined with clinical background,nursing strategies were generated through expert demonstration meetings and used as clinical review indicators.On the basis of evidence-based i-PARIHS as the theoretical framework,through the establishment of core groups,removal of existing obstacles,education and training and quality control,the evidence was applied to the clinical practice effectively,and the data were collected by means of on-the-spot observation and consulting cases,and the effect of evidence application was evaluated from the three aspects including system,nurses and patients.Results Systemically speaking,in the process of evidence application,the department established the standards and procedures for perioperative venous thromboembolism prevention of lung cancer patients,improved thrombus risk assessment tools,made educational materials,brought thrombus prevention into the scope of quality control,and optimized the organizational environment with full consideration of manpower and materials.For nurses,after the application of evidence,the scores of nurses'knowledge,attitude and practice of venous thromboembolism prevention were(17.6±1.8),(17.4±1.8),(18.8±1.2),(53.8±2.9)respectively,which were higher than those before the application of evidence(12.0±2.9),(14.5±2.8),(11.6±2.7),(38.3±5.1),the differences were significant(t values were-11.40--3.90,all P<0.05).For patients,the incidence of venous thromboembolism before the application of evidence was 4.7%(19/403),and venous thromboembolism after the application of evidence was 0(0/118),and the difference was statistically sig

关 键 词：肺肿瘤 静脉血栓栓塞症 证据应用 

分 类 号：R473.73[医药卫生—护理学]