经皮冠状动脉介入术后患者规范化饮水的审查指标及障碍因素分析

doi:10.3761/j.issn.0254-1769.2021.07.012

摘要/Abstract

摘要：

目的开展急诊经皮冠状动脉介入术后患者规范化饮水预防造影剂肾病的循证护理,制订审查指标,分析循证护理实践过程中的障碍因素及促进因素,制订行动策略。方法以乔安娜布里格斯研究所（Joanna Brigga Institute,JBI）临床证据应用模式为理论指导,明确临床护理问题、组建循证护理团队、系统检索文献、评价及汇总证据,制订相应的护理质量审查指标及审查方法,依据基线审查结果分析障碍因素及促进因素,并制订行动策略。结果该研究最终纳入12条最佳证据,依此制订了12条审查指标,主要障碍因素为科室缺乏经皮冠状动脉介入术后规范化饮水的相关流程和教育资料、科室缺乏造影剂肾病发生风险评估工具、护士对规范化饮水预防造影剂肾病的相关知识欠缺等,主要促进因素为组织领导力强、医护团队合作等,据此制订了相应的行动策略。结论该研究制订的急诊经皮冠状动脉介入术后患者规范化饮水预防造影剂肾病的护理质量审查指标具有科学性和可操作性,可为预防经皮冠状动脉介入术后患者造影剂肾病的发生提供指导。

关键词: 冠状动脉介入术, 规范化饮水, 造影剂肾病, 循证实践, 护理管理研究

Abstract:

Objective To carry out evidence-based nursing care of standardized oral hydration for prevention of contrast-induced nephropathy（CIN） in patients after emergency percutaneous coronary intervention,and to formulate nursing quality review indicators,and analyze the obstacle factors based on the current situation of clinical practice. Methods Guided by the evidence-based health care model of Joanna Brigga Institute,the problems of evidence-based nursing,team building,systematic retrieval,evaluation and summary of evidence were determined;the nursing indicators and methods were formulated. According to the baseline study results,the obstacle and promotion factors were analyzed,and the corresponding methods and countermeasures were developed. Results A total of 12 pieces of best evidence were included in the study,and 12 quality review indicators were formulated based on the best evidence. The main obstacle factors were the lack of standardized drinking water process,the lack of assessment tools for the risk of CIN,insufficient training of nurses on the knowledge of CIN,and insufficient cognition of patients and their families on contrast nephropathy. The main motivating factors are strong organizational leadership and medical team cooperation and etc. Conclusion Combined with the judgment of clinical professionals,the evidence-based nursing quality review index of oral hydration for prevention of CIN after emergency coronary intervention is scientific,operable and practical,which can lay the foundation for evidence-based nursing.

Key words: Percutaneous Coronary Intervention, Oral Hydration, Contrast-Induced Nephropathy, Evidence-Based Practice, Nursing Management Research

周雪梅,钱红继,吴娟,朱小玲,缪爱凤,陈志芳,陆水花,查曼丽,王月圆. 经皮冠状动脉介入术后患者规范化饮水的审查指标及障碍因素分析[J]. 中华护理杂志, 2021, 56(7): 1031-1037.

ZHOU Xuemei,QIAN Hongji,WU Juan,ZHU Xiaoling,MIAO Aifeng,CHEN Zhifang,LU Shuihua,ZHA Manli,WANG Yueyuan. Establishment and obstacles analysis of evidence-based nursing examination indicators for oral hydration to prevent contrast-induced nephropathy in patients after emergency percutaneous coronary intervention[J]. Chinese Journal of Nursing, 2021, 56(7): 1031-1037.

图/表 2

表1 急诊经皮冠状动脉介入术后规范化饮水预防造影剂肾病审查指标及审查方法

Table 1 Indicatorsand review methods of oral hydration prevention of contrast-induced nephropathy in patients after emergency percutaneous coronary intervention

表2 急诊经皮冠状动脉介入术后患者规范化饮水预防造影剂肾病实施的障碍因素、促进因素及行动策略

Table 2 Obstacle factors, promoting factors and action strategies of oral hydration for prevention of contrast induced nephropathy after emergency coronary intervention

