降低经桡动脉冠状动脉介入术后老年患者桡动脉闭塞发生的循证实践

doi:10.16460/j.issn1008-9969.2025.02.037

摘要/Abstract

摘要： 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。

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

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.;

Key words: elderly, transradial coronary intervention, radial artery occlusion, evidence-based practice

中图分类号:

R473.6

夏碧芸, 陈瑜, 吴彦妍, 胡雁. 降低经桡动脉冠状动脉介入术后老年患者桡动脉闭塞发生的循证实践[J]. 护理学报, 2025, 32(2): 37-43.

XIA Bi-yun, Chen Yu, WU Yan-yan, Hu Yan. Evidence-based practice to reduce incidence of radial artery occlusion in elderly patients after transradial coronary intervention[J]. Journal of Nursing, 2025, 32(2): 37-43.

参考文献

[1] Andò G, Capodanno D.Radial access reduces mortality in patients with acute coronary syndromes: results from an updated trial sequential analysis of randomized trials[J]. JACC Cardiovasc Interv,2016,9(7):660-670.DOI:10.1016/j.jcin.2015.12.008.
[2] Neumann FJ, Sousa-Uva M, Ahlsson A, et al.2018 ESC/EACTS guidelines on myocardial revascularization[J]. Eur Heart J, 2019,40(2):87-165.DOI:10.1093/eurheartj/ehy394.
[3] Dogherty EJ, Harrison MB, Baker C, et al.Following a natural experiment of guideline adaptation and early implementation: a mixed-methods study of facilitation[J]. Implement Sci, 2012(7):9.DOI:10.1186/1748-5908-7-9.
[4] Kappert K, Meyborg H, Baumann B, et al.Integrin cleavage facilitates cell surface-associated proteolysis required for vascular smooth muscle cell invasion[J]. Int J Biochem Cell Biol,2009,41(7):1511-1517.DOI:10.1016/j.biocel.2009.01.004.
[5] Porritt K, McArthur A, Lockwood C, et al. JBI's approach to evidence implementation: a 7-phase process model to support and guide getting evidence into practice[J]. JBI Evid Implement, 2023, 21(1):3-13.DOI:10.1097/XEB.0000000000000361.
[6] Munn Z, McArthur A, Klugar M, et al. Providing a scaffold for considering theoretical frameworks in evidence implementation projects: the JBI approach to evidence implementation[J]. JBI Evid Implement, 2023,21(4):386-393.DOI:10.1097/XEB.0000000000000397.
[7] 王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志,2015,30(11):964-967.DOI:10.16821/j.cnki.hsjx.2015.11.002.
[8] Bonnett C, Becker N, Hann B, et al.Preventing radial artery occlusion by using reverse barbeau assessment: bringing evidence-based practice to the bedside[J]. Crit Care Nurse, 2015,35(4):77-82.DOI:10.4037/ccn2015428.
[9] Williams T, Condon J, Davies A, et al.Nursing-led ultrasound to aid in trans-radial access in cardiac catheterisation: a feasibility study[J]. J Res Nurs, 2020,25(2):159-172.DOI:10.1177/1744987119900374.
[10] Aminian A, Saito S, Takahashi A, et al.Comparison of a new slender 6 Fr sheath with a standard 5 Fr sheath for transradial coronary angiography and intervention: RAP and BEAT (Radial Artery Patency and Bleeding, Efficacy, Adverse evenT), a randomised multicentre trial[J]. EuroIntervention, 2017,13(5):e549-e556.DOI:10.4244/EIJ-D-16-00816.
[11] Dangoisse V, Guédès A, Chenu P, et al.Usefulness of a gentle and short hemostasis using the transradial band device after transradial access for percutaneous coronary angiography and interventions to reduce the radial artery occlusion rate (from the prospective and randomized CRASOC I, II, and III studies)[J]. Am J Cardiol, 2017,120(3):374-379.DOI:10.1016/j.amjcard.2017.04.037.
