中华护理杂志 ›› 2024, Vol. 59 ›› Issue (7): 820-827.DOI: 10.3761/j.issn.0254-1769.2024.07.008
收稿日期:
2023-05-24
出版日期:
2024-04-10
发布日期:
2024-04-09
通讯作者:
陈惜遂,E-mail:xisuichen@126.com作者简介:
郑娉婷:女,本科(硕士在读),主管护师,E-mail:811874274@qq.com
ZHENG Pingting(), JI Chaona, WANG Yiru, CHEN Xisui()
Received:
2023-05-24
Online:
2024-04-10
Published:
2024-04-09
摘要:
目的 构建肺癌患者术后肺部感染预防护理方案并进行初步验证,为临床护理提供参考依据。 方法 采用文献分析法,检索国内外数据库、指南网、协会网站,检索时限为2011年1月至2021年12月,获取相关证据,构建肺癌患者术后肺部感染预防护理方案初稿,并采用德尔菲专家函询法,于2022年9月—12月对广东省、河南省、四川省的专家进行函询,确定方案终稿。2023年11月—12月,选取汕头市某三级甲等医院15名胸外科护士及15例肺癌患者进行方案的初步应用,并通过护士对方案的临床意义、适用性、可行性评价以及患者满意度等评价方案效果。 结果 共21名专家完成2轮函询。2轮函询中,问卷回收率分别为95.65%、95.45%;专家的权威系数分别为0.941、0.948;肯德尔和谐系数分别为0.176、0.310;第2轮函询中,各条目的变异系数为0.04~0.25。方案终稿包括团队合作、健康教育、风险评估、康复训练、液体管理、口腔管理、气道管理、营养管理、疼痛管理、管路管理等10个方面,37项措施。方案初步应用后,100%的护士认为该方案很有意义,87%的护士认为该方案很具有临床适用性、可行性,100%的患者表示对该方案满意,其中80%的患者表示很满意。 结论 构建的肺癌患者术后肺部感染预防护理方案具有科学性、针对性和可行性,可为临床医护人员制订预防肺癌患者术后肺部感染措施提供参考。
郑娉婷, 纪超娜, 王逸如, 陈惜遂. 肺癌患者术后肺部感染预防护理方案的构建及验证[J]. 中华护理杂志, 2024, 59(7): 820-827.
ZHENG Pingting, JI Chaona, WANG Yiru, CHEN Xisui. Construction and validation of a postoperative lung infection prevention care program for lung cancer patients[J]. Chinese Journal of Nursing, 2024, 59(7): 820-827.
[1] |
Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2021, 71(3):209-249.
DOI URL |
[2] |
Wang YQ, Liu X, Jia Y, et al. Impact of breathing exercises in subjects with lung cancer undergoing surgical resection:a systematic review and meta-analysis[J]. J Clin Nurs, 2019, 28(5/6):717-732.
DOI URL |
[3] |
Semenkovich TR, Frederiksen C, Hudson JL, et al. Postoperative pneumonia prevention in pulmonary resections:a feasibility pilot study[J]. Ann Thorac Surg, 2019, 107(1):262-270.
DOI PMID |
[4] |
李京京, 吕晓晴, 刘杉杉, 等. 围手术期肺癌患者症状群与生活质量相关性的纵向研究[J]. 中华护理杂志, 2020, 55(11):1635-1641.
DOI |
Li JJ, Lü XQ, Liu SS, et al. A longitudinal study on the correlations between symptom clusters and quality of life in patients with lung cancer during perioperation[J]. Chin J Nurs, 2020, 55(11):1635-1641.
DOI |
|
[5] |
Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia:2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society[J]. Clin Infect Dis, 2016, 63(5):e61-e111.
DOI URL |
[6] |
Alper BS, Haynes RB. EBHC pyramid 5.0 for accessing preappraised evidence and guidance[J]. Evid Based Med, 2016, 21(4):123-125.
