重症动脉瘤性蛛网膜下腔出血患者术后目标血压管理的循证实践

doi:10.3761/j.issn.0254-1769.2025.24.006

摘要/Abstract

摘要：

目的将重症动脉瘤性蛛网膜下腔出血患者术后目标血压管理最佳证据应用于临床实践，评价其实施效果。方法采用循证护理学方法，系统检索建库至2024年3月国内外有关重症动脉瘤性蛛网膜下腔出血患者术后目标血压管理的临床决策、指南、系统评价、证据总结、专家共识等。以研究者-管理者-实践者理论模型为指导，筛选最佳证据，制订循证实践方案，并于2024年8—9月在南京市某三级甲等医院ICU实施。比较循证实践前后患者血压在目标范围内时间、医护人员对最佳证据的认知水平及审查条目执行率的差异。结果共纳入15篇文献，遴选出13条适合临床的最佳证据，构建了12条审查条目。循证实践后，患者收缩压和平均动脉压在目标范围内时间由（69.74±5.09）%和（70.50±5.09）%提高至（80.50±3.07）%和（80.85±3.24）%；医护人员对最佳证据的认知水平由（59.69±8.67）分提高至（76.06±10.03）分；各审查条目执行率由58.22%~95.77%提高至89.87%~100%，差异具有统计学意义（均P<0.05）。结论开展重症动脉瘤性蛛网膜下腔出血患者术后目标血压管理的循证实践，提高了患者血压在目标范围内时间、医护人员对最佳证据的认知水平以及审查条目的执行率。

关键词: 动脉瘤, 蛛网膜下腔出血, 重症监护病房, 循证护理学

Abstract:

Objective To apply the best evidence for targeted blood pressure management in patients with severe aneurysmal subarachnoid hemorrhage（aSAH） after surgery into clinical practice and evaluate its implementation outcomes. Methods Using evidence-based nursing methodology，we systematically searched clinical decision protocols，guidelines，systematic reviews，evidence summaries，and expert consensuses on postoperative targeted blood pressure management for severe aSAH from database inception to March 2024. Guided by the Researcher-Administrator-Practitioner theoretical model，we screened the best evidence and developed an evidence-based practice protocol. This protocol was implemented in the ICU of a tertiary A hospital in Nanjing from August to September 2024. We compared differences before and after evidence-based practice implementation in time spent within target blood pressure ranges，healthcare providers’ knowledge of best evidence，and compliance rates with audit criteria. Results A systematic review of 15 included studies yielded 13 clinically applicable best practice recommendations，which informed the development of 12 evidence-based audit criteria. The percentage of time patients spent within target systolic blood pressure and mean arterial pressure ranges increased from（69.74±5.09）% and （70.50±5.09）% to （80.50±3.07）% and （80.85±3.24）%. Healthcare providers’ knowledge scores improved from（59.69±8.67） to （76.06±10.03）. Compliance rates across audit metrics demonstrated significant improvement，increasing from a baseline range of 58.22%~95.77% to 89.87%~100% post-implementation. All differences were statistically significant（all P<0.05）. Conclusion The evidence-based nursing practice for postoperative targeted blood pressure management in severe aSAH，guided by the Researcher-Administrator-Practitioner theoretical model，significantly improved time-in-target blood pressure ranges，healthcare providers’ knowledge，and protocol adherence.

Key words: Aneurysm, Subarachnoid Hemorrhage, Intensive Care Unit, Evidence-Based Nursing

史广玲, 张燕红, 王筱筱, 刘娟, 蒋学娟, 余天浩, 施伟. 重症动脉瘤性蛛网膜下腔出血患者术后目标血压管理的循证实践[J]. 中华护理杂志, 2025, 60(24): 2986-2992.

SHI Guangling, ZHANG Yanhong, WANG Xiaoxiao, LIU Juan, JIANG Xuejuan, YU Tianhao, SHI Wei. Evidence-based practice for targeted blood pressure management in postoperative patients with critical aneurysmal subarachnoid hemorrhage[J]. Chinese Journal of Nursing, 2025, 60(24): 2986-2992.

图/表 3

表1 重症动脉瘤性蛛网膜下腔出血患者术后目标血压管理的证据内容及审查指标

Table 1 Evidence content and review indicators for postoperative target blood pressure management after severe aSAH

表2 循证实践前后患者一般资料的比较[例（百分比,%）]

Table 2 Comparison of general patient data before and after evidence-based practice[cases（percentage,%）]

表3 循证实践前后审查条目执行率的比较

Table 3 Comparison of implementation rate of review indicators before and after evidence-based practice

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