基于德尔菲法构建心脏骤停后患者目标体温管理护理方案

Construction of target temperature management nursing program for patients after cardiac arrest based on the Delphi method

目的为心脏骤停后复苏患者实施目标体温管理(targeted temperature management,TTM)构建科学规范,推广性强的综合护理方案。方法成立研究小组,在前期循证研究的基础上开展小组头脑风暴形成心脏骤停后患者TTM护理方案初稿,通过2轮德尔菲专家函询,对方案条目进行修改完善补充,确定最终方案。结果2轮专家函询的问卷回收率分别为88%和100%,专家权威系数为0.93;第2轮函询条目的重要性及可操作性评价的变异系数分别为0~0.18、0~0.13,肯德尔和谐系数分别为0.089、0.105,差异具有统计学意义(P<0.05)。最终方案包括准备阶段、低温诱导阶段、体温维持阶段、复温阶段、正常体温控制阶段5个一级条目,16个二级条目,45个三级条目。结论本研究专家积极性及权威程度较高,专家意见协调程度较好,构建的心脏骤停后患者TTM护理方案具有可靠性、针对性和可行性。

Objective To construct a scientific and standardized comprehensive nursing program for the implementation of target temperature management(TTM)for resuscitated patients after cardiac arrest.Methods A research team was set up to brainstorm on the basis of the previous evidence-based study to form the first draft of the nursing program for TTM of post-cardiac arrest patients,and the final program was determined through two rounds of Delphi expert correspondence to modify and improve the program entries.Results The questionnaire recovery rates of the 2 rounds of expert correspondence were 88%and 100%,respectively,with an expert authority coefficient of 0.93;the coefficients of variation of the importance and operability evaluation of the 2nd round of correspondence entries were 0-0.18 and 0-0.13,respectively,and the Kendall's harmony coefficients were 0.089 and 0.105,with the differences being statistically significant(P<0.05).The final program included 5 first-level entries,16 second-level entries,and 45 third-level entries for the preparation phase,hypothermia induction phase,temperature maintenance phase,rewarming phase,and normal temperature control phase.Conclusion The experts in this study had a high degree of motivation and authority,a good degree of coordination of expert opinions,and the constructed nursing program for TTM of patients after cardiac arrest was reliable,targeted,and feasible.