参考文献 25

[1]	Verbeke F, Lindley E, Van Bortel L, et al. A European renal best practice(erbp) position statement on the kidney disease:improving global outcomes(kdigo)clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease:an endorsement with some caveats for real-life application[J]. Nephrol Dial Transplant, 2014, 29(3):490-496. DOI URL
[2]	Kong DG, Hou YF, Ma LL, et al. Comparison of oral and intravenous hydration strategies for the prevention of contrast-induced nephropathy in patients undergoing coronary angiography or angioplasty:a randomized clinical trial[J]. Acta Cardiol, 2012, 67(5):565-569. PMID
[3]	Zhang WD, Zhang JW, Yang BJ, et al. Effectiveness of oral hydration in preventing contrast-induced acute kidney injury in patients undergoing coronary angiography or intervention:a pairwise and network meta-analysis[J]. Coron Artery Dis, 2018, 29(4):286-293. DOI URL
[4]	Cheungpasitporn W, Thongprayoon C, Brabec BA, et al. Oral hydration for prevention of contrast-induced acute kidney injury in elective radiological procedures:a systematic review and meta-analysis of randomized controlled trials[J]. N Am J Med Sci, 2014, 6(12):618-624. DOI URL
[5]	陈玉倩, 熊钰, 李光琴, 等. 口服水化预防冠状动脉介入术后造影剂肾病效果的Meta分析[J]. 循证护理, 2018, 4(9):780-786.
	Chen YQ, Xiong Y, Li GQ, et al. Meta-analysis of effect of oral hydration for preventing contrast-induced nephropathy after percutaneous coronary intervention[J]. Chin Evid Based Nurs, 2018, 4(9):780-786.
[6]	陈健红, 朱春梅, 邓瑞珍. 不同饮水法对心脏介入治疗患者造影剂相关性肾损伤的影响[J]. 护理学报, 2010, 17(15):35-37.
	Chen JH, Zhu CM, Deng RZ. Observation on different drinking methods to prevent contrast-induced renal impairment after cardiac intervention[J]. J Nurs, 2010, 17(15):35-37.
[7]	孙树英, 何晓兰, 吴建飞. 个性化饮水计划对减轻PCI术后对比剂相关性肾损伤的临床观察[J]. 心脑血管病防治, 2017, 17(3):235-236,239.
	Sun SY, He XL, Wu JF. Clinical observation on the effect of individualized drinking water plan on reducing contrast related renal injury after PCI[J]. Prev Treat Cardio Cereb Vasc Dis, 2017, 17(3):235-236,239.
[8]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:56-83.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018:56-83.
[9]	中华医学会放射学分会对比剂安全使用工作组. 碘对比剂使用指南(第2版)[J]. 中华医学杂志, 2014, 94(43):3363-3369.
	Working Group on Safe Use of Contrast Media,Radiology Branch,Chinese Medical Association. Guidelines for the use of iodine contrast media(2nd edition)[J]. Natl Med J China, 2014, 94(43):3363-3369.
[10]	Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention:a report of the American college of cardiology foundation/American heart association task force on practice guidelines and the society for cardiovascular angiography and interventions[J]. Cathet Cardio Interv, 2013, 82(4):E266-E355.
[11]	Agarwal SK, Mohareb S, Patel A, et al. Systematic oral hydration with water is similar to parenteral hydration for prevention of contrast-induced nephropathy:an updated meta-analysis of randomised clinical data[J]. Open Heart, 2015, 2(1):e000317. DOI URL
[12]	Hiremath S, Akbari A, Shabana W, et al. Prevention of contrast-induced acute kidney injury:is simple oral hydration similar to intravenous? A systematic review of the evidence[J]. PLoS One, 2013, 8(3):e60009. DOI URL
[13]	王丽江. 老年冠脉介入患者术后短期饮水量对预防造影剂肾病效果观察[J]. 中国误诊学杂志, 2012, 12(9):2086-2087.
