神经重症患者气管插管管理的最佳证据总结及其应用效果研究  

Summary of the best evidence for tracheal intubation management in neurological critical ill patients and its application effects

作　　者：张莹莹 盛李昕贝 徐博[1] Zhang Yingying;Sheng Lixinbei;Xu Bo(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,南京210008

出　　处：《中华现代护理杂志》2024年第1期45-54,共10页Chinese Journal of Modern Nursing

基　　金：国家自然科学基金青年项目(82203876)。

摘　　要：目的总结神经重症患者气管插管管理的最佳证据并探讨其应用效果。方法采用澳大利亚乔安娜布里格斯研究所临床证据实践应用系统, 检索并总结最佳证据, 结合临床情景和专业判断, 制订相应的审查指标, 辨析证据应用的障碍因素, 构建最佳行动策略。采用便利抽样法, 选取南京大学医学院附属鼓楼医院神经外科监护室68名护士、2022年1—4月开展基线审查时的98例气管插管患者和2022年9 —12月开展证据应用后的99例气管插管患者为研究对象, 比较循证实践前后审查指标的执行率、护士对神经重症患者气管插管管理知识的掌握程度以及患者气道并发症(口腔黏膜溃疡、气道黏膜出血、气管食管瘘、肺部感染)发生率。结果共总结28条最佳证据并制定了相应审查指标, 除了6项审查指标(指标11、13、19、20、27、28)由开展循证实践前的97.96%~100.00%提升至100.00%, 差异无统计学意义(P>0.05), 其余22项审查指标的执行率在开展循证实践后均有所提高, 其中有8项指标(指标5、6、9、14、18、21、25、26)执行率从0提升至89.90%~100.00%, 差异有统计学意义(P<0.05)。开展循证实践后, 护士对神经重症患者气管插管管理知识水平得分由(62.41±6.07)分提升至(93.82±2.74)分, 差异有统计学意义(P<0.05);除气管食管瘘外, 患者其他气道并发症发生率均有所降低, 差异有统计学意义(P<0.05)。结论基于证据的神经重症患者气管插管管理方案可提高护士对神经重症患者气管插管管理的知识水平, 降低患者气道并发症发生率, 改善患者临床结局。Objective To summarize the best evidence for tracheal intubation management in neurological critical ill patients and explore its application effect.Methods The Clinical Evidence Practice Application System of Joanna Briggs Institute in Australia was adopted to retrieve and summarize the best evidence,develop appropriate review indicators based on clinical scenarios and professional judgement,identify obstacles to the application of evidence,and construct the best action strategy.Using the convenient sampling method,a total of 68 nurses from the Neurosurgical Care Unit of Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,98 tracheal intubation patients during baseline review from January to April 2022,and 99 tracheal intubation patients after evidence application from September to December 2022 were selected as the research objects.Before and after evidence-based practice,the implementation rate of review indicators,nurses'knowledge of tracheal intubation management in neurocritical critical ill patients,and the incidence of patients'airway complications(oral mucosal ulcer,airway mucosal hemorrhage,tracheoesophageal fistula,pulmonary infection)were compared.Results A total of 28 best evidences were summarized and corresponding review indicators were developed.Except for six review indicators(indicators 11,13,19,20,27,28),which increased from 97.96%-100.00%before evidence-based practice to 100.00%,the differences were not statistically significant(P>0.05),and the implementation rates of the remaining 22 review indicators were improved after evidence-based practice.Among them,the implementation rates of eight indicators(indicators 5,6,9,14,18,21,25,26)increased from 0 to 89.90%-100.00%,and the differences were statistically significant(P<0.05).After evidence-based practice,the scores of nurses'knowledge of tracheal intubation management in neurological critical ill patients increased from(62.41±6.07)to(93.82±2.74),and the difference was statistically significant(P<0.05).Exce

关 键 词：循证护理 神经重症 气管插管 人工气道 证据应用 

分 类 号：R473.74[医药卫生—护理学]