颅脑损伤患者目标温度管理的循证实践

doi:10.3761/j.issn.0254-1769.2023.19.001

摘要/Abstract

摘要：

目的将颅脑损伤患者目标温度管理最佳证据应用于临床实践并评价其效果。方法遵循乔安娜布里格斯研究所循证护理中心应用模式，基于最佳证据制订16条审查指标，以基于证据的持续质量改进模式为理论框架，于2021年6月—2022年4月，按照基线审查、实践变革和证据应用后变革效果的再审查将循证实践应用于神经外科ICU颅脑损伤患者，比较循证实践前后护理人员审查指标的执行率、目标温度管理相关知识水平、循证实践能力、患者并发症发生率及组织文化水平等。结果循证实践后，各项审查指标第1、2轮审查执行率较基线均有提升，其中审查指标2~3、7~11、13执行率提升显著，差异有统计学意义（P<0.05）；基线审查、第1轮审查、第2轮审查3组患者的3级寒颤发生率显著降低（χ²=7.680，P=0.021）；基线审查、第1轮审查、第2轮审查护士关于颅脑损伤患者目标温度管理的知识现状调查问卷、循证实践影响因素问卷得分均提高（F=3.827，P=0.025；F=4.997，P=0.009），循证实践后护士循证护理实践障碍量表得分较基线降低（F=4.174，P=0.018），组织文化水平较基线提升（F=7.421，P=0.024）。结论通过循证实践对神经外科ICU颅脑损伤患者进行目标温度管理，可有效规范医护人员的诊疗、护理行为，降低患者并发症发生率，但后期仍需持续质量监管及审查。

关键词: 颅脑损伤, 目标温度管理, 神经外科, 循证实践, 循证护理学

Abstract:

Objective To apply the best evidence of target temperature management in patients with traumatic brain injury to clinical practice and to evaluate its effect. Methods Followed the application model of JBI evidence-based nursing center，16 review indicators were developed based on the best evidence，and the evidence-based continuous quality improvement model was taken as the theoretical framework. From June 2021 to April 2022，the evidence-based practice was applied to patients with traumatic brain injury in neurosurgery ICU according to the baseline review，practice change and review of change effect after evidence application，and the implementation rate，target temperature management related knowledge level，evidence-based ability，patient complication rate and organizational culture level were compared. Results After evidence-based practice，the implementation rates of the first and second rounds of reviews for various review indicators have improved compared to the baseline，with significant increases in the implementation rates of review indicator 2，3，7，8，9，10，11 and 13（P<0.05）. There was a significant decrease in the incidence of grade 3 chills in the 3 groups of patients before and after the baseline review，the first review，and the second review（χ²=7.680，P=0.021）. Before and after the implementation of the baseline review，the first round of review，and the second round of review，the scores of the nurses’ knowledge status questionnaire on target temperature management for patients with traumatic brain injury，and the evidence-based practice influencing factors questionnaire were all improved（F=3.827，P=0.025；F=4.997，P=0.009），while the scores of the nurses’ evidence-based nursing practice obstacle scale were lower than those before the implementation（F=4.174，P=0.018）. The level of organizational culture has improved compared to it before implementation（F=7.421，P=0.024）. Conclusion Through the continuous improvement of evidence-based practice，target temperature management for patients with traumatic brain injury in neurosurgery ICU can effectively standardize the diagnosis and care behavior of medical staff and reduce the incidence of patients’ complications，but it still needs continuous quality supervision and review in the later stage.

Key words: Traumatic Brain Injury, Target Temperature Management, Neurosurgery Department, Evidence-Based Practice, Evidence-Based Nursing

孟晓静, 李翔, 冯英璞, 范晶丽, 霍晓冉, 张春霞, 周立民, 高敏. 颅脑损伤患者目标温度管理的循证实践[J]. 中华护理杂志, 2023, 58(19): 2309-2318.

MENG Xiaojing, LI Xiang, FENG Yingpu, FAN Jingli, HUO Xiaoran, ZHANG Chunxia, ZHOU Limin, GAO Min. Evidence-based practice of target temperature management in patients with traumatic brain injury[J]. Chinese Journal of Nursing, 2023, 58(19): 2309-2318.

图/表 5

表1 颅脑损伤患者目标温度管理的证据、审查指标及审查方法

Table 1 Evidence, review indicators and data collection methods for target temperature management in patients with traumatic brain injury

表2 证据应用前后患者一般资料比较（n=98）

Table 2 Comparison of patients’ general data before and after evidence application （n=98）

表3 证据应用前后审查标准执行情况比较 [例（百分率，%）]

Table 3 Comparison of the implementation of review standards before and after application of evidence [case（percent，%）]

表4 证据应用前后患者3级寒颤、目标温度管理相关并发症发生率比较 [例（百分率，%）]

Table 4 Comparison of complications related to Grade 3 chills and target temperature management before and after evidence application [case（percent，%）]

表5 证据应用前后护士颅脑损伤患者目标温度管理知识水平及循证实践能力比较（分，$ \overline{x}\pm s$，n=27）

Table 5 Comparison of target temperature management knowledge level and evidence-based practice ability of nurses with traumatic brain injury before and after the application of evidence （scores，$ \overline{x}\pm s$，n=27）

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