全身麻醉下纤维支气管镜检查患者围手术期饮食护理的循证实践

doi:10.3761/j.issn.0254-1769.2023.019.002

摘要/Abstract

摘要：

目的根据全身麻醉下纤维支气管镜检查患者围手术期饮食管理的最佳证据，开展循证实践，并评价其应用效果。方法 2021年7月—2022年3月，采用乔安娜布里格斯研究所临床证据实践应用模式，根据前期获得的最佳证据制订审查指标，进行基线审查，分析障碍因素，制订最佳临床决策在临床应用，然后进行2轮临床审查。分别比较证据应用前（98例）、证据应用后第1轮审查（73例）、证据应用后第2轮审查（59例）中49名医护人员相关知识认知水平、审查指标的执行情况、全身麻醉下纤维支气管镜检查患者术前禁食禁饮时长、术后禁食禁饮时长以及呛咳、口渴感、饥饿感、恶心或呕吐的发生率。结果证据应用后，医护人员相关知识的认知水平提升，患者围手术期禁食禁饮时长明显缩短，口渴感、饥饿感发生率较应用前下降，差异有统计学意义（P<0.001）；呛咳及恶心呕吐发生率的比较，差异无统计学意义（P>0.05）；13条指标的执行率从0~89.80%提升至81.36%~100%，除指标2和13，其余11条审查指标执行率均有显著提升（P<0.001）。结论全身麻醉下纤维支气管镜检查患者围手术期饮食护理的循证实践，有助于缩短患者围手术期禁饮禁食时长，改善患者不适感。

关键词: 麻醉，全身, 支气管镜检查, 围手术期, 饮食管理, 循证护理学

Abstract:

Objective Evidence-based nursing practice based on the best evidence of perioperative dietary management in patients undergoing fiberoptic bronchoscopy under general anesthesia was carried out and its application was evaluated. Methods From July 2021 to March 2022，the Joanna Briggs Institute（JBI） clinical evidence practice application model was conducted at the Department of Respiratory and Critical Care Medicine at our hospital to develop review metrics for baseline review based on the best evidence obtained previously，and barriers were analyzed，and the best clinical decisions for clinical application were developed，followed by 2 rounds of clinical reviews. The level of knowledge and the implementation rate of review indicators of 49 healthcare professionals in patients undergoing fiberoptic bronchoscopy under general anesthesia were compared before the application of evidence（98 patients），the first round review after the application of evidence（73 patients），and the second round review after the application of evidence（59 patients）. The duration of preoperative and postoperative fasting，the incidence of choking，thirst，hunger，nausea or vomiting were also compared. Results After the application of the evidence，the level of knowledge of healthcare professionals was improved；the length of perioperative fasting was significantly shortened；the difference in the sense of thirst and hunger was statistically significant；the difference in the incidence of choking，nausea and vomiting was not statistically significant，and the implementation rate of the 13 reviewed indicators increased from 0~89.80% to 81.36%~100%，with significant differences in the implementation rate of the remaining 12 reviewed indicators，except for indicator 2 and 13（P<0.001）. Conclusion Evidence-based practice of perioperative diet management in patients undergoing fiberoptic bronchoscopy under general anesthesia can help to shorten the duration of perioperative fasting and improve patients’ discomfort，and it can be promoted in clinical practice.

Key words: Anesthesia，General, Bronchoscopy, Perioperative Period, Dietary Management, Evidence-Based Nursing

李亚新, 邵红艳, 安艳涛, 张振霞, 王菲菲. 全身麻醉下纤维支气管镜检查患者围手术期饮食护理的循证实践[J]. 中华护理杂志, 2023, 58(19): 2319-2325.

LI Yaxin, SHAO Hongyan, AN Yantao, ZHANG Zhenxia, WANG Feifei. Evidence-based practice of perioperative dietary management of patients undergoing fiberoptic bronchoscopy under general anesthesia[J]. Chinese Journal of Nursing, 2023, 58(19): 2319-2325.

图/表 4

表1 纤维支气管镜检查患者围手术期饮食管理的临床实践审查指标

Table 1 Quality review metrics of clinical practice for perioperative dietary management

表2 患者一般资料的比较

Table 2 Comparison of general information of study subjects

表3 证据应用前后审查指标的执行情况比较（%）

Table 3 Comparison of the implementation of the review indicators before and after the application of the evidence （%）

表4 证据应用前后患者结局指标比较

Table 4 Comparison of patient outcome indicators before and after evidence application

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