基于证据的持续质量改进模式在经股动脉脑血管造影术制动时间循证实践中的应用  

Application of evidence-based continuous quality improvement mode in clinical practice of limb immobilization of patients receiving transfemoral cerebral angiography

作　　者：谭晓青 贺雄军 黎凯锋 周宏星 何少玲 赖裕辉 李桂茹 黎杰 戈全荣 罗伟 刘亚杰 TAN Xiaoqing;HE Xiongjun;LI Kaifeng;ZHOU Hongxing;HE Shaoling;LAI Yuhui;LI Guiru;LI Jie;GE Quanrong;LUO Wei;LIU Yajie(Department of Neurology,Shenzhen Hospital of Southern Medical University,Shenzhen,Guangdong Province 518100,China)

机构地区：[1]南方医科大学深圳医院神经内科,广东深圳518100 [2]南方医科大学深圳医院影像科,广东深圳518100 [3]南方医科大学深圳医院B超室,广东深圳518100 [4]精益企业中国(上海)

出　　处：《介入放射学杂志》2024年第4期397-403,共7页Journal of Interventional Radiology

基　　金：深圳市医学重点专病项目(SZXK074);深圳市宝安区科技计划项目(2021JD114)。

摘　　要：目的探讨经股动脉脑血管造影术最佳证据应用于术后缩短患者卧床制动时间的可行性。方法以基于证据的持续质量改进模式为指导,分析临床现状和收集证据,制定经股动脉脑血管造影术循证实践方案,对比方案应用前后审查指标执行率。采用随机对照试验(RCT)法确定方案有效性及术后并发症发生率。结果循证方案应用后,6项审查指标执行率由0~78.86%上升至96.26%~100%。术后患者卧床制动时间缩短。干预组与对照组间术后穿刺处血肿、假性动脉瘤、动静脉瘘、股静脉血栓、出血、尿潴留发生率比较差异无统计学意义(均P>0.05);穿刺处淤青面积、穿刺处疼痛评分、术后当晚失眠发生率、腰背部疼痛评分比较差异有统计学意义(均P<0.05),对照组高于干预组;两组均未发生腹膜后血肿。结论基于证据的持续质量改进模式指引下循证实践提示,经股动脉穿刺行脑血管造影术后术侧肢体制动2 h、包扎4 h,静卧6 h是安全的,在不增加穿刺处并发症发生率情况下提高了患者舒适度。但必须规范股动脉穿刺点选择、穿刺技术和压迫制动方法。Objective To discuss the feasibility of applying the best evidence to shorten the patient’s limb immobilization time on bed after transfemoral cerebral angiography.Methods Under the guidance of evidence-based continuous quality improvement mode,the clinical status was analyzed and the evidences were collected,based on which the evidence-based practice scheme for transfemoral cerebrovascular angiography was formulated.The implementation rates of controlling indicators before and after applying new scheme were compared.Randomized controlled trial(RCT)was used to identify the effectiveness of the scheme and the incidence of postoperative complications.Results After applying the evidence-based practice scheme,the implementation rate of the six controlling indicators increased from 0%-78.86%to 96.26%-100%.The patient’s limb immobilization time in bed was shortened.The difference in the incidences of postoperative hematoma,pseudoaneurysm,arteriovenous fistula,femoral vein thrombus,bleeding,and urinary retention between the intervention group and the control group were not statistically significant(all P>0.05).The skin bruising area at the puncture site,pain score at the puncture site,incidence of insomnia on the night of the operation,and lower back pain score in the control group were remarkably higher than those in the intervention group(all P<0.05).No retroperitoneal hematoma occurred in both groups.Conclusion Under the guidance of evidence-based continuous quality improvement mode,it is clinically safe to keep immobilization of surgical side limb for 2 hours,to bandage the puncture site for 4 hours,and to keep patient in bed for 6 hours,which improves the degree of patient comfort while not increasing the incidence of complications at the puncture site.However,the selection of femoral artery puncture point,the puncture technique and the compression immobilization method must be standardized.

关 键 词：脑血管造影术 股动脉穿刺 卧床时间 循证实践 

分 类 号：R473.74[医药卫生—护理学]