颈椎手术患者气道梗阻预防及管理的最佳证据应用

doi:10.3761/j.issn.0254-1769.2023.02.001

摘要/Abstract

摘要：

目的将颈椎手术患者气道梗阻预防及管理的最佳证据应用于临床实践，评价应用效果。方法筛选颈椎手术后气道梗阻预防及管理的最佳证据，制订循证实践方案，经过基线审查、分析障碍因素并构建最佳证据应用策略，于2020年8月—2021年12月在湖北省武汉市某三级甲等医院骨科实施，比较证据应用前后审查指标的执行率以及护士对颈椎手术气道梗阻预防及管理的知识水平。结果最佳证据应用后，23个审查指标中，19个审查指标的执行率显著高于基线审查水平（P<0.05）。护士颈椎手术气道梗阻知识水平得分由（48.38±9.40）分提升至（53.49±9.67）分，差异有统计学意义（P<0.001）。结论颈椎手术后气道梗阻预防及管理最佳证据的应用提高了护士对审查指标的执行率和知识水平，保障了患者安全。

关键词: 颈椎手术, 气道梗阻, 循证护理学

Abstract:

Objective To summarize the best evidence of airway obstruction prevention and management in patients undergoing cervical spinal surgery，and to apply evidence-based nursing practice and evaluate the effects. Methods The best evidence for prevention and management of airway obstruction in patients undergoing cervical surgery was summarized using an evidence-based care approach，and an evidence-based practice protocol was developed. The best evidence application strategy was constructed after baseline review and analysis of barriers，and it was implemented in the department of orthopedics in a tertiary hospital in Hubei Province from August 2020 to December 2021. The knowledge level of nurses about airway obstruction and the implementation rate of the reviewed indicators were compared before and after the application of evidence. Results After the application of best evidence, the implementation rate of 19 review indicators out of 23 significantly improved compared with baseline review（P<0.05）. The score of nurses’ knowledge level of airway obstruction after cervical spine surgery increased from（48.38±9.40） to （53.49±9.67），with a statistically significant difference（P<0.001）. Conclusion The application of the best evidence for prevention and management of airway obstruction after cervical spine surgery can improve nurses’ implementation rate，improve their knowledge level，and ensure patient safety.

Key words: Cervical Spinal Surgery, Airway Obstruction, Evidence-Based Nursing

吴明珑, 周雁荣, 詹雪, 刘洪娟, 谈晶, 赵娅, 高云, 陈媛, 潘美琪, 王玮荻, 王兰. 颈椎手术患者气道梗阻预防及管理的最佳证据应用[J]. 中华护理杂志, 2023, 58(2): 133-140.

WU Minglong, ZHOU Yanrong, ZHAN Xue, LIU Hongjuan, TAN Jing, ZHAO Ya, GAO Yun, CHEN Yuan, PAN Meiqi, WANG Weidi, WANG Lan. Evidence-based nursing practice of airway obstruction prevention and management in patients undergoing cervical spinal surgery[J]. Chinese Journal of Nursing, 2023, 58(2): 133-140.