DOI PMID |
[7] |
Methley AM, Campbell S, Chew-Graham C, et al. PICO,PICOS and SPIDER:a comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews[J]. BMC Health Serv Res, 2014, 14:579-588.
DOI URL |
[8] | 朱政, 胡雁, 周英凤, 等. 推动证据向临床转化(五)证据临床转化研究中的文献质量评价[J]. 护士进修杂志, 2020, 35(11):996-1000. |
Zhu Z, Hu Y, Zhou YF, et al. Promotion evidence to clinical transformation:evidence resource retrieval for the purpose of clinical transformation[J]. J Nurses Train, 2020, 35(11):996-1000. | |
[9] | 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967. |
Wang CQ, Hu Y. JBl evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967. | |
[10] | 支修益, 刘伦旭. 中国胸外科围手术期气道管理指南(2020版)[J]. 中国胸心血管外科临床杂志, 2021, 28(3):251-262. |
Zhi XY, Liu LX. Chinese guidelines for perioperative airway management in thoracic surgery(2020 edition)[J]. Chin J Thorac Cardiovasc Surg, 2021, 28(3):251-262. | |
[11] |
Berna P, Quesnel C, Assouad J, et al. Guidelines on enhanced recovery after pulmonary lobectomy[J]. Anaesth Crit Care Pain Med, 2021, 40(1):100791.
DOI URL |
[12] | NICE. Lung cancer:diagnosis and management[EB/OL]. [2023-05-23]. www.nice.org.uk/guidance/ng122. |
[13] | 中华医学会呼吸病学分会感染学组. 中国成人医院获得性肺炎与呼吸机相关性肺炎诊断和治疗指南[J]. 中华结核和呼吸杂志, 2018, 41(4):255-280. |
Infectious Diseases Group, Chinese Society of Respiratory Medicine. Guidelines for diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults in China[J]. Chin J Tuberc Respir Dis, 2018, 41(4):255-280. | |
[14] | 刘辉文, 王美玲, 潘丽婷, 等. 呼吸训练方式及时间对肺癌患者术后肺炎影响的Meta分析[J]. 中华现代护理杂志, 2021, 27(31):4263-4269. |
Liu HW, Wang ML, Pan LT, et al. Meta-analysis of effects of breathing training method and time on postoperative pneumonia in patients with lung cancer[J]. Chin J Mod Nurs, 2021, 27(31):4263-4269. | |
[15] | 马龙, 李德生, 张力为, 等. 负压吸引对肺手术后康复效果的Meta分析[J]. 中国医药科学, 2021, 11(7):40-46. |
Ma L, Li DS, Zhang LW, et al. Meta-analysis of the efficacy of negative pressure suction on rehabilitation after lung surgery[J]. Chin Med Pharm, 2021, 11(7):40-46. | |
[16] | 吴雪, 杨川川, 李燕, 等. 加速康复外科技术在老年肺癌手术病人中应用效果的Meta分析[J]. 护理研究, 2020, 34(24):4324-4330. |
Wu X, Yang CC, Li Y, et al. Application effect of enhanced recovery after surgery technology in elderly patients with lung cancer surgery:a Meta-analysis[J]. Chin Nurs Res, 2020, 34(24):4324-4330. | |
[17] | 夏燕, 常淑文, 叶敬霆, 等. 快速康复外科在肺癌手术患者中应用效果的meta分析[J]. 中国肺癌杂志, 2016, 19(12):827-836. |
Xia Y, Chang SW, Ye JT, et al. Application effect of fast track surgery for patients with lung cancer:a Meta-analysis[J]. Chin J Lung Cancer, 2016, 19(12):827-836. | |
[18] | 李冠珠, 来源, 郑筱卓, 等. 目标导向液体治疗对胸科手术患者术中氧供需平衡及术后结局影响的Meta分析[J]. 临床荟萃, 2021, 36(8):677-684. |
Li GZ, Lai Y, Zheng XZ, et al. Effects of goal-directed fluid therapy on intraoperative balance between oxygen delivery and consumption and postoperative outcomes in thoracic surgery patients:a meta-analysis[J]. Clin Focus, 2021, 36(8):677-684. | |
