踝泵运动预防关节置换患者围手术期下肢深静脉血栓形成的循证实践

Evidence-based practice of ankle pump exercises in preventing perioperative lower limb deep vein thrombosis in joint replacement patients

目的总结踝泵运动预防关节置换患者围手术期下肢深静脉血栓形成(DVT)的最佳证据,并评价其临床应用效果。方法基于证据的持续质量改进模式的标准程序,应用循证护理的方法系统检索国内外相关临床实践指南、专家共识、系统评价及随机对照试验等。评价并汇总最佳证据,制订审查指标进行基线审查,并基于基线审查结果分析促进与障碍因素。于2022年12月—2023年4月在河南省人民医院骨科将证据应用于临床,将2022年12月—2023年1月骨关节病区的36例关节置换患者及所在科室18名护士作为循证实践前组开展基线审查,将2023年3—4月的36例关节置换患者及基线审查中的18名护士为循证实践后组。比较循证实践前后护士踝泵运动知识水平、关节置换患者执行踝泵运动的有效性、患者对踝泵运动的执行率、依从性得分及程度等。结果最终纳入12篇文献,包括临床实践指南1篇、专家共识5篇、系统评价1篇、随机对照试验5篇。在踝泵运动适用人群、运动评估、运动体位、运动时机、运动方式、运动频次及运动宣教方面总结了10条最佳证据。开展循证实践后,护士对踝泵运动知识问卷的得分为(82.78±8.26)分,高于循证实践前的(70.56±9.98)分,差异具有统计学意义(P<0.01)。护士对审查条目2、3、4、5、6的执行率由循证实践前的0、22.2%、0、27.8%、11.1%提升至94.4%、94.4%、83.3%、100.0%、100.0%;患者层面的审查条目7、8的执行率由循证实践前的5.6%、0提升至86.1%、94.4%,差异均具有统计学意义(P<0.01)。结论基于最佳证据开展踝泵运动预防关节置换患者下肢DVT形成的循证实践,可提高护士踝泵运动循证知识水平,实践踝泵运动的标准化开展路径,探索宣教策略普适性和个性化的平衡途径,使临床踝泵运动的实施有据可依,提高患者运动依从性。

Objective To summarize the best evidence for the use of ankle pump exercises in preventing perioperative lower limb deep vein thrombosis(DVT)in patients undergoing joint replacement surgery and to evaluate its clinical application.Methods This study utilized an evidence-based continuous quality improvement model.A systematic search was conducted for relevant clinical practice guidelines,expert consensus,systematic reviews,and randomized controlled trials(RCTs)from both domestic and international sources.The best evidence was evaluated and summarized,and audit indicators were developed for baseline assessments.Facilitating and hindering factors were analyzed based on the baseline results.From December 2022 to April 2023,the evidence was applied in the Department of Orthopedics at Henan Provincial People's Hospital.The pre-evidence group for baseline assessments included 36 joint replacement patients and 18 nurses from the orthopedic unit between December 2022 and January 2023,while the post-evidence group included 36 joint replacement patients and the same 18 nurses between March and April 2023.The knowledge level of nurses,the effectiveness of ankle pump exercises,the execution rate,and patient compliance were compared before and after evidence-based practice.Results A total of 12 articles were included in the study,comprising one clinical practice guideline,five expert consensus papers,one systematic review,and five RCTs.Ten best practices were summarized in terms of applicable populations,exercise assessment,exercise positions,timing,methods,frequency,and patient education.After implementing evidence-based practice,the knowledge scores of nurses on ankle pump exercises significantly improved from(70.56±9.98)to(82.78±8.26)(P<0.01).The compliance rates of audit items 2,3,4,5,and 6 among nurses increased from 0,22.2%,0,27.8%,and 11.1%respectively,to 94.4%,94.4%,83.3%,100.0%,and 100.0%respectively(P<0.01).On the patient side,the compliance rates for audit items 7 and 8 increased from 5.6%and 0 to 86.1%and 94.4%,respectively(P<0.01).Conclusions Implementing evidence-based ankle pump exercises to prevent DVT in joint replacement patients can significantly improve nurses'knowledge of evidence-based practice,standardize the practice of ankle pump exercises,and explore balanced educational strategies that enhance patient compliance,ensuring clinical practices are evidence-based.