重癥監(jiān)護(hù)室管道管理的循證實踐

Evidence-based practice for intensive care unit pipeline management

LI Ming，WANG Zhenhua，TIAN YingyingTengzhou Central People′s Hospital，Shandong 277599 ChinaCorresponding Author TIAN Yingying，E-mail：yfchh@163.com

Abstract Objective：To investigate the application effect of evidence-based tube management in the intensive care unit （ICU）. Methods： The relevant literature on tube management in ICU patients was retrieved from The Clinical Evidence Practice Application System （PACES） of Joanna Briggs Institute （JBI）. The relevant literature was evaluated， and the 17 best pieces of evidence were summarized. The included review indicators were screened and analyzed to formulate countermeasures and implement them.Results： After the application of evidence， the completion rate of the 17-piece evidence was significantly improved. The scores of ICU nurses′ tube risk prediction ability， tube supervision intensity， tube management awareness， tube fixation method， and correctness of risk assessment were significantly higher than those before the application of the evidence， and the differences were statistically significant （Plt;0.05）. The standardization rate of fixation with gastric tubes， urinary tubes， ventricular drainage tubes， closed thoracostomy drain tubes， and lumbar cistern drainage tubes was significantly improved， and the difference was statistically significant （Plt;0.05）. Conclusions：The evidence-based practice of ICU tube management standardizes clinical tube management and improves the quality of nursing services.

Keywords intensive care unit;pipeline safety;nursing;nursing quality;evidence-based practice

摘要 目的：探討基于循證的重癥監(jiān)護(hù)室（ICU）管道管理循證實踐效果。方法：采用Joanna Briggs Institute（JBI）的臨床證據(jù)實踐應(yīng)用系統(tǒng)（PACES），對ICU病人管道管理相關(guān)資料進(jìn)行檢索并評價，總結(jié)出17條最佳證據(jù)，針對納入的審查指標(biāo)逐項篩查并分析，制定應(yīng)對措施并實施。結(jié)果：證據(jù)應(yīng)用后，17條審查完成率明顯提高；ICU護(hù)士管道風(fēng)險預(yù)見性能力、管道監(jiān)管力度、管道管理意識性、管道固定方法和風(fēng)險評估的正確性得分較證據(jù)應(yīng)用前明顯提高，差異均有統(tǒng)計學(xué)意義（Plt;0.05）；胃管、尿管、腦室引流管、胸腔閉式引流管、腰大池引流管固定規(guī)范率明顯提高，差異有統(tǒng)計學(xué)意義（Plt;0.05）。結(jié)論：基于循證的ICU管道管理循證實踐規(guī)范了臨床管道管理，提高了護(hù)理服務(wù)質(zhì)量。

關(guān)鍵詞 重癥監(jiān)護(hù)室；管道安全；護(hù)理；護(hù)理質(zhì)量；循證實踐

doi：10.12102/j.issn.2095-8668.2024.13.006

重癥監(jiān)護(hù)室（intensive care unit，ICU）急危重癥病人聚集，病人留置的管道數(shù)量及種類較多［1］。留置管道的目的主要是觀察病情、判斷預(yù)后，以便采取有效的預(yù)防措施并在搶救時發(fā)揮重要作用［2］。如果管道護(hù)理不夠精細(xì)，會對病人病情產(chǎn)生影響，嚴(yán)重者可能導(dǎo)致死亡。目前，ICU管道護(hù)理證據(jù)充分［3］，但國內(nèi)循證護(hù)理實踐主要研究意外脫管、管道堵塞及危重病人的機(jī)械通氣，對ICU管道管理的研究較少，管道管理的證據(jù)還比較少［4］。科學(xué)、規(guī)范的管道管理方案可減少急危重癥病人各種并發(fā)癥的發(fā)生［5］。ICU病人應(yīng)用管道管理最佳證據(jù)，可規(guī)范ICU護(hù)士各種操作，降低急危重癥病人管道相關(guān)并發(fā)癥。本研究對ICU管道管理進(jìn)行循證實踐，取得了較好的效果。……