喉切除患者气道安全管理的循证实践

Evidence-based practice of airway care for patients with laryngectomy

目的促进基于证据的喉切除患者气道安全管理的应用,提高临床护理质量。方法采用澳大利亚JBI的临床证据实践应用系统(PACES),通过对喉切除患者气道安全管理相关主题的系统检索及质量评价,总结21条最佳证据,并结合临床情景和专业判断,制订21条质量审查指标,逐条审查并进行障碍因素分析,制定行动策略。比较最佳证据应用前后耳鼻喉科护士对气道安全指标的执行率、气道安全管理知识水平、气道并发症发生率的差异。结果21条审查指标中,17条审查指标的完成率均得到提高;证据应用前后,耳鼻喉科护士对气道安全管理水平得分由基线时的(65.96±13.98)分增高到(88.06±9.98)分,差异有统计学意义(P<0.05);证据应用前后,皮下气肿、造口皮肤感染和乳糜漏的例数均由基线时的1例降为0,2组患者均未发生堵管和脱管;证据应用前,刺激性咳嗽发生例数为59例(24.69%),证据应用后,刺激性咳嗽发生率为11例(9.24%),差异均有统计学意义(P<0.05)。结论基于证据的质量审查项目,可以规范护士气道护理行为,提高护士气道安全管理知识,降低部分相关并发症的发生率,提高临床护理质量。

Objective To promote the application of evidence-based airway safety management for patients with laryngectomy and improve the quality of clinical care.Methods The Practical Application of Clinical Evidence System(PACES)of Joanna Briggs Institute(JBI)in Australia was used to conduct systematic retrieval and quality evaluation of related topics on topics related to the safety and management for laryngectomy patients.Combined with clinical scenarios and professional judgments,21 best evidences were formulated as 21 quality review indicators.After reviewing item by item and analyzing all obstacle factors,action strategies were formulated.The differences ofthe implementation rate of airway safety indicators,management knowledge level of airway safety,and the incidence of airway complications in otolaryngology nurses before and after the application were compared.Results Among 21 review indicators,the completion rate of 17 review indicators had been improved.The score of otolaryngology nurses'managementknowledge related to airway safety awareness increased from(65.96±13.98)points at baseline to(88.06±9.98)points,and the difference was statistically significant(P<0.05);The number of cases of subcutaneous emphysema,stoma skin infection,and chyle leakage decreased from 1 at baseline to 0.There was no occlusion or detubation in the two groups of patients.The number of cases of irritant cough before and after the project was 59 cases(24.69%)and 11 cases(9.24%),and the difference was statistically significant(P<0.05).Conclusion The evidence-based quality review project can standardize nurses'airway nursing behavior,improve nurses'knowledge of airway safety awareness,reduce the incidence of some related complications,and improve the quality of clinical care.