[19] | 王爱田, 刘芳, 么改琦, 等. 目标导向治疗对高风险外科手术患者术后感染影响的Meta分析[J]. 中华普通外科杂志, 2012, 27(8):650-655. |
Wang AT, Liu F, Yao GQ, et al. The effect of goal-directed therapy on postoperative infections in high risk surgical patients:a Meta analysis[J]. Chin J Gen Surg, 2012, 27(8):650-655. | |
[20] | 高小月, 侯黎莉. 术前雾化吸入对胸外科患者术后肺部并发症影响的Meta分析[J]. 解放军护理杂志, 2018, 35(10):9-14. |
Gao XY, Hou LL. Effects of preoperative aerosol inhalation on postoperative pulmonary complications in patients undergoing thoracic surgery:a meta-analysis[J]. Nurs J Chin PLA, 2018, 35(10):9-14. | |
[21] | 梁冬燕, 公丕欣, 邱玲动, 等. 胸腔镜下肺癌根治术患者加速康复效果的Meta分析[J]. 护理学报, 2021, 28(23):41-46. |
Liang DY, Gong PX, Qiu LD, et al. Rehabilitation effect of enhanced recovery after surgery on lung cancer patients undergoing thoracoscopic radical surgery:a meta analysis[J]. J Nurs (China), 2021, 28(23):41-46. | |
[22] | 姜文静, 张文文, 刘俊, 等. 振动排痰仪与人工叩背排痰对预防开胸术后患者肺部并发症效果的Meta分析[J]. 中国实用护理杂志, 2014, 30(19):31-34. |
Jiang WJ, Zhang WW, Liu J, et al. Meta-analysis of the effect of sputum elimination by vibrating sputum elimination apparatus and back percussion on prevention of pulmonary complications after thoracotomy[J]. Chin J Prac Nurs, 2014, 30(19):31-34. | |
[23] |
Liang SQ, Zhang XX, Hu YJ, et al. Association between perioperative chlorhexidine oral care and postoperative pneumonia in non-cardiac surgical patients:a systematic review and meta-analysis[J]. Surgery, 2021, 170(5):1418-1431.
DOI URL |
[24] |
Perry R, Herbert G, Atkinson C, et al. Pre-admission interventions(prehabilitation) to improve outcome after major elective surgery:a systematic review and meta-analysis[J]. BMJ Open, 2021, 11(9):e050806.
DOI URL |
[25] |
Pu CY, Batarseh H, Zafron ML, et al. Effects of preoperative breathing exercise on postoperative outcomes for patients with lung cancer undergoing curative intent lung resection:a meta-analysis[J]. Arch Phys Med Rehabil, 2021, 102(12):2416-2427.
DOI URL |
[26] | 吴秀. 高流量鼻导管氧疗与常规氧疗在成人心胸外科手术后疗效的Meta分析[D]. 西安: 西安医学院, 2020. |
Wu X. Meta-analysis of the efficacy of high-flow nasal catheter oxygen therapy and conventional oxygen therapy after adult cardiothoracic surgery[D]. Xi’an: Xi’an Med College, 2020. | |
[27] | 吴白女, 米元元, 杜世正, 等. 肺癌手术患者呼吸肌训练效果的系统评价[J]. 护士进修杂志, 2021, 36(19):1746-1754. |
Wu BN, Mi YY, Du SZ, et al. Systematic effect evaluation of respiratory muscle training in surgical patients with lung cancer[J]. J Nurses Train, 2021, 36(19):1746-1754. | |
[28] |
Pedersen PU, Larsen P, Håkonsen SJ. The effectiveness of systematic perioperative oral hygiene in reduction of postoperative respiratory tract infections after elective thoracic surgery in adults:a systematic review[J]. JBI Database System Rev Implement Rep, 2016, 14(1):140-173.
