急性主动脉夹层患者院内急救护理方案的构建

doi:10.3761/j.issn.0254-1769.2023.11.007

摘要/Abstract

摘要：

目的构建适宜中国临床情境的急性主动脉夹层患者院内急救护理方案，为开展循证护理实践提供理论和实践指导。方法基于循证方法检索国内外相关文献并对其进行质量评价，总结最佳证据，形成急性主动脉夹层患者院内急救护理方案初稿。运用德尔菲技术对30名急诊医疗、护理专家进行2轮函询，完善并确立最终方案。结果共纳入58篇文献，总结了95条最佳证据，形成方案初稿，2轮函询问卷回收率均为100%，专家权威系数分别为0.869、0.868，变异系数均为0~0.17，肯德尔和谐系数分别为0.473、0.613（P<0.05）。最终构建的急性主动脉夹层患者院内急救护理方案包括3个一级指标（预检分诊、急诊抢救与护理、安全转运）、17个二级指标和97个三级指标。结论该研究构建的急性主动脉夹层院内急救护理方案内容详实、涵盖面广、科学性强、可操作性强，可为急诊护理实践提供指导。

关键词: 主动脉夹层, 急救, 循证护理学, 德尔菲技术

Abstract:

Objective To construct an intra-hospital emergency nursing program for patients with acute aortic dissection suitable for the clinical scenarios in China，aiming to provide theoretical and practical guidance for carrying out evidence-based nursing practice. Methods Based on evidence-based methods，domestic and foreign literature was retrieved and summarized for the best evidence to form the first draft of intra-hospital emergency nursing program for acute aortic dissection. Delphi technique was used to conduct 2 rounds of correspondence among 30 selected emergency medical and nursing experts，and the final program was improved and established. Results 58 pieces of literature were included，and 95 pieces of best evidence were summarized. The first draft of the program was formed and 2 rounds of correspondence were conducted，with the recovery rate of the questionnaire of 100%，the expert authority coefficients of 0.869 and 0.868，the coefficient of variation of 0~0.17；the coordination coefficients of 0.473 and 0.613，respectively（P<0.05）. The final intra-hospital emergency nursing programe for acute aortic dissection includes 3 level Ⅰ indicators，17 level Ⅱ indicators and 97 level Ⅲ indicators，including pre-examination triage，emergency rescue and nursing，and safe transferring. Conclusion The constructed intra-hospital emergency nursing programe for acute aortic dissection has detailed contents，wide coverage，strong scientificity and operability，which can provide references for emergency nursing practice.

Key words: Aortic Dissection, First Aid, Evidence-Based Nursing, Delphi Technique

徐伟, 米钰, 陈晓莉, 林文风, 孙立琴, 程宝珍, 张小红. 急性主动脉夹层患者院内急救护理方案的构建[J]. 中华护理杂志, 2023, 58(11): 1322-1329.

XU Wei, MI Yu, CHEN Xiaoli, LIN Wenfeng, SUN Liqin, CHENG Baozhen, ZHANG Xiaohong. Construction of an intra-hospital emergency nursing program for patients with acute aortic dissection[J]. Chinese Journal of Nursing, 2023, 58(11): 1322-1329.

