基于循证的全麻苏醒期躁动预防方案在机器人巨结肠手术中的应用实践

目的:构建基于循证的全麻苏醒期躁动(Emergence agitation,EA)预防方案,并评价其应用效果。方法:在最佳证据的基础上,通过小组讨论进行证据FAME属性的评价,针对11条证据进行临床应用并构建质量审查指标,于2020年7月~2021年2月实施循证护理实践,通过基线审查(29例患儿)分析障碍因素,构建全麻EA护理预防方案,并将此方案应用于34例患儿。结果:患儿EA发生率由24.1%降至2.9%,显著低于证据应用前(P<0.05)。医护人员对预防全麻患儿EA的相关知识、态度与行为得分显著高于证据应用前(P<0.05)。结论:基于循证构建的全麻EA护理预防方案可在机器人巨结肠手术中推广,且在实施中应结合临床情景考虑患儿个性化意愿,降低全麻患儿EA的发生率。

Application of evidence-based prevention protocol of emergence agitation in children with congenital megacoln under robotic surgery

Objective:To construct an evidence-based prevention protocol of emergence agitation(EA)in children undergoing general anesthesia and evaluate its effect.Methods:The feasibility,appropriateness,meaningfulness and effectiveness of evidences were evaluated by group discussion.11 items of evidence were clinically applied and quality review indicators were established.Evidence-based nursing practice was performed from July 2020 to February 2021.Clinical obstacles were identified by baseline review(29 children),and an evidence-based prevention protocol for EA with general anesthesia was constructed.Then the protocol was applied to another 34 children.Results:After application of the prevention protocol,the incidence of EA decreased from 24.1% to 2.9%,which was significantly lower than that before the application of evidence(P<0.05).The scores on knowledge,attitude and behavior of medical staff on EA were significantly higher than that before the application of evidence.Conclusion:The evidence-based prevention protocol of EA in children with Hirschsprung’s disease underwent robotic surgery could be popularized clinically.To decrease the incidence of EA,clinical settings and personalized patients’willingness shall be considered during the implementation of the protocol.