摘要
目的将预防围手术期低体温的证据总结应用于临床实践, 提高临床护理人员对证据应用的依从性, 进而探讨证据应用对成年肝移植患者围手术期低体温的影响。方法 2018年1月—2019年11月长庚医院行原位肝移植手术的149例患者作为对照组, 2020年2月—12月于长庚医院行原位肝移植手术的137例患者作为循证组。对照组采取传统保温模式, 术中以加温水毯进行保温为主, 体温<36 ℃时增加压力暖风毯保温;循证组运用围手术期低体温防治的最佳证据总结, 术前评估患者低体温风险, 术前以压力暖风毯进行预保温, 术中以压力暖风毯进行保温为主, 体温<36 ℃时增加输液加温设备进行保温。比较两组患者的基础体温及麻醉后30 min、麻醉后1 h、腹腔打开、无肝期、新肝期、术毕时的体温;比较证据应用前后护理人员对围手术期低体温防治相关知识知晓情况, 以及对基于证据的围手术期低体温防治措施的执行率。结果证据应用前护理人员对基于证据的围手术期低体温防治知识的调查问卷正确率为62%, 低于证据应用后的正确率90%(P<0.05);证据应用后, 护理人员对标准1、2、3、7的执行率高于应用证据前(P<0.05), 而对标准4、5、6的执行率两组差异无统计学意义(P>0.05)。无肝期、新肝期和术毕时循证组体温高于对照组(P<0.05), 两组患者基础体温及麻醉后30 min、麻醉后1 h、腹腔打开时的体温差异无统计学意义(P>0.05)。结论通过证据临床转化, 可降低成年肝移植患者围手术期低体温的发生率, 规范护理人员行为, 提高围手术期医疗和护理质量。
Objective To summarize the evidence concerning the prevention of perioperative hypothermia and apply into clin⁃ical practice,so as to improve the compliance of nursing staff to the application of evidence,and discuss the influence of evidence appli⁃cation on perioperative hypothermia in adult liver transplantation patients.Methods A total of 149 patients who underwent ortho⁃topic liver transplantation in Changgung Hospital from January 2018 to November 2019 were selected as a control group,while 137 pa⁃tients who underwent orthotopic liver transplantation Changgung Hospital from February to December 2020 were selected as an evidence⁃based group.The control group implemented the traditional temperature protection mode:patients were kept warm with circu⁃lating water blanket during the operation,and the forced⁃air warming blanket was added to keep warm when the temperature fell below 36℃.The evidence⁃based group applied the best evidence for the prevention and treatment of perioperative hypothermia.The risk of hypothermia was assessed before surgery.The forced⁃air warming blanket was used for pre⁃warming and warming for the patient during surgery.When the temperature fell below 36℃,an infusion heating device was added for warming.Both groups were compared for the basal body temperature and the body temperature 30 min after anesthesia,1 h after anesthesia,when the abdominal cavity was opened,at liver free stage,at new liver stage and after surgery.The knowledge of perioperative hypothermia and the implementation rate of the evidence⁃based preventive measures of perioperative hypothermia were compared before and after application.Results In the ques⁃tionnaire survey,the correct rate of the knowledge of evidenced⁃based prevention and treatment of perioperative hypothermia before evidence application was 62%,which was lower than 90%after application(P<0.05).After evidence application,the implementation rate of nursing staff to standards 1,2,3,7 was higher than those before evidence applicat
作者
邢雪燕
张欢
李蒙
涂淑敏
Xing Xueyan;Zhang Huan;Li Meng;Tu Shumin(Department of Anesthesiology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)
出处
《国际麻醉学与复苏杂志》
CAS
2022年第4期376-380,共5页
International Journal of Anesthesiology and Resuscitation
关键词
肝移植
成年人
围手术期
低体温
证据
循证医学
Liver transplantation,adult
Perioperative
Hypothermia
Evidence
Evidence⁃based medicine
