心房颤动患者长期口服抗凝药物管理审查指标制订及障碍和促进因素分析  

Construction of review indicators and analysis of obstacles and promoting factors for long-term oral anticoagulant management in patients with atrial fibrillation

作　　者：刘君[1] 赵小艳[1] 曹松梅[2] 朱丽群[2] 姜姣姣[1] 董程洁 王芳[1] Liu Jun;Zhao Xiaoyan;Cao Songmei;Zhu Liqun;Jiang Jiaojiao;Dong Chengjie;Wang Fang(Department of Cardiology,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China;Department of Nursing,Affiliated Hospital of Jiangsu University,Zhenjiang 212001,China)

机构地区：[1]江苏大学附属医院心内科,镇江212001 [2]江苏大学附属医院护理部,镇江212001

出　　处：《中国实用护理杂志》2025年第6期452-458,共7页Chinese Journal of Practical Nursing

基　　金：江苏大学临床医学专项基金(JDLCHL202202)。

摘　　要：目的评估心房颤动患者长期口服抗凝药物管理临床现状,分析证据实施过程中的障碍和促进因素,为证据进行临床转化提供依据。方法本研究属于横断面调查研究。通过循证护理方法,以渥太华理论模式为指导,基于最佳证据制订审查指标和审查方法。采用便利抽样法于2022年8-11月对江苏大学附属医院心内科符合纳入和排除标准的100例患者开展临床现状审查,根据审查结果,进行障碍和促进因素分析,制订临床对策。结果纳入审查的100例患者,男60例,女40例,年龄(70.14±10.39)岁。共纳入26条证据,制订24条审查指标,其中4条审查指标依从性100%,2条审查指标>60%,5条审查指标<60%,13条审查指标依从性为0。根据审查结果,从系统层面、实践者层面、患者及家属层面进行全面系统分析,针对每一维度,均从基于证据的变革、潜在采纳者及实践环境深入剖析障碍和促进因素。结论心房颤动患者长期口服抗凝药物管理最佳证据与临床现状存在差距,应深入分析障碍和促进因素,拟订对策,促进证据在临床的高效实施。ObjectiveTo evaluate the clinical status of long-term oral anticoagulant management in patients with atrial fibrillation,and to analyze the obstacles and promoting factors in the implementation of evidence,so as to provide evidence for clinical transformation.MethodsThis study was a cross-sectional study.Through the evidence-based nursing method,guided by the Ottawa Model,the review indicators and review methods were developed based on the best evidence.The clinical status review of 100 patients who met the inclusion criteria in the Department of Cardiology,Affiliated Hospital of Jiangsu University was conducted from August to November 2022 using a convenience sampling method,and based on the results of the review,an analysis of obstacles and promoting factors was carried out to develop a clinical response.ResultsThis study included 100 patients with atrial fibrillation,60 males and 40 females,aged(70.14±10.39)years.Totally 26 best items were included,and 24 review indicators were developed,among which only 4 indicators had a compliance rate of 100%,2 indicators had a compliance rate of>60%,5 indicators had a compliance rate of<60%,and 13 indicators had a compliance rate of 0.According to the results of the review,a comprehensive and systematic analysis was conducted from the three dimensions of system,practitioners,patients and family members.For each dimension,obstacles and promoting factors were analyzed in depth from evidence-based change,potential adopters and practical environment.ConclusionsThere is a gap between the best evidence and clinical status of long-term oral anticoagulant management in patients with atrial fibrillation.In-depth analysis of obstacle factors,formulate countermeasures,and promote the efficient implementation of evidence in clinical practice.

关 键 词：心房颤动 口服抗凝 审查指标 障碍因素 证据转化 

分 类 号：R541.75[医药卫生—心血管疾病]