前列腺穿刺患者临床管理的证据转化

Evidence transformation of clinical management in patients with prostate biopsy

目的 总结前列腺穿刺患者临床管理的循证证据,将证据进行临床转化,并验证其临床应用效果。方法 通过JBI循证框架、结构化检索文献、质量评价和整合,获得前列腺穿刺术前患者评估及准备、术中穿刺途径、术后抗生素预防及教育证据共11条;根据FAME原则,生成审查指标9条,进行基线审查。采用鱼骨图分析障碍因素并制定对策,将证据转化至临床后,进行再审查。采用类实验研究,以医护人员及住院前列腺穿刺患者为对象,按入院时间分为证据应用前对象和证据应用后对象。证据应用前进行基线审查,采用传统穿刺流程和护理;证据应用后进行再审查,采用证据临床转化后的穿刺流程和护理。评价医护人员证据应用前后的审查指标依从率及知识得分、患者证据应用前后的疼痛得分、等候穿刺时间及感染并发症发生率。结果 证据应用后医护人员临床实践与最佳证据的6条审查指标依从率提高(依从率>75%,P<0.05);护士知识得分提高[(67.64±6.99)分vs (85.12±4.22)分,P<0.05];患者等候穿刺时间缩短[(55±7)min vs(37±3) min,P<0.05];穿刺后疼痛得分下降[(1.53±1.44)分vs(0.69±1.31)分,P<0.05];48 h内的感染并发症发生率差异无统计学意义(P>0.05)。结论 经循证实践,前列腺穿刺患者的临床管理与最佳证据之间的差距缩小,护士专业技能得到提高,患者等候穿刺时间缩短、疼痛得分下降,形成医护联合的一体化患者管理闭环流程,优化了护理常规及操作。

Objective To review the current status of nursing practice for patients with prostate biopsy,and to transform the evidence into clinical practice,in order to verify its clinicial application effect.Methods Using the JBI evidence-based framework,structured literature search,quality assessment and integration,a total of 11 evidence of pre-biopsypatient assessment and preparation,intra-biopsy way chosen,post-biopsyantibiotic prophylaxis and patient education were achieved.According to the FAME principle,9 audit criteria were generated for baseline audit.The fishbone diagram was used to analyze the obstacles factors and formulate countermeasures,and after the evidence was transformed into clinical practice,it was reviewed again.A quasi-experimental study was conducted,medical staff and hospitalized patients with prostate biopsy were selected as the research objects,and were divided into control group and observation group according to the time of admission.The control group underwent a baseline audit and adopted traditional biopsy procedures and care;The practice group conducted second round audit and adopted the evidenced biopsy procedures and care after evidence clinical transformation.The compliance rate and knowledge score of medical staff,the pain score of patients,waiting time for puncture,and incidence of infection complications were evaluated before and after the application of evidence.Results After the application of evidence,compliance rate of 6 audit criteria of medical staff were increased(compliance rate>75%,P<0.05),the score of nurses knowledge was increased[(67.64±6.99)points vs(85.12±4.22)points,P<0.05],the waiting time of patients for puncture was shortened[(55±7)min vs(37±3)min,P<0.05],and the pain score after puncture was decreased[(1.53±1.44)points vs(0.69±1.31)points,P<0.05];There was no significant difference in the incidence of infectious complications within 48 hours(P>0.05).Conclusion Through evidence-based practice,the gap between the clinical management of patients with prostate biopsy and the best evidence has been narrowed,the professional skills of nurses have been improved,the waiting time of patients for biopsy has been shortened,and the pain scores of patients has been relieved.An integrated closed-loop process of patient management of medical and nursing cooperation is formed,and nursing routines and operations are optimized.