DOI PMID |
[29] | 卢雨松. 围术期口腔护理对降低胸心外科术后肺部感染的有效性的系统评价[D]. 遵义: 遵义医科大学, 2021. |
Lu YS. Perioperative oral care for reducing pulmonary infection after thoracic and cardiac surgery:a systematic review[D]. Zunyi: Zunyi Med Univ, 2021. | |
[30] | 胸外科围手术期肺保护中国专家共识版专家组, 中国医学基金会胸外科专业委员会. 胸外科围手术期肺保护中国专家共识(2019版)[J]. 中国胸心血管外科临床杂志, 2019, 26(9):835-842. |
Chinese Expert Consensus on Perioperative Lung Protection in Thoracic SurgeryVersion Expert Group,Thoracic Surgery Professional Committee of the Chinese Medical Foundation. Chinese experts consensus on perioperative lung protection (Version 2019)[J]. Chin J Thorac Cardiovasc Surg, 2019, 26(9):835-842. | |
[31] | 中华医学会呼吸病学分会. 雾化祛痰临床应用的中国专家共识[J]. 中华结核和呼吸杂志, 2021, 44(4):340-348. |
Society of Respiratory Diseases,Chinese Medical Association. Consensus of Chinese experts on the clinical application of nebulized expectorants[J]. Chin J Tuberc Respir Dis, 2021, 44(4):340-348. | |
[32] | 中华预防医学会医院感染控制分会第四届委员会重点部位感染防控学组. 术后肺炎预防和控制专家共识[J]. 中华临床感染病杂志, 2018, 11(1):11-19. |
The Group of Prevention and Control of Infection in Key Sites of the 4th Committee of Hospital Infection Control Branch,Chinese Preventive Medicine Association. Expert consensus on prevention and control of postoperative pneumonia[J]. Chin J Clin Infect Dis, 2018, 11(1):11-19. | |
[33] | 马玉芬, 成守珍, 刘义兰, 等. 卧床患者常见并发症护理专家共识[J]. 中国护理管理, 2018, 18(6):740-747. |
Ma YF, Cheng SZ, Liu YL, et al. Common complications of expert consensus on bedridden patients nursing[J]. Chin Nurs Manag, 2018, 18(6):740-747. | |
[34] |
Zaman M, Bilal H, Mahmood S, et al. Does getting smokers to stop smoking before lung resections reduce their risk[J]. Interact Cardiovasc Thorac Surg, 2012, 14(3):320-323.
DOI URL |
[35] |
Villeneuve PJ. Interventions to avoid pulmonary complications after lung cancer resection[J]. J Thorac Dis, 2018, 10(Suppl 32):S3781-S3788.
DOI URL |
[36] |
Wang C, Guo M, Zhang N, et al. Association of body mass index and outcomes following lobectomy for non-small-cell lung cancer[J]. World J Surg Oncol, 2018, 16(1):90.
DOI PMID |
[37] |
张新娜, 李倩倩, 王红钰, 等. 振动呼气正压装置与诱发性肺量计在肺癌术后患者康复训练中的应用研究[J]. 中华护理杂志, 2021, 56(3):330-335.
DOI |
Zhang XN, Li QQ, Wang HY, et al. The research of the rehabilitation effects of oscillatory positive expiratory pressure device combined with incentive spirometer for patients with lung cancer after surgery[J]. Chin J Nurs, 2021, 56(3):330-335.
DOI |
|
[38] |
覃梦霞, 潜艳, 徐蓉, 等. 基于互联网+肺康复全程健康教育在肺癌手术患者中的应用[J]. 中华护理杂志, 2023, 58(15):1808-1814.
DOI |
Qin MX, Qian Y, Xu R, et al. The application of internet based whole health education of pulmonary rehabilitation in patients undergoing lung cancer surgery[J]. Chin J Nurs, 2023, 58(15):1808-1814.