	Wang LJ. Effect of short-term water consumption for preventing contrast-induced nephropathy after percutaneous coronary intervention on elderly patients[J]. Chin J Misdiagnostics, 2012, 12(9):2086-2087.
[14]	冯艮娇, 罗思妮, 钟志安, 等. 不同口服水化护理对冠状动脉慢性完全闭塞病人造影剂肾病的影响[J]. 护理研究, 2017, 31(28):3573-3575.
	Feng GJ, Luo SN, Zhong ZA, et al. Effects of different oral hydration care on contrast agent nephropathy in patients with chronic total occlusion of coronary artery[J]. Chin Nurs Res, 2017, 31(28):3573-3575.
[15]	杨献军, 王晓璟, 时永超. 规范口服水化方案对合并糖尿病的冠脉介入患者水化效果的影响[J]. 糖尿病新世界, 2016, 19(20):129-130.
	Yang XJ, Wang XJ, Shi YC. Effect of standardized oral hydration on hydration of coronary intervention in patients with diabetes mellitus[J]. Diabetes New World, 2016, 19(20):129-130.
[16]	高瑞雪, 李明子. 术后不同饮水方法对减轻冠状动脉介入术后造影剂相关性肾损伤的效果及护理[J]. 中华护理杂志, 2009, 44(4):293-296.
	Gao RX, Li MZ. The effect of different drinking methods to preventing renal impairment after coronary angiography or percutaneous coronary intervention[J]. Chin J Nurs, 2009, 44(4):293-296.
[17]	金丽英, 黄丽华, 刘瑶. 阶段式强化教育对造影剂相关性肾损伤水疗依从性的影响[J]. 吉林医学, 2010, 31(8):1088-1089.
	Jin LY, Huang LH, Liu Y. The effect of staged intensive education on the compliance of hydrotherapy in contrast media related renal injury[J]. Jilin Med J, 2010, 31(8):1088-1089.
[18]	宋静. 冠状动脉介入治疗术后定时定量饮水研究[J]. 护理学杂志(综合版), 2010(5):22-24.
	Song J. Comparison of oral hydration regimens in patients undergoing percutaneoas coronary intervention for prevention of contrast-induced nephropathy[J]. J Nurs Sci, 2010(5):22-24.
[19]	陈韵岱, 陈纪言, 傅国胜, 等. 碘对比剂血管造影应用相关不良反应中国专家共识[J]. 中国介入心脏病学杂志, 2014, 22(6):341-348.
	Chen YD, Chen JY, Fu GS, et al. Consensus among Chinese experts on adverse reactions related to the application of iodine contrast angiography[J]. Chin J Interv Cardiol, 2014, 22(6):341-348.
[20]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advancing guideline development,reporting,and evaluation in health care[J]. Prev Med, 2010, 51(5):421-424. DOI PMID
[21]	顾莺, 张慧文, 周英凤, 等. JBI循证卫生保健中心关于不同类型研究的质量评价工具:系统评价的方法学质量评价[J]. 护士进修杂志, 2018, 33(8):701-703.
	Gu Y, Zhang HW, Zhou YF, et al. JBI evidence-based health center’s quality assessment tool for different types of research—the quality evaluation of diagnostic and economic evaluation[J]. J Nurses Train, 2018, 33(8):701-703.
[22]	钱红继, 周雪梅, 王伶俐, 等. 冠状动脉介入术后病人口服水化方法预防造影剂肾病的最佳证据总结[J]. 护理研究, 2020, 34(12):2062-2067.
	Qian HJ, Zhou XM, Wang LL, et al. Best evidences summary on oral hydration therapy for the prevention of contrast-induced nephropathy in patients after percutaneous coronary intervention[J]. Chin Nurs Res, 2020, 34(12):2062-2067.
[23]	曹锐, 胡芬, 朱小平, 等. ICU患者身体约束循证护理审查指标的制订及障碍因素分析[J]. 中华护理杂志, 2019, 54(4):485-489.
	Cao R, Hu F, Zhu XP, et al. Construction of clinical audits and analysis of obstacles for evidence-based physical restraint in ICU patients[J]. Chin J Nurs, 2019, 54(4):485-489.
[24]	庞永丽, 方蘅英, 罗媛容, 等. 肝硬化患者营养评估与管理的最佳证据总结[J]. 中华护理杂志, 2020, 55(9):1420-1425.
	Pang YL, Fang HY, Luo YR, et al. Best evidence summary of nutritional assessment and management in patients with liver cirrhosis[J]. Chin J Nurs, 2020, 55(9):1420-1425.
[25]	程湘玮, 王培红, 屠凤鸣, 等. 妊娠期糖尿病产妇分娩的新生儿血糖管理审查指标的制订及障碍因素分析[J]. 中华护理杂志, 2020, 55(10):1497-1502.
	Cheng XW, Wang PH, Tu FM, et al. Establishment and obstacle analysis of evidence-based nursing indexes of blood glucose management in neonates delivered by mothers with gestafional diabetes[J]. Chin J Nurs, 2020, 55(10):1497-1502.