急性胰腺炎患者早期液体复苏管理审查指标的制订及障碍因素分析  

Establishment of review indicators for early fluid resuscitation management in patientswith acute pancreatitis and analysis of obstacle factors

作　　者：厉丽 朱丽群[1] 张文华[1] 周英凤[2] 阮园[1] 孙国付[1] 包磊 杨丽萍[1] 仲蕾媛 张炜[1] LI Li;ZHU Liqun;ZHANG Wenhua;ZHOU Yingfeng;RUAN Yuan;SUN Guofu;BAO Lei;YANG Liping;ZHONG Leiyuan;ZHANG Wei(Affiliated Hospital of Jiangsu University,Zhenjiang 212001,Jiangsu,China;School of Nursing,Fudan University,Shanghai 200032,China)

机构地区：[1]江苏大学附属医院,江苏镇江212001 [2]复旦大学护理学院,上海200032

出　　处：《护士进修杂志》2024年第3期283-288,共6页Journal of Nurses Training

基　　金：国家卫生健康委医院管理研究所医疗质量循证管理持续改进研究项目(编号:YLZLXZ22G033);复旦循证护理中心证据转化与临床应用项目(编号:Fudanebn202205);江大临床医学专项基金项目(编号:JDLCHL202201)。

摘　　要：目的 全面评估急性胰腺炎患者早期液体复苏管理相关证据的应用现状,制定审查指标,分析障碍因素及促进因素。方法 以知识转化框架(KTA)为理论框架,确定临床问题,组建循证团队,系统检索、评价及整合证据,制订审查指标及明确审查方法。于2022年5月1日-10月1日进行临床审查,并根据审查结果分析障碍因素及促进因素,制订行动策略。结果 该研究最终纳入15条最佳证据,制订了16条审查指标,其中15条审查指标执行率<60%。对审查结果逐条分析得出主要障碍因素:证据不可及,改变了既往工作模式;潜在采纳者认知度不够,相关知识和技能有待提高,证据转化会增加临床工作量;实践环境缺乏基于证据相关流程和变革所需设备,多学科沟通渠道不畅。主要促进因素:本院为复旦大学循证护理证据应用基地,已有多项循证项目成功转化经验;转化科室为江苏省重点专科,有变革所需要的各类人才储备,医护合作氛围良好,积极性高,学习能力强。结论 急性胰腺炎患者早期液体复苏管理的临床实践与最佳证据间尚存在较大差距,通过深入辨析障碍因素,制定相应的行动策略,促进证据向临床有效转化,以保障急性胰腺炎患者早期液体复苏执行的安全性及合理性。Objective To comprehensively evaluate the application status of evidence related to early fluid resuscitation management in patients with acute pancreatitis,formulate review indicators,and analyze barrier factors and promoting factors.Methods With the knowledge transformation framework(KTA)as the theoretical framework,clinical problems were identified,evidence-based teams were established,the evidence was systematically searched,evaluated,and integrated,and review indicators and clarify review methods were developed.From May 1 to October 1,2022,clinical review was carried out,obstacles and promoting factors were analyzed according to the review results,and action strategies were formulated.Results Totally 15 pieces of best evidence were included and 16 clinical review indicators were formulated,of which there were 15 indicators with the compliance rate of<60%.By analyzing the review results one by one and the main obstacles factors were found out:The evidence was beyond reach,which changed the previous work mode;Relevant knowledge and skills of potential adopters needed to be improved,and evidence conversion would increase the workload of nurses;The practice environment lacked the equipment needed for evidence-based processes and changes,and the multidisciplinary communication channels were not smooth.The main promoting factors were as followed:Our hospital was the evidence application base of evidence-based nursing in Fudan University,and had successfully transformed many evidence-based projects;The transformation department was a key specialty in Jiangsu province and had all kinds of talent reserves needed for transformation,and the department had a good atmosphere of medical and nursing cooperation,and the majority of young nurses had strong learning ability.Conclusion There is a big gap between the clinical practice and the best evidence of early fluid resuscitation management for AP patients.Through in-depth analysis of obstacle factors,corresponding action strategies were formulated to promote the effective

关 键 词：急性胰腺炎 液体复苏 审查指标 障碍因素 循证护理 

分 类 号：R473.57[医药卫生—护理学]