ICU患者眼部并发症预防及护理的循证实践

Evidence-based practice for the prevention and care of ocular complications in ICU patients

目的以Stetler研究应用模式为指导,将ICU眼部护理最佳证据应用于临床实践,以减少ICU患者眼部并发症,提高护理质量。方法系统检索国内外有关ICU患者眼部护理的指南、系统评价、证据总结、专家共识等;对纳入文献进行质量评价、证据汇总;结合专家建议、临床情境及利益相关者意见筛选证据;从证据应用的方法、层次、类型3个方面制订临床转化的实施策略;2022年4月—9月采用阶梯设计的整群随机抽样,选取浙江省某三级甲等医院5个ICU作为研究场所,采用阶梯试验设计法,由计算机产生随机数确定各ICU的入组顺序,第1个月各ICU皆处于循证实践前期,第2个月第1个ICU开始进入循证实践期,直至第6个月,所有ICU都进入循证实践期,比较循证实践前后眼部护理措施执行率的差异,根据患者收治特点,将各ICU分为非脑科ICU、脑科ICU,比较循证实践前后患者眼部并发症发生率的差异。结果共纳入1540例患者。在眼部护理措施执行率方面,循证实践后眼部并发症高风险患者润滑剂的使用率和可疑眼部感染处理率有所提高(P<0.001),但促使眼睑闭合率的比较,差异无统计学意义。循证实践后,非脑科ICU患者结膜下出血、结膜充血、眼部分泌物多的发生率较实践前下降(P<0.05);脑科ICU患者的结膜水肿、结膜充血发生率较实践前也有所下降(P<0.001)。结论以Stetler研究应用模式为概念框架的ICU患者眼部护理循证实践可促进护士规范执行ICU患者眼部护理措施,减少ICU患者发生眼部并发症。

Objective To develop an evidence-based practice program for ICU eye care and evaluate its application effect using Stetler model of research utilization.Methods The systematic search was carried out in domestic and foreign guidelines,systematic reviews,evidence summaries,expert consensuses on eye care for ICU patients.The quality of the included literature was evaluated and the evidence was summarized.The evidence based on expert advice,clinical context and stakeholder opinions was screened.According to Stetler model of research utilization,the evidence translation/application was formulated from 3 aspects,including method,level and type of evidence application,and the evidence translation was implemented using a stepwise trial design.Five ICUs in a tertiary hospital in Zhejiang Province were selected,and the order of enrollment of each ICU was determined by computer-generated random numbers from April to september,2022.In the first month,all ICUs were in pre-evidence-based practice period,and in the second month,an ICU was trained and entered the evidence-based practice period.Until the 6th month,all ICUs entered the evidence-based practice period.Then the rate of ocular symptoms and implementation rate of eye care measures were compared before and after EBP.Results A total of 1540 patients were included.With regard to the implementation rate of eye care measures,the rate of lubricant use and suspected ocular infection management in patients at high risk for ocular complications in evidence-based practice period was significantly higher compared with pre-evidence-based practice period(P<0.001),and no statistically significant difference was found in the rate of eyelid closure.The incidence of conjunctival exposure,subconjunctival hemorrhage,conjunctival congestion,and ocular discharge in non-neurology critical care patients decreased compared with pre-evidence-based practice period(P<0.05),and the incidence of conjunctival edema and conjunctival congestion in NICU patients decreased compared with pre-evidence-based practice period as the intervention continued(P<0.001).Conclusion Evidence-based practice in eye care for ICU patients using Stetler model of research utilization can standardize the practice of eye care for ICU patients and improve the quality of care.