神经外科重症气管插管患者口腔黏膜压力性损伤预防管理的审查指标制订及障碍因素分析  

Establishment of review indexes and analysis of obstacle factors for prevention and management of oral-mucosal pressure injury in patients with severe tracheal intubation in neurosurgery

作　　者：张莹莹 张娟[1] 冯敏[1] 陈成[1] 朱蓓蓓[1] 李明[1] 陶震楠 徐博[1] ZHANG Yingying;ZHANG Juan;FENG Min;CHEN Cheng;ZHU Beibei;LI Ming;TAO Zhennan;XU Bo(Department of Neurosurgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,Jiangsu,China)

机构地区：[1]南京大学医学院附属鼓楼医院神经外科,江苏南京210008

出　　处：《护士进修杂志》2025年第3期256-263,共8页Journal of Nurses Training

基　　金：国家自然科学基金青年项目(编号:82203876)。

摘　　要：目的评估神经外科重症气管插管患者口腔黏膜压力性损伤(oral-mucosal pressure injury,OMPI)预防管理证据在临床的应用现状,制订审查指标,并进行障碍因素与促进因素分析,据此制订变革策略。方法以乔安娜布里格斯研究所(Joanna Briggs Institute,JBI)循证卫生保健模式为理论指导,遴选神经外科重症气管插管患者OMPI预防管理的最佳证据,制订审查指标并规范审查对象及方法,于2023年6—9月选取南京市某三甲医院神经外科监护室气管插管患者45例及神经外科监护室护士23名进行临床审查,并根据审查结果分析障碍因素及促进因素,构建相应的变革策略。结果本研究共纳入27条最佳证据,制订31条审查指标,其中22条指标依从率均<60%,对审查结果逐条分析得出,主要障碍因素包括证据内容复杂、护士工作负荷大、相关知识掌握不足及重视程度不够,科室缺乏相关标准化流程、护理常规较陈旧、缺乏有效的多学科团队的协作形式且培训不足等,促进因素包括护士态度积极、变革氛围强、医院及科室重视度高、循证科研力量扎实、师资力量充足等;据此构建的变革策略,包括制订标准化流程将证据转化为临床可用的形式、开展培训考核及质量监督促使接受者的行为转变、通过设立气管插管防控专员和优化多学科沟通渠道的途径来创造支持性实践环境。结论神经外科重症气管插管患者OMPI预防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,制订相应的变革策略,以保障神经外科重症气管插管患者OMPI预防管理方案执行的安全性及合理性。Objective To evaluate the current clinical application of evidence on the prevention and management of oral mucosal pressure injury(OMPI)in patients with severe tracheal intubation in neurosurgery,formulate review indicators,analyze obstacle factors and promoting factors,and formulate reform strategies accordingly.Methods Using Joanna Briggs Institute(JBI)evidence-based health care model as theoretical guidance,the best evidence of prevention and management of OMPI in patients with severe tracheal intubation in neurosurgery was selected,the review indicators were established,and the review objects and methods were standardized.From June to September 2023,45 cases of tracheal intubation patients and 23 cases of nurses in the neurosurgical care unit of a Grade A hospital in Nanjing were selected for clinical review,and obstacle factors and promoting factors were analyzed according to the review results,and corresponding reform strategies were constructed.Results A total of 27 best evidences were included in this study,and 31 review indicators were developed,of which 22 indicators had compliance rates lower than 60%.According to the analysis of the review results,the main obstacle factors included complex evidence content,large workload of nurses,insufficient knowledge and insufficient attention,the departments lack relevant standardized procedures,outdated nursing practices,lack of effective multidisciplinary team cooperation forms,and insufficient training,etc.The contributing factors included positive attitude of nurses,strong atmosphere for change,high attention from hospitals and departments,solid evidence-based scientific research strength,and sufficient teachers,etc.The resulting change strategy included developing standardized processes to translate evidence into a clinically usable form,conducting training assessments and quality monitoring to induce behavioral change in recipients,and creating a supportive practice environment through the establishment of intubation prevention and control specialists,and o

关 键 词：神经外科 危重症 气管插管 口腔黏膜压力性损伤 审查指标 障碍因素 循证实践 

分 类 号：R471[医药卫生—护理学] R473.6[医药卫生—临床医学]