重癥監護病房體外膜肺氧合聯合連續性腎臟替代療法護士核心能力評價體系的構建

Construction of core competency evaluation system for ECMO combine CRRT nurses in intensive care unit

WANG Ying，WANG Shulin，ZHONG Bohua，GUO Enhui，LUO Haibin，WEI Mingshang，XU Wei，LI ChunpengThe First Affiliated Hospital of Guangxi Medical University，Guangxi 530021 ChinaCorresponding Author WANG Shulin，E-mail：wangshulin102@126.com

Abstract Objective：To construct a core competency evaluation system for nurses in intensive care units using extracorporeal membrane oxygenation combined with continuous renal replacement therapy （ECMO amp; CRRT），providing objective basis for cultivating specialized nursing talents and evaluating the core competency of specialized nurses.Methods：By combining theoretical analysis，Delphi method，and analytic hierarchy process constructed the evaluation system.Theoretical analysis determined the basic framework of the ECMO amp; CRRT nurse core competency evaluation system.After consulting experts with the Delphi method，it was organized，summarized，and statistically analyzed.The analytic hierarchy process was used to determine the weights of each indicator.Results：Two rounds of inquiry were conducted，with 31 questionnaires distributed.The effective response rates for the two rounds of questionnaires was 87.10% and 90.32%，respectively.The second round of expert judgment had a coefficient of 0.901，a familiarity coefficient of 0.968，and an authority coefficient of 0.935.The Kendall harmony coefficients for the first，second，and third level indicators in the second round of inquiry was 0.084，0.096，and 0.085，respectively，all of which was statistically significant（Plt;0.05）.The final formation of the ECMO amp; CRRT nurse core competency evaluation system included 8 primary indicators，28 secondary indicators，and 97 tertiary indicators.Conclusion：The core competency indicators of ECMO amp; CRRT nurses constructed in this study are scientific and reliable，and can provide reference for the training and assessment of ECMO amp; CRRT nurses.

Keywords extracorporeal membrane oxygenation，ECMO;continuous renal replacement therapy，CRRT;specialist nurse;core competency;intensive care unit，ICU；nursing

摘要 目的：構建重癥監護病房體外膜肺氧合聯合連續性腎替代療法（ECMO amp; CRRT）護士核心能力評價體系，為培養專業化護理人才及評價?？谱o士核心能力提供客觀依據。方法：采用理論分析、德爾菲法和層次分析法結合的方式構建評價體系。理論分析確定ECMO amp; CRRT護士核心能力評價體系的基本框架，之后進行德爾菲法專家函詢，對數據進行整理、歸納、統計后通過層次分析法確定各指標權重。結果：共進行兩輪函詢，均發放問卷31份，兩輪問卷有效回收率分別為87.10%、90.32%。第2輪專家判斷依據系數為0.901，熟悉程度系數為0.968，權威系數為0.935。第2輪函詢一級指標、二級指標、三級指標的肯德爾和諧系數分別為0.084，0.096，0.085，差異均有統計學意義（P＜0.05）。最終形成包括一級指標8個、二級指標28個、三級指標97個的ECMO amp; CRRT護士核心能力評價體系。結論：構建的ECMO amp; CRRT護士核心能力指標具有科學性和可靠性，可為ECMO amp; CRRT護士的培養、考核等提供參考依據。

關鍵詞 體外膜肺氧合；連續性腎臟替代療法；?？谱o士；核心能力；重癥監護病房；護理

doi：10.12102/j.issn.2095-8668.2024.19.019

近年來，高級生命支持手段及儀器不斷發展［1］。體外膜肺氧合（extracorporeal membrane oxygenation，ECMO）是目前公認的治療難治性心臟和/或肺衰竭的一項有效體外生命支持技術［2］。連續性腎臟替代療法（continuous renal replacement therapy，CRRT）臨床應用范圍不斷擴大，是治療重癥急性腎功能衰竭的主要腎臟替代治療方式［3］。Thongprayoon等［4］研究顯示，在接受ECMO治療的危重癥病人中，急性腎衰竭和嚴重急性腎衰竭的發生率分別為62.8%和44.9%，需要ECMO聯合CRRT（ECMO amp; CRRT）共同進行高級生命支持。ECMO amp; CRRT一體化治療作為危重癥病人治療的新技術，能發揮各自優勢，較長時間替代心、肺、腎的功能，能明顯改善感染、肝腎功能障礙，糾正電解質失衡，提高病人生活質量，改善預后，明顯提高危重癥病人的搶救成功率［5-6］。……