成人全麻气管插管患者术后咽喉疼痛预防的证据审查及分析

Prevention of postoperative sore throat due to the use of endotracheal intubation during general anesthesia:best evidence review and analysis

目的审查全麻气管插管患者术后咽喉疼痛预防及护理的应用现况,分析障碍因素及促进因素,为预防全麻术后咽喉疼痛提供参考。方法依据循证护理的方法,共形成证据20条,制订16条审查指标,对临床142例患者及140名医护人员进行审查,采用i-PARIHS框架分析障碍因素及促进因素。结果共有10项指标依从率<60%;变革方面障碍因素为需要对流程及系统进行改变、未纳入评估系统、证据未指出详细的方法及流程、证据可能对医护人员的工作环境有冲突等;接受者方面障碍因素为医护相关的知识水平不足、不认为变革措施有价值、缺乏有效的多学科、多团队协作等;组织环境方面障碍因素为医院缺乏相关的疾病治疗支持系统、缺乏相应的设备、科室缺乏相关的流程、图示及宣教材料等。结论临床医护人员应采取多学科合作,充分考虑各科存在的障碍因素,制订相关的流程及标准,促进证据的临床转化。

Objective To review the application of evidence regarding prevention and nursing care of postoperative sore throat due to the use of endotracheal intubation during general anesthesia,analyze the barriers and facilitators,and to provide reference for PSG after general anesthesia.Methods According to the methodology of evidence-based nursing,a total of 20 pieces of evidence were formed,and 16 review indicators were formulated.Then 142 patients and 140 doctors and nurses were clinically reviewed,and the i-PARIHS framework was used to analyze barriers and facilitators.Results As many as 10 indicators had a compliance rate<60%.The main barriers to change included:(1)some evidence required changes to processes and systems;(2)some evidence was not included in the evaluation system;(3)evidence did not described the methods and processes in details;(4)evidence might conflict with the working environment of medical care.The barriers reported by the recipients included the lack of knowledge related to health care,denial of the values of the evidence,the lack of effective multidisciplinary and multi-team assistance,etc.The barriers to the organizational environment included:the lack of relevant disease treatment support systems in the hospital,the lack of relevant equipment,as well as the lack of related processes,graphics,and educational materials in departments.Conclusion Clinical medical staff should adopt multidisciplinary cooperation,fully consider the barriers in each department,and develop relevant technologies,procedures and standards,so as to promote clinical transformation of evidence.