基于循证的慢性阻塞性肺病患者围麻醉期护理变革策略研究  

Research on Evidence-based Nursing Strategies for Patients with Chronic Obstructive Pulmonary Disease During the Perioperative Period of Anesthesia

作　　者：丁敏玲 张偌翠 张转运[1] 王晴 侯敏 李雪云[1] 顾小萍[1] DING Minling;ZHANG Ruocui;ZHANG Zhuanyun;WANG Qing;HOU Min;LI Xueyun;GU Xiaoping(Department of Anesthesia Surgery,Drum Tower Hospital Affiliated to Medical School of Nanjing University,Nanjing 210008,Jiangsu Province,China)

机构地区：[1]南京大学医学院附属鼓楼医院麻醉手术科,江苏南京210008

出　　处：《军事护理》2025年第2期50-53,共4页MILITARY NURSING

基　　金：南京鼓楼医院临床研究专项资金培育项目(2021-LCYJ-PY-14)。

摘　　要：目的 审查慢性阻塞性肺病患者围麻醉期评估与干预的证据应用现状,分析证据转化过程中的障碍因素及促进因素,并据此制订行动策略,为临床实践提供依据。方法 遵循循证研究方法,检索国内外数据库及指南网站关于慢性阻塞性肺病患者围麻醉期护理的证据并汇总,制订审查指标和审查方法;并于2024年4-9月进行基线审查,采用i-PARIHS框架分析障碍因素及促进因素,并制订相应策略。结果 共纳入15条最佳证据,制订25条审查指标,其中15条指标准确执行率<60%,有2条准确执行率为0。障碍因素为需革新现有工作流程、增加工作量、医护人员重视程度不够且缺乏相关循证知识、科室缺乏系统化管理流程与制度;促进因素为管理者对变革的支持、科室对循证护理的重视、医护人员学习意愿强烈,以及科室培训条件良好等;并据此制订变革策略。结论 临床实践与患者围麻醉期评估与干预的最佳证据存在显著差距,需结合障碍因素及促进因素制订改进措施,以促进最佳证据转化。Objective To review the evidence application status of perianaesthetic assessment and intervention in patients with chronic obstructive pulmonary disease(COPD),analyze the obstacle factors and promoting factors in the process of evidence transformation,and to formulate action strategies accordingly to provide basis for clinical practice.Methods Based on evidence-based research methods,the evidence of perianaesthetic care of patients with COPD in domestic and foreign databases and guideline websites was retrieved and summarized,and the review indicators and review methods were formulated.A baseline review was conducted from April to September 2024,using the i-PARIHS framework to analyze barriers and contributing factors and formulate corresponding strategies.Results A total of 15 best pieces of evidence were included and 25 review indicators were formulated.Among them,the accurate implementation rate of 15 indicators was less than 60%,and the accurate implementation rate of 2 indicators was 0.The obstructive factors were the need to innovate the existing work process,increase of the workload,insufficient attention from medical staff and lack of relevant evidence-based knowledge,and the lack of systematic management processes and systems in the department.The promoting factors were the support of managers for the change,the department’s emphasis on evidence-based nursing,the strong learning willingness of medical staff,and good training conditions in the department,etc.Accordingly the change strategies were formulated.Conclusions There is a significant gap between clinical practice and the best evidence of perianaesthesia assessment and intervention,and improvement measures should be developed in combination with obstacle factors and promoting factors to promote the best evidence transformation.

关 键 词：慢性阻塞性肺病 围麻醉期护理 障碍因素 促进因素 循证护理 

分 类 号：R473.56[医药卫生—护理学]