基于循证的老年心力衰竭住院患者容量管理变革策略研究

Evidence-based Capacity Management Strategies for Elderly Heart Failure Inpatients

目的 了解老年心力衰竭(heart failure, HF)患者容量管理证据临床应用现状,分析循证实践中的障碍因素及促进因素,为临床证据转化提供参考。方法 检索国内外数据库及指南网站关于老年HF患者容量管理的临床决策、指南、专家共识、证据总结、系统评价,评价和汇总最佳证据,建立审查指标。根据基线审查结果分析障碍因素,制订行动策略。结果 共纳入8篇文献,形成20条证据,制订18条审查指标,12条审查指标执行率<60%。障碍因素主要为缺乏容量管理标准化流程和评估工具、低年资医护人员依从性差、老年患者缺乏容量管理知识等。结论 老年HF患者容量管理证据与临床实践存在一定差距,应全面评估障碍因素及促进因素,采取变革策略,促进证据转化。

Objective To explore the clinical application status of evidence on volume management in elderly patients with heart failure(HF),analyze the obstacles and promoting factors in evidence-based practice,thus to provide reference for clinical transformation of evidence.Methods Clinical decisions,guidelines,expert consensus,evidence summary,systematic review on volume management of elderly HF patients in domestic and foreign databases and guide websites were searched,and the best evidence was evaluated and summarized to establish review indicators.Based on the results of the baseline review,obstacle factors were analyzed and action strategies were developed.Results A total of 8 articles were included,with 20 pieces of evidence and 18 quality review indicators were formulated.The implementation rate for 12 review indicators were less than 60%.The main obstacle factors were the lack of standardized procedures and assessment tools for volume management,poor compliance among junior healthcare staff,and sufficient knowledge of volume management in elderly patients.Conclusions There is a certain gap between the evidence of volume management in elderly HF patients and clinical practice.It is necessary to comprehensively evaluate the obstacle factors and promoting factors,and adopt reform strategies to promote the transformation of evidence.