基于健康服务领域研究成果应用的整合性行动促进框架预防无创机械通气患者面部压力性损伤的循证实践  

Evidence-based practice of non-invasive mechanical ventilation related pressure injury prevention guided by the integrated promoting action on research implementation in health services framework

作　　者：王霞[1] 王海妍 宋葵[1] 王雪莲[1] 聂圣肖[1] 郭红[3] Wang Xia;Wang Haiyan;Song Kui;Wang Xuelian;Nie Shengxiao;Guo Hong(Nursing Department,Beijing Hospital,National Center of Gerontology Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Gerontology,Beijing Hospital,National Center for Gerontology Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;School of Nursing,Beijing University of Chinese Medicine,Beijing 102488,China)

机构地区：[1]北京医院护理部,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [2]北京医院老年医学科,国家老年医学中心,中国医学科学院老年医学研究院,北京100730 [3]北京中医药大学护理学院,北京102488

出　　处：《中国实用护理杂志》2024年第8期568-575,共8页Chinese Journal of Practical Nursing

基　　金：北京医院院级科研课题(BJ-2019-165)。

摘　　要：目的以健康服务领域研究成果应用的整合性行动促进(i-PARIHS)框架为指导,将无创机械通气患者面部压力性损伤预防最佳证据应用于临床,并评价其效果。方法采用非同期前后对照研究。采用便利抽样法,选取2019年10月至2021年9月北京医院7个病区进行无创机械通气的患者作为研究对象,将2019年10月至2020年9月收治的575例患者纳入对照组,2020年10月至2021年9月收治的602例患者纳入干预组,对照组采用常规护理措施,干预组应用无创机械通气相关面部压力性损伤预防方案,比较2组压力性损伤发生率以及严重程度;分别在实施干预方案前后对7个病区的护士进行调查,比较方案应用前后护士面部压力性损伤知识水平的变化情况。结果对照组患者男354例,女221例,年龄(77.13±14.49)岁;干预组患者男392例,女210例,年龄(75.60±14.27)岁。干预组患者面部压力性损伤的发生率与对照组比较差异无统计学意义(P>0.05)。对照组患者2期及以上面部压力性损伤共计11例,其中2期5例、3期及以上6例;干预组面部压力性损伤共计9例,其中2期8例、3期及以上1例,干预组压力性损伤的严重程度低于对照组,差异均有统计学意义(χ^(2)=3.83、4.11,均P<0.05)。护士压力性损伤知识评分由实施前的(6.77±1.53)分提高至实施后的(7.15±1.47)分,差异有统计学意义(t=-2.31,P<0.05)。结论通过循证实践对无创机械通气患者面部压力性损伤的预防进行管理,对降低压力性损伤发生率及其严重程度有积极影响,有利于提高临床护士对于无创机械通气患者面部压力性损伤的预防知识及临床实践水平。Objective To use the best evidence of noninvasive mechanical ventilation related pressure injury prevention in the clinic guided by integrated promoting action on research implementation in health services framework(i-PARIHS)and evaluate its effect.Methods This study is an unsynchronized before and after control study.Convenience sampling method was used to select patients receiving non-invasive mechanical ventilation from 7 wards of Beijing Hospital from October 2019 to September 2021.A total of 575 patients receiving non-invasive mechanical ventilation from October 2019 to September 2020 were included in the control group and 602 patients from October 2020 to September 2021 were included in the trial group.The control group adopted the usual care measures,and the trial group applied the prevention program for noninvasive ventilation related facial pressure injuries.The incidence of pressure injury was compared between the two groups.Nurses in 7 wards were investigated before and after the intervention program to compare the changes of knowledge level.Results In the control group,there were 354 males,221 females,aged(77.13±14.49)years old;in the trial group there were 392 males,210 females,aged(75.60±14.27)years old.The incidence of pressure injury in the trial group was lower than the control group,but showed no significant difference(P>0.05).In the control group,11 cases suffered pressure injury,including 5 cases in stage 2,6 cases in stage 3 and above.There were 9 cases in the trial group,including 8 in stage 2 and 1 in stage 3 and above.The severity of pressure injury in the trial group was lower than that in the control group,and the difference was significant(χ^(2)=3.83,4.11,both P<0.05).The scores of the nurse′pressure injury knowledge increased from(6.77±1.53)points to(7.15±1.47)points,with a significant difference(t=-2.31,P<0.05).Conclusions Management of the prevention of noninvasive mechanical ventilation related facial pressure injury through evidence-based practice can reduce its incidence,re

关 键 词：通气机 机械 压力性溃疡 循证实践 预防 i-PARIHS 

分 类 号：R472[医药卫生—护理学]