目的 通过实施基于最佳证据的经桡动脉冠状动脉介入术后老年患者桡动脉闭塞（radial artery occlusion, RAO）管理的实践方法并评价其效果。方法 应用JBI证据总结数据库中的降低经桡动脉冠状动脉介入术后老年患者RAO发生的最佳证据。在上海市某三级甲等医院心血管内科开展循证实践,包括3个部分7个阶段,历时6个月,制定审查标准规范护士和多学科团队对RAO的管理行为,比较证据应用前后RAO发生率、护士对预防RAO的知识水平、手术前后RAO的评估率以及证据执行的依从率等。结果 最佳证据应用前后,经桡动脉冠状动脉介入术后老年患者RAO发生率由10%下降至3%、护士对预防RAO的知识水平由65%上升至87%、RAO的评估率由60%上升至100%,护士对证据执行的依从率均有提高,差异有统计学意义（P<0.05）。结论 本项目通过最佳证据的实践应用,规范了介入术后预防老年患者RAO的管理行为,提高护士对预防RAO的护理知识,有效降低了老年患者RAO的发生。
Abstract
Objective To evaluate the effectiveness of best evidence-based practice for the management of radial artery occlusion (RAO) in elderly patients after transradial coronary intervention. Methods The best evidence for reducing the incidence of RAO in elderly patients after transradial coronary intervention was applied in cardiovascular medicine department in a tertiary grade-A hospital in Shanghai to carry out an evidence-based practice which consisted of three parts and seven phases over six months. A review standard was formulated to regulate nurses' and multidisciplinary team's behaviors in the management of RAO. The incidence of RAO, nurses' knowledge on RAO prevention, preoperative and postoperative RAO assessment rate, and adherence of evidence application were compared before and after evidence application. Results The incidence of RAO in elderly patients after transradial coronary intervention decreased from 10% to 3%; the level of nurses' knowledge of RAO prevention increased from 65% to 87%; assessment rate of preoperative and postoperative RAO increased from 60% to 100%, and nurses' adherence of evidence application increased. All showed statistical significance (P<; 0.05). Conclusion Through best evidence-based practice, this project reduces the incidence of RAO in elderly patients by standardizing management behaviors for preventing RAO in elderly patients after intervention and improving nurses' knowledge of preoperative and postoperative care for preventing RAO.;
关键词
老年 /
经桡动脉冠状动脉介入术 /
桡动脉闭塞 /
循证实践
Key words
elderly /
transradial coronary intervention /
radial artery occlusion /
evidence-based practice
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基金
2022年度JB1 Fellowship证据临床转化科研项目（FNSF202204）
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