DOI |
[1] | 周樊华, 甘霖, 梅艳丽, 杜芬, 严冶, 熊莉娟. 中西医结合病房患者入院护理评估单的研制及信效度检验[J]. 中华护理杂志, 2024, 59(7): 802-807. |
[2] | 郭俊晨, 许湘华, 刘超毅, 王英, 刘君清照, 谌永毅, 朱丽辉, 肖亚洲, 刘阳. 安宁疗护患者远程居家照护方案的构建及初步应用[J]. 中华护理杂志, 2024, 59(5): 517-525. |
[3] | 马景双, 王爱平, 王艳杰, 李魏, 刘艳霞. 基于前哨症状的肺癌术后化疗患者护理干预方案的构建及应用[J]. 中华护理杂志, 2024, 59(2): 133-141. |
[4] | 何佩佩, 陈丽, 孙淼娟, 胡丽君, 殷晓红. 基于系统教学模式的腹膜透析患者再培训方案的构建及应用[J]. 中华护理杂志, 2024, 59(2): 149-155. |
[5] | 朱虹宣, 庞建美, 孙盛楠, 李燕. 老年肺癌患者术后过渡期肺康复行为影响因素的质性研究[J]. 中华护理杂志, 2024, 59(1): 15-21. |
[6] | 林琦, 刘玉荣, 杨慧, 杨凤娟, 王丹, 陈瑞云. 肺癌患者运动训练行为感知量表的编制及信效度检验[J]. 中华护理杂志, 2024, 59(1): 22-28. |
[7] | 韩娜菲, 冯华丽, 贺红, 李茜, 徐剑锋, 金尧娟, 沈孟雅, 孙佳烨, 黄天海. 肺癌合并慢性阻塞性肺疾病患者术后肺康复管理的证据总结[J]. 中华护理杂志, 2024, 59(1): 42-49. |
[8] | 胡娴静, 鄢嫣, 王璟, 张鹤立, 陈雅玫, 马莉, 耿荣梅, 李葆华. 核辐射暴露患者医院救治关键护理技术体系的构建[J]. 中华护理杂志, 2024, 59(1): 57-63. |
[9] | 江淀淀, 崔妙玲, 黄维, 陈庆梅, 麻月娥, 陈泉芳. 肺癌患者就医延迟风险预测模型的构建及验证[J]. 中华护理杂志, 2023, 58(6): 682-688. |
[10] | 于甜栖, 孙国珍, 高敏, 王洁, 刘沈馨雨, 黄杨曦, 鲍志鹏. 慢性心力衰竭患者运动康复参与护理干预方案的构建[J]. 中华护理杂志, 2023, 58(4): 414-420. |
[11] | 张梦月, 施颖辉, 章晓贤, 陈晨, 洪益荣, 夏伟丹, 陈燕燕. 基于时机理论的糖尿病视网膜病变手术患者护理干预方案的构建[J]. 中华护理杂志, 2023, 58(24): 2957-2963. |
[12] | 王蓓蓓, 顾莺, 胡静, 陆国平, 程晔, 沈伟杰, 陈伟明, 李阳. 危重症患儿院际转运实践方案的构建[J]. 中华护理杂志, 2023, 58(22): 2693-2701. |
[13] | 梅茵, 黄立学, 刘晔, 陈伟. 老年肺癌患者静脉血栓栓塞症风险预测工具的比较研究[J]. 中华护理杂志, 2023, 58(19): 2333-2338. |
[14] | 叶艳欣, 秦岚, 骆佳慧, 曾凯, 刘素婷, 于雅, 梁静文, 张立力. 肺癌患者化疗相关症状群的发生现状及影响因素分析[J]. 中华护理杂志, 2023, 58(18): 2230-2237. |
[15] | 张辰, 杨浩杰, 张哲, 李茹, 季诗明, 胡宇乐, 周彦君, 梁涛. 晚期心力衰竭患者安宁疗护准入评估指标的构建[J]. 中华护理杂志, 2023, 58(13): 1544-1551. |
阅读次数 | ||||||
全文 |
|
|||||
摘要 |
|
|||||