肺切除术后胸腔引流管管理的最佳证据应用审查及障碍分析

Best evidence application review and obstacle analysis of thoracic drainage tube management after pneumonectomy

目的:了解肺切除术后胸腔引流管管理最佳证据的临床实践现状,讨论最佳证据应用可能存在的障碍因素并提出相应的解决对策。方法:采用便利抽样法,于2019年5月1—31日选取山东第一医科大学附属省立医院胸外科病房15名临床护理人员及91例患者为研究对象。纳入胸腔引流管管理的30条最佳证据,制订38条审查指标,进行证据应用的临床现状审查,根据审查结果讨论证据应用的障碍因素及相应对策。结果:38条审查指标的临床依从率为0~100%,临床依从率<50%的指标有18条,障碍因素主要包括护理人员缺乏胸腔引流管管理的循证知识培训、胸腔引流管管理规范不够完善、证据应用导致临床工作量增加、健康宣教内容不够全面等。结论:肺切除术后胸腔引流管管理的临床现状与最佳实践之间尚有较大差距,应当针对障碍因素制订并实施相应对策,促进最佳证据向临床实践有效转化。

Objective To understand the current clinical practice of the best evidence for thoracic drainage tube management after pneumonectomy,discuss the possible obstacles to the application of the best evidence and propose corresponding solutions.Methods Using the convenient sampling method,a total of 15 clinical nurses and 91 patients in the thoracic surgery ward of Shandong Provincial Hospital Affiliated to Shandong First Medical University were selected as the research objects from May 1 to May 31,2019.A total of 30 pieces of best evidence were included in thoracic drainage tube management,38 pieces of review indexes were formulated and the clinical status of evidence application was reviewed.According to the results of the review,obstacles to the application of evidence and the corresponding countermeasures were discussed.Results The clinical compliance rate of 38 reviewed indexes ranged from 0 to 100%,and 18 indexes with a clinical compliance rate less than 50%.The obstacle factors mainly include the lack of evidence-based knowledge training for the management of thoracic drainage tube by nursing staff,the incomplete management of thoracic drainage tube,the increase of clinical workload caused by the application of evidence,and the incomplete health promotion and education content.Conclusions There is still a big gap between the current clinical status of thoracic drainage tube management and best practice after pneumonectomy.Corresponding countermeasures should be formulated and implemented to promote the effective transformation of best evidence into clinical practice.