经皮冠状动脉介入术后患者规范化饮水的审查指标及障碍因素分析

目的 开展急诊经皮冠状动脉介入术后患者规范化饮水预防造影剂肾病的循证护理,制订审查指标,分析循证护理实践过程中的障碍因素及促进因素,制订行动策略。 方法 以乔安娜布里格斯研究所（Joanna Brigga Institute,JBI）临床证据应用模式为理论指导,明确临床护理问题、组建循证护理团队、系统检索文献、评价及汇总证据,制订相应的护理质量审查指标及审查方法,依据基线审查结果分析障碍因素及促进因素,并制订行动策略。 结果 该研究最终纳入12条最佳证据,依此制订了12条审查指标,主要障碍因素为科室缺乏经皮冠状动脉介入术后规范化饮水的相关流程和教育资料、科室缺乏造影剂肾病发生风险评估工具、护士对规范化饮水预防造影剂肾病的相关知识欠缺等,主要促进因素为组织领导力强、医护团队合作等,据此制订了相应的行动策略。 结论 该研究制订的急诊经皮冠状动脉介入术后患者规范化饮水预防造影剂肾病的护理质量审查指标具有科学性和可操作性,可为预防经皮冠状动脉介入术后患者造影剂肾病的发生提供指导。

Establishment and obstacles analysis of evidence-based nursing examination indicators for oral hydration to prevent contrast-induced nephropathy in patients after emergency percutaneous coronary intervention

Objective To carry out evidence-based nursing care of standardized oral hydration for prevention of contrast-induced nephropathy（CIN） in patients after emergency percutaneous coronary intervention,and to formulate nursing quality review indicators,and analyze the obstacle factors based on the current situation of clinical practice. Methods Guided by the evidence-based health care model of Joanna Brigga Institute,the problems of evidence-based nursing,team building,systematic retrieval,evaluation and summary of evidence were determined;the nursing indicators and methods were formulated. According to the baseline study results,the obstacle and promotion factors were analyzed,and the corresponding methods and countermeasures were developed. Results A total of 12 pieces of best evidence were included in the study,and 12 quality review indicators were formulated based on the best evidence. The main obstacle factors were the lack of standardized drinking water process,the lack of assessment tools for the risk of CIN,insufficient training of nurses on the knowledge of CIN,and insufficient cognition of patients and their families on contrast nephropathy. The main motivating factors are strong organizational leadership and medical team cooperation and etc. Conclusion Combined with the judgment of clinical professionals,the evidence-based nursing quality review index of oral hydration for prevention of CIN after emergency coronary intervention is scientific,operable and practical,which can lay the foundation for evidence-based nursing.