图/表 2

参考文献 28

[1]	Debkowska MP, Butterworth JF, Moore JE, et al. Acute post-operative airway complications following anterior cervical spine surgery and the role for cricothyrotomy[J]. J Spine Surg, 2019, 5(1):142-154. DOI PMID
[2]	Nanda A, Sharma M, Sonig A, et al. Surgical complications of anterior cervical diskectomy and fusion for cervical degenerative disk disease:a single surgeon’s experience of 1576 patients[J]. World Neurosurg, 2014, 82(6):1380-1387. DOI PMID
[3]	黎小霞, 梁伟, 肖萍, 等. 颈椎肿瘤切除手术患者呼吸道并发症的预防与护理[J]. 中华护理杂志, 2011, 46(12):1221-1222.
	Li XX, Liang W, Xiao P, et al. Prevention and nursing of respiratory complications in patients undergoing cervical tumor resection[J]. Chin J Nurs, 2011, 46(12):1221-1222.
[4]	严晓云, 李玉伟, 温艳, 等. 零切迹椎间融合内固定系统治疗脊髓型颈椎病患者的护理[J]. 中华护理杂志, 2015, 50(9):1052-1054.
	Yan XY, Li YW, Wen Y, et al. Perioperative nursing of patients with cervical spondylotic myelopathy treated by zero profile anterior cervical interbody fusion system[J]. Chin J Nurs, 2015, 50(9):1052-1054.
[5]	王成硕, 程雷, 刘争, 等. 耳鼻咽喉头颈外科围术期气道管理专家共识[J]. 中国耳鼻咽喉头颈外科, 2019, 26(9):463-471.
	Wang CS, Cheng L, Liu Z, et al. Expert consensus on perioperative airway management in otolaryngology,head and neck surgery[J]. Chin Arch Otolaryngol Head Neck Surg, 2019, 26(9):463-471.
[6]	吴明珑, 刘洪娟, 张春瑾, 等. 颈椎术后气道梗阻危险评估指标体系的构建[J]. 护士进修杂志, 2021, 36(19):1819-1823.
	Wu ML, Liu HJ, Zhang CJ, et al. Construction of risk assessment index system for cervical airway obstruction after operation[J]. J Nurses Train, 2021, 36(19):1819-1823.
[7]	刘洪娟, 张春瑾, 王玮荻, 等. 颈部手术后气道梗阻预防及管理的最佳证据总结[J]. 护士进修杂志, 2021, 36(10):948-953.
	Liu HJ, Zhang CJ, Wang WD, et al. Summary of best evidence for prevention and management of airway obstruction after neck surgery[J]. J Nurses Train, 2021, 36(10):948-953.
[8]	Nekhendzy V. Anesthesia for head and neck surgery[EB/OL]. (2020-03-17)[2021-05-10]. https://www.uptodate.com/contents/anesthesia-for-head-and-neck-surgery.
[9]	Herth FJ. Clinical presentation,diagnostic evaluation,and management of central airway obstruction in adults[EB/OL]. (2020-04-03)[2021-05-10]. https://www.uptodate.com/contents/clinical-presentation-diagnostic-evaluation-and-management-of-central-airway-obstruction-in-adults.
[10]	Mathews L, Lee LA. Anesthesia for adults with acute spinal cord injury[EB/OL]. (2019-08-07)[2021-05-10]. https://www.uptodate.com/contents/anesthesia-for-adults-with-acute-spinal-cord-injury.
[11]	Brown MJ. Anesthesia for elective spine surgery in adults[EB/OL]. (2020-04-02)[2021-05-10]. https://www.uptodate.com/contents/anesthesia-for-elective-spine-surgery-in-adults.
[12]	Wittels KA. Basic airway management in adults[EB/OL]. (2019-09-17)[2021-05-10]. https://www.uptodate.com/contents/basic-airway-management-in-adults.
[13]	Zheng G. Anesthesia for laryngeal surgery[EB/OL]. (2021-02-20)[2020-05-10]. https://www.uptodate.com/contents/anesthesia-for-laryngeal-surgery.
[14]	丁琛, 洪瑛, 王贝宇, 等. 颈椎前路手术加速康复外科实施流程专家共识[J]. 中华骨与关节外科杂志, 2019, 12(7):486-497.
	Ding C, Hong Y, Wang BY, et al. Expert consensus on the implementation of enhanced recovery after surgery in anterior cervical spine surgery[J]. Chin J Bone Jt Surg, 2019, 12(7):486-497.
