提升经皮冠状动脉介入治疗术后患者出院准备度的最佳证据总结

Evidence summary for improvement of readiness for hospital discharge of patients after percutaneous coronary intervention

目的检索、评价和总结提升经皮冠状动脉介入治疗(PCI)术后患者出院准备度的最佳证据,为临床工作提供依据。方法系统检索BMJ Best Practice、UpToDate、Joanna Briggs Institute(JBI)循证卫生保健中心数据库、英国国家卫生与临床优化研究所指南网、苏格兰院际指南网、安大略注册护士协会、国际指南协作网、美国心脏协会网站、欧洲心脏协会网站、Cochrane Library、Pubmed、CINAHL、CNKI、万方数据库内关于提升PCI术后患者出院准备度的的文献,包括指南、系统评价、最佳实践信息册、证据总结、专家共识、随机对照研究。检索时限为自建库至2019年10月。由4名研究者对文献质量进行评价,对符合质量标准的文献进行证据提取。结果共纳入8篇文献,其中指南2篇,专家共识2篇、系统评价1篇、随机对照研究3篇。最佳证据涵盖出院准备度的评估、给予患者和照顾者知识和技能的教育、提升患者和照顾者对疾病管理的自我效能、确保患者和照顾者出院后有可及的社会支持和医疗卫生资源4个方面,共15条。结论建议在临床实践中医务人员借助出院准备度评估工具全面评估PCI术后患者,同时开展程序化健康教育和心理干预、提高患者疾病管理的自我效能,并尽可能保障患者和照顾者出院后的社会支持和医疗支持。

Objective To collect and summarize evidence for improvement of readiness for hospital discharge of patients after PCI.Methods BMJ Best Practice,UpToDate,Joanna Briggs Institute(JBI)evidence-based health care center database,National Institutes of Health and Clinical Optimization Guidelines Network,Scotland Inter Hospital Guidelines Network,Ontario Registered Nurses Association,International Guidelines Collaboration Network,American Heart Association website,European Heart Association website,Cochrane The literatures about improving the discharge readiness of patients after PCI in library,PubMed,CINAHL,CNKI and Wanfang databases included guidelines,system reviews,best practice information books,evidence summary,expert consensus,and randomized controlled studies.The retrieval time limit was from the establishment of the database to October 2019.Four researchers evaluated the quality of the literature,and extracted evidence from the literature that met the quality standards.Results A total of 5 articles were included,including 2 guidelines,2 expert consensus,1 systematic reviews,3 randomized controlled trials.The best evidence included evaluation of discharge readiness,education of knowledge and skills to patients and caregivers,improvement of self-efficacy of patients and caregivers in disease management,and assurance of social support and health resources for patients and caregivers after discharge.Conclusion It is suggested that in clinical practice,medical personnel should use the discharge readiness assessment tool to comprehensively evaluate patients after PCI,carry out programmed health education,improve patients'self-efficacy in disease management,and ensure social and medical support for patients and caregivers after discharge as much as possible.