预防ICU患者大便失禁性皮炎的循证实践

doi:10.3761/j.issn.0254-1769.2021.06.002

摘要/Abstract

摘要：

目的总结预防ICU患者大便失禁性皮炎的循证证据,并评价其临床应用效果。方法应用循证护理的方法系统检索2010年1月—2019年9月国内外相关临床实践指南、专家共识和系统评价。评价并汇总最佳证据,制订审查条目进行基线审查,并基于审查结果分析促进与障碍因素。于2020年5月—9月将证据应用于临床,比较循证实践前后ICU患者失禁性皮炎发生率、护士对失禁性皮炎相关知识的认知水平以及对审查条目的执行率。结果最终纳入8篇文献,包括临床实践指南3篇、专家共识2篇、系统评价3篇,在风险评估和预防策略2方面总结了11条最佳证据。循证实践后,ICU患者失禁性皮炎发生率为19.10%,低于循证实践前（40.48%）,差异具有统计学意义（P<0.05）;护士对失禁性皮炎相关知识问卷的得分为（42.35±5.77）分,高于循证实践前（35.65±5.07）分,差异具有统计学意义（P<0.001）。护士对审查条目2、4、5、6的执行率由循证实践前的0、0、66.67%、22.62%上升至100%、84.27%、97.75%、76.40%,差异具有统计学意义（P<0.001）。结论将预防ICU患者大便失禁性皮炎的最佳证据应用于临床,可降低失禁性皮炎发生率,提高护士对失禁性皮炎相关知识的认知水平以及执行依从性。

关键词: 重症监护病房, 大便失禁, 失禁性皮炎, 循证护理学

Abstract:

Objective To summarize the evidence for the prevention of fecal incontinence associated dermatitis in ICU patients and to evaluate its application effect. Methods To obtain the best evidence,we used the method of evidence-based nursing to search related guidelines,expert consensuses and systematic reviews from domestic and foreign databases from January 2010 to September 2019. The best evidence was evaluated and summarized;review indicators were developed;the baseline review was conducted,and facilitation and obstacles based on the review results were analyzed. From May to September in 2020,the evidence was applied to clinical practice,and the incidence of incontinence associated dermatitis,nurses’ cognitive level of incontinence associated dermatitis knowledge and the implementation rate of review items were compared before and after the application of evidence-based practice. Results Finally,8 articles were included,including 3 clinical practice guidelines,2 expert consensuses and 3 systematic reviews. 11 pieces of best evidence were summarized in terms of risk assessment and prevention strategies. After evidence-based practice,the incidence of incontinence associated dermatitis was 19.10%,which was lower than that before evidence-based practice （40.48%） with statistically significant differences（P<0.05）;the score of nurses on incontinence associated dermatitis knowledge questionnaire was（42.35±5.77）,which was higher than that before evidence-based practice （35.65±5.07）,and the difference was statistically significant （P<0.001）. The implementation rates of items 2,4,5,6 increased from 0,0,66.67% and 22.62% to 100%,84.27%,97.75% and 76.40%,and the differences were statistically significant（P<0.001）. Conclusion The application of evidence-based practice in the prevention of fecal incontinence related dermatitis in ICU patients can reduce the incidence of incontinence associated dermatitis,improve nurses’ cognitive level and the implementation compliance.

Key words: Intensive Care Units, Fecal Incontinence, Incontinence Associated Dermatitis, Evidence-Based Nursing

徐元元,史广玲,张燕红,徐建珍,刘娟,蒋学娟,杜海燕. 预防ICU患者大便失禁性皮炎的循证实践[J]. 中华护理杂志, 2021, 56(6): 811-817.

XU Yuanyuan,SHI Guangling,ZHANG Yanhong,XU Jianzhen,LIU Juan,JIANG Xuejuan,DU Haiyan. Evidence-based practice in prevention of fecal incontinence associated dermatitis in ICU patients[J]. Chinese Journal of Nursing, 2021, 56(6): 811-817.

图/表 4

表1 预防ICU患者大便失禁性皮炎的最佳证据

Table 1 Best evidence for prevention of fecal incontinence associated dermatitis in ICU patients

表2 审查条目及方法

Table 2 Review criteria and methods

表3 两组一般资料比较

Table 3 Baseline characteristics of 2 groups patients

表4 循证应用前后护士对审查条目执行情况的比较

Table 4 Comparison of nurses’ implementation of review items before and after evidence-based application

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