[15]	周非非, 韩彬, 刘楠, 等. 颈椎后路手术加速康复外科实施流程专家共识[J]. 中华骨与关节外科杂志, 2019, 12(7):498-508.
	Zhou FF, Han B, Liu N, et al. Expert consensus on the implementation of enhanced recovery after surgery in posterior cervical spine surgery[J]. Chin J Bone Jt Surg, 2019, 12(7):498-508.
[16]	车国卫, 吴齐飞, 邱源, 等. 多学科围手术期气道管理中国专家共识(2018版)[J]. 中国胸心血管外科临床杂志, 2018, 25(7):545-549.
	Che GW, Wu QF, Qiu Y, et al. Chinese expert consensus statement on multi-disciplinary perioperative airway management(version 2018)[J]. Chin J Clin Thorac Cardiovasc Surg, 2018, 25(7):545-549.
[17]	Kuzniar TJ. Assessment of dyspnoea[EB/OL]. (2019-02)[2021-05-10]. https://bestpractice.bmj.com/topics/en-gb/862/urgent-considerations.
[18]	Santacruz JF. Central airway obstruction[EB/OL]. (2018-09)[2021-05-10]. https://bestpractice.bmj.com/topics/en-us/1069/management-approach.
[19]	Kornusky J. Airway obstruction:managing[EB/OL]. (2017-04-21)[2021-05-10]. http://web.b.ebscohost.com/nrc/detail?vid=4&sid=418ad30f-697a-4ea5-ac35-1fda7fa9558f%40sessionmgr101&bdata=Jmxhbmc9emgtY24mc2l0ZT1ucmMtbGl2ZQ%3d%3d#AN=T703880&db=nrc.
[20]	Zadegan SA, Jazayeri SB, Abedi A, et al. Corticosteroid administration to prevent complications of anterior cervical spine fusion:a systematic review[J]. Global Spine J, 2018, 8(3):286-302. DOI URL
[21]	胡雁. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018.
	Hu Y. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018.
[22]	王玮荻, 刘洪娟, 张春瑾, 等. 颈椎手术后气道梗阻危险因素及风险管理研究进展[J]. 护理研究, 2021, 35(12):2172-2175.
	Wang WD, Liu HJ, Zhang CJ, et al. Research progress on risk factors and risk management of airway obstruction after cervical spine surgery[J]. Chin Nurs Res, 2021, 35(12):2172-2175.
[23]	周英凤, 胡雁, 邢唯杰, 等. 推动基于证据的临床审查,促进临床质量持续改进[J]. 中国循证医学杂志, 2020, 20(6):621-627.
	Zhou YF, Hu Y, Xing WJ, et al. Promoting evidence-based clinical audit for continuous improvement of clinical quality[J]. Chin J Evid-Based Med, 2020, 20(6):621-627.
[24]	胡美华, 王童语, 邱翠玲, 等. 护士对护理质量督查态度与建议的质性研究[J]. 中国护理管理, 2022, 22(2):179-183.
	Hu MH, Wang TY, Qiu CL, et al. Nurses’ attitudes and suggestions on nursing quality supervision:a qualitative study[J]. Chin Nurs Manag, 2022, 22(2):179-183.
[25]	丁震敏, 康宝丽, 蔡红苗, 等. 气道管理模拟教学课程的开发与实践研究[J]. 中华医学教育探索杂志, 2021, 20(2):130-133.
	Ding ZM, Kang BL, Cai HM, et al. Study on the development and practice of east airway simulation training course[J]. Chin J Med Educ Res, 2021, 20(2):130-133.
[26]	张帅, 姚惠萍, 富燕萍, 等. ICU低年资护士气道管理能力的系统化培训[J]. 中华护理教育, 2020, 17(2):156-158.
	Zhang S, Yao HP, Fu YP, et al. The systematic training of airway management ability of the junior nurses in the intensive care unit[J]. Chin J Nurs Educ, 2020, 17(2):156-158.
[27]	夏菁, 周谊霞, 覃瑛, 等. “双通道教学”的雨课堂平台在气道梗阻教学中的应用[J]. 华西医学, 2018, 33(12):1539-1543.
	Xia J, Zhou YX, Qin Y, et al. Application of “dual-channel teaching” of the rain classroom platform in airway obstruction teaching[J]. West China Med J, 2018, 33(12):1539-1543.
[28]	张艳, 吕飞飞, 陈勤, 等. 培训迁移的研究进展及对专科护士培训的启示[J]. 中华护理杂志, 2022, 57(11):1391-1395. DOI
	Zhang Y, Lü FF, Chen Q, et al. Research advances in training transfer and implications for specialist nurse training[J]. Chin J Nurs, 2022, 57(11):1391-1395. DOI