图/表 1

参考文献 24

[1]	葛均波, 徐永健, 王辰. 内科学[M]. 9版. 北京: 人民卫生出版社, 2018:323-324.
	Ge JB, Xu YJ, Wang C. Internal medicine[M]. 9th ed. Beijing: People’s Medical Publishing House, 2018:323-324.
[2]	中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识[J]. 中华胸心血管外科杂志, 2017, 33(11):641-654.
	Professional Committee of Macrovascular Surgery,Cardiovascular Surgery Branch,Chinese Physicians Association. Chinese expert consensus on aortic dissection diagnosis and treatment[J]. Chin J Thorac Cardiovasc Surg, 2017, 33(11):641-654.
[3]	方方, 周田田, 林玉博, 等. 基于团队资源管理模式建立主动脉夹层绿色通道的实践与效果评价[J]. 解放军护理杂志, 2019, 36(11):79-82.
	Fang F, Zhou TT, Lin YB, et al. Effectiveness of the green channel for aortic dissection based on team resource management mode[J]. Nurs J Chin PLA, 2019, 36(11):79-82.
[4]	孔冉冉, 龙锋, 易绍东, 等. 区域协同救治体系建设改变了什么?:中国最早的胸痛中心数据分析[J]. 中国循环杂志, 2022, 37(1):39-44.
	Kong RR, Long F, Yi SD, et al. What has been changed since the establishment of regional cooperative rescue system? Analysis on the center database of the first chest pain center in China[J]. Chin Circ J, 2022, 37(1):39-44.
[5]	Chaikof EL, Dalman RL, Eskandari MK, et al. The society for vascular surgery practice guidelines on the care of patients with an abdominal aortic aneurysm[J]. J Vasc Surg, 2018, 67(1):2-77.e2. DOI PMID
[6]	Ohle R, Yan JW, Yadav K, et al. Diagnosing acute aortic syndrome:a Canadian clinical practice guideline[J]. CMAJ, 2020, 192(29):E832-E843. DOI URL
[7]	孙立忠, 李建荣. 我国Stanford A型主动脉夹层诊疗进展与挑战[J]. 浙江医学, 2017, 39(19):1630-1632,1660.
	Sun LZ, Li JR. Progress and challenges in diagnosis and treatment of Stanford A aortic dissection in China[J]. Zhejiang Med J, 2017, 39(19):1630-1632, 1660.
[8]	朱政, 胡雁, 邢唯杰, 等. 不同类型循证问题的构成[J]. 护士进修杂志, 2017, 32(21):1991-1994.
	Zhu Z, Hu Y, Xing WJ, et al. The composition of different types of evidence based problems[J]. J Nurses Train, 2017, 32(21):1991-1994.
[9]	胡雁, 郝玉芳. 循证护理学[M]. 2版. 北京: 人民卫生出版社, 2018:36-37.
	Hu Y, Hao YF. Evidence-based nursing[M]. 2nd ed. Beijing: People’s Medical Publishing House, 2018:36-37.
[10]	Brouwers MC, Kho ME, Browman GP, et al. AGREE Ⅱ:advancing guideline development,reporting and evaluation in health care[J]. J Clin Epidemiol, 2010, 63(12):1308-1311. DOI PMID
[11]	Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2:a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions,or both[J]. BMJ, 2017, 358:j4008.
[12]	The Joanna Briggs Institute. JBI critical appraisal checklist for text and opinion paper[EB/OL]. (2017-07-15)[2020-04-26]. http://joannabriggs.org/research/cri-tical-appraisal-tools.html.
[13]	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. JBI evidence pre-classification and evidence rank system(2014 Edition)[J]. J Nurses Train, 2015, 30(11):964-967.
[14]	蔡立柏, 刘延锦, 郭玉茹, 等. 骨科康复护理质量评价指标的构建[J]. 中华护理杂志, 2021, 56(4):508-514. DOI
	Cai LB, Liu YJ, Guo YR, et al. Establishment of a nursing quality evaluation indicator system for orthopedic rehabilitation[J]. Chin J Nurs, 2021, 56(4):508-514. DOI
[15]	Hirata K, Wake M, Takahashi T, et al. Clinical predictors for delayed or inappropriate initial diagnosis of type A acute aortic dissection in the emergency room[J]. PLoS One, 2015, 10(11):e0141929. DOI URL
[16]	史冬雷, 刘晓颖, 周瑛. 急诊预检分诊专家共识[J]. 中华急诊医学杂志, 2018, 27(6):599-604.
	Shi DL, Liu XY, Zhou Y. Expert consensus on emergency pretest triage[J]. Chin J Emerg Med, 2018, 27(6):599-604.
[17]	Hiratzka LF, Bakris GL, Beckman JA, et al. 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM guidelines for the diagnosis and management of patients with thoracic aortic disease[J]. J Am Coll Cardiol, 2010, 55(14):e27-e129. DOI URL
[18]	王丽, 翁艳敏, 傅巧美. 72例腹主动脉瘤合并髂动脉瘤腔内修复术中封闭髂内动脉患者的护理[J]. 中华护理杂志, 2017, 52(8):954-957.
	Wang L, Weng YM, Fu QM. Nursing of 72 patients with internal iliac artery coverage during endovascular abdominal aortic aneurysm repair[J]. Chin J Nurs, 2017, 52(8):954-957.
[19]	Dong N, Piao HL, Li B, et al. Poor management of hypertension is an important precipitating factor for the development of acute aortic dissection[J]. J Clin Hypertens(Greenwich), 2019, 21(6):804-812.
[20]	Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the international registry of acute aortic dissection:a 20-year experience of collaborative clinical research[J]. Circulation, 2018, 137(17):1846-1860. DOI PMID
[21]	殷慧智, 崔玉玲, 巩越丽, 等. 29例A型急性主动脉夹层患者围手术期目标血压的管理[J]. 中华护理杂志, 2014, 49(10):1188-1190.
	Yin HZ, Cui YL, Gong YL, et al. Perioperative blood pressure monitoring and control in 29 patients with acute type A aortic dissection[J]. Chin J Nurs, 2014, 49(10):1188-1190.
[22]	徐伟, 陈晓莉, 林文风, 等. 急性主动脉夹层患者急诊目标血压管理的循证实践[J]. 护理学杂志, 2022, 37(7):90-94.
	Xu W, Chen XL, Lin WF, et al. Evidence-based practice of emergency target blood pressure management for patients with acute aortic dissection[J]. J Nurs Sci, 2022, 37(7):90-94.
[23]	刘盎, 孟倩倩, 张洪磊, 等. 急诊危重患者院内转运质量评价指标的构建[J]. 中华护理杂志, 2021, 56(3):336-341. DOI
	Liu A, Meng QQ, Zhang HL, et al. Construction of a quality evaluation index for intra-hospital transport of emergency critically ill patients[J]. Chin J Nurs, 2021, 56(3):336-341. DOI
[24]	乔亚娟, 白向威, 袁方方, 等. 多学科协作护理模式在主动脉夹层患者院内转运中的应用[J]. 齐鲁护理杂志, 2020, 26(8):35-37.
	Qiao YJ, Bai XW, Yuan FF, et al. Application of multidisciplinary collaborative nursing model in in-hospital transport of patients with aortic dissection[J]. J Qilu Nurs, 2020, 26(8):35-37.