肝移植患者术后早期活动管理审查指标的制订及障碍因素分析

Postoperative analysis on construction and obstacles of clinical audits for evidence-based early activity management after liver transplantation patients

目的分析肝移植患者术后早期活动循证实践的障碍因素及促进因素,有助于制定行动策略。方法以澳大利亚循证卫生保健中心“证据临床应用模式”为理论指导,对证据进行检索、评价并汇总,确定审查指标后再依次进行质量审查,采用渥太华研究应用模式评估证据应用过程中出现的促进因素和障碍因素,进而制定行动策略。结果本研究最终纳入19条证据,制定21条审查指标,其中仅2条指标的临床依从性为100%,其余指标临床依从性均小于80%。主要障碍因素为科室缺乏规范化早期活动的流程和教育资料、医护人员缺乏肝移植术后早期活动相关知识、肝移植患者及家属对术后早期活动认识不够等。主要促进因素为领导力、医护人员学习积极性高、多学科团队合作等。结论肝移植患者术后早期活动审查指标的制定具有科学性及可操作性,其临床实践与证据之间存在较大差距,应进行障碍因素分析,并实施行动策略,以便更快促进最佳证据向临床转化。

Objective To analyze the construction and obstacles of clinical audits for evidence-based early activity management after liver transplantation patients,and to formulate the action strategies.Methods Under the theoretical guidance of Evidence-based Clinical Application Model of Australian Evidence-based Health Care Center,the evidence was searched,evaluated and summarized.Then,the quality review conducted one by one after the review indicators were determined.The Ottawa Research Application Model was used to evaluate the promoting factors and obstacles in the process of evidence application,and then the action strategy was formulated.Results In this study,19 evidences were finally included and 21 review indexes were established.Based on these evidence,the clinical compliance of only two indexes was 100%,and that of the other indexes was less than 80%.The main obstacles were the lack of standardized procedures and educational materials for early activities in departments,the lack of related knowledge among medical staff about early activities after liver transplantation,and the insufficient awareness of patients undergoing liver transplantation and their families on early activities after surgery.The main promoting factors were leadership,high learning enthusiasm of medical staff and multi-disciplinary team cooperation,etc.Conclusion The establishment of early activity review indicators for patients after liver transplantation is scientific and operable.Moreover,there is a big gap between clinical practice and evidence.Ttherefore,the obstacle factors should be analyzed and action strategies should be implemented to promote the transformation of the best evidence to clinic more quickly.