基于循证和德尔菲法构建肝移植术后血糖管理方案  

Constructing a blood glucose management program after liver transplantation based on evidence-based medicine and Delphi method

作　　者：黄旭叶[1] 邵冬玲 卢芳燕 Huang Xuye;Shao Dongling;Lu Fangyan(The First Affiliated Hospital Zhejiang University School of Medicine,Hangzhou Zhejiang 310009,China)

机构地区：[1]浙江大学医学院附属第一医院,浙江杭州310009

出　　处：《护理与康复》2023年第11期1-9,共9页Journal of Nursing and Rehabilitation

基　　金：浙江省卫生健康科技计划项目,编号2022KY147。

摘　　要：目的构建肝移植术后血糖管理方案,为临床提供循证依据及决策支持。方法采用循证医学系统评价法,检索UpToDate、Embase、PubMed、Cochrane Library、万方数据知识服务平台、中国生物医学文献数据库、中国知网、维普资讯中文期刊服务平台、中国医脉通指南网,筛选最佳证据。以渥太华研究应用模式为指导,研究小组对最佳证据进行障碍因素及促进因素分析,结合专业判断及目前临床实践常规,初拟肝移植术后血糖管理方案。采用德尔菲法,对26位从事器官移植、急危重症、内分泌、康复、营养、临床药学的专家进行函询。结果本研究共纳入9篇文献,通过2轮专家函询,最终构建了6项一级指标,18项二级指标,56项三级指标的肝移植术后血糖管理方案。2轮专家函询的积极系数分别为96.15%和96.00%;专家权威系数分别为0.84和0.84;指标重要性W值分别为0.126和0.147,指标可操作性W值分别为0.201和0.180,P均<0.01。2轮函询后各指标重要性变异系数为0.06~0.23,可操作性变异系数为0.06~0.26。结论本研究基于循证和德尔菲法构建肝移植术后血糖管理方案,构建过程严谨,方法科学,结果可靠,可用于指导肝移植受者术后规范化的血糖管理。Objective To construct a glycemic management program after liver transplantation to provide evidence-based basis and decision support for clinical practice.Methods The systematic evaluation method of evidence-based medicine was used by searching UpToDate,Embase,PubMed,Cochrane Library,WANGFANG DATA,China Biomedical Literature Database,CNKI,VIP,and China Medical Pulse Guide to screen the best evidence.Guided by the Ottawa Model of Research Use,the research team analyzed the best evidence for obstacles and facilitators,and combined with the professional judgments and the current clinical practice routines,to draft a blood glucose management program after liver transplantation.Using the Delphi method,26 experts engaged in organ transplantation,acute and critical care,endocrinology,rehabilitation,nutrition,and clinical pharmacy were inquired.Results A total of 9 papers were included in this study,and through 2 rounds of expert consultation,a blood glucose management program for liver transplantation with 6 primary,18 secondary,and 56 tertiary indicators was finally constructed.The positive coefficients of the 2 rounds of expert consultation were 96.15%and 96.00%,respectively,and the experts authority coefficients were 0.84 and 0.84.Indicator importance were 0.126 and 0.147,indicator operability were 0.201 and 0.180,all the P<0.01.The variation coefficients of the importance of each index after 2 rounds of consultation ranged from 0.06 to 0.23,and the variation coefficients of operability ranged from 0.06 to 0.26.Conclusion This study constructed a postoperative glycemic management program for liver transplantation based on the evidence-based and Delphi method,with a rigorous process of constructing,a scientific methodology,and a reliable result,which can be used to guide the standardized blood glucose management of liver transplantation patients in the postoperative period.

关 键 词：肝移植 血糖管理 移植术后糖尿病 循证护理 德尔菲法 

分 类 号：R473.58[医药卫生—护理学]