[12] 费叶萍,徐文博,程俊亚,等.经皮冠状动脉介入术后桡动脉压迫TR Band止血器首次最佳减压时间的Meta分析[J].心脑血管病防治,2024, 24(6):57-61. DOI:10.3969/j.issn.1009-816x.2024.06.015.
[13] Hahalis G, Aznaouridis K, Tsigkas G, et al.Radial artery and ulnar artery occlusions following coronary procedures and the impact of anticoagulation: ARTEMIS (Radial and Ulnar ARTEry Occlusion Meta-AnalysIS) systematic review and Meta-analysis[J]. J Am Heart Assoc,2017,6(8):e005430.DOI:10.1161/JAHA.116.005430.
[14] Dahal K, Sharma S, Yousuf A, et al.A comparison of standard versus low dose heparin on access-related complications after coronary angiography through radial access: a Meta-analysis of randomized controlled trials[J]. Cardiovasc Revasc Med, 2018,19(5 Pt B):575-579.DOI:10.1016/j.carrev.2017.10.018.
[15] 赵宁. 经前臂桡/尺动脉入径冠脉介入诊疗术后桡/尺动脉闭塞的危险因素分析[D]. 石家庄:河北医科大学,2016. DOI:10.7666/d.D844960.
[16] Chen Y, Ke Z, Xiao J, et al.Subcutaneous injection of nitroglycerin at the radial artery puncture site reduces the risk of early radial artery occlusion after transradial coronary catheterization: a randomized, placebo-controlled clinical trial[J]. Circ Cardiovasc Interv, 2018,11(7):1-6.DOI:10.1161/CIRCINTERVENTIONS.118.006571.
[17] Bernat I, Aminian A, Pancholy S, et al.Best practices for the prevention of radial artery occlusion after transradial diagnostic angiography and intervention: an international consensus paper[J]. JACC Cardiovasc Interv, 2019,12(22):2235-2246.DOI:10.1016/j.jcin.2019.07.043.
[18] 胡雁, 周英凤. 循证护理:证据临床转化理论与实践[M]. 上海: 复旦大学出版社, 2021.
[19] Rolley JX, Salamonson Y, Wensley C, et al.Nursing clinical practice guidelines to improve care for people undergoing percutaneous coronary interventions[J]. Aust Crit Care, 2011,24(1): 18-38.DOI: 10.1016/j.aucc.2010.08.002.
[20] Baloh J, Zhu X, Ward MM.Types of internal facilitation activities in hospitals implementing evidence-based interventions[J]. Health Care Manage Rev, 2018,43(3):229-237.DOI:10.1097/HMR.0000000000000145.
[21] Lizarondo L, McArthur A. Strategies for effective facilitation as a component of an evidence-based clinical fellowship program[J]. J Contin Educ Nurs, 2017,48(10):458-463.DOI:10.3928/00220124-20170918-07.
[22] Cranley LA, Cummings GG, Profetto-McGrath J, et al. Facilitation roles and characteristics associated with research use by healthcare professionals: a scoping review[J]. BMJ Open, 2017, 7(8):1-18.DOI:10.1136/bmjopen-2016-014384.
[23] Dogherty EJ, Harrison MB, Graham ID, et al.Turning knowledge into action at the point-of-care: the collective experience of nurses facilitating the implementation of evidence-based practice[J]. Worldviews Evid Based Nurs, 2013,10(3):129-139.DOI:10.1111/wvn.12009.
[24] Hunt JB, Curran G, Kramer T, et al.Partnership for implementation of evidence-based mental health practices in rural federally qualified health centers: theory and methods[J]. Prog Community Health Partnersh, 2012,6(3):389-398.DOI:10.1353/cpr.2012.0039.
[25] Khan A, Boukrina O, Oh-Park M, et al.Preventing delirium takes a village: systematic review and Meta-analysis of delirium preventive models of care[J]. J Hosp Med, 2019,14(9):558-564.DOI:10.12788/jhm.3212.
[26] Rosen MA, DiazGranados D, Dietz AS, et al. Teamwork in healthcare: key discoveries enabling safer, high-quality care[J]. Am Psychol, 2018,73(4):433-450.DOI:10.1037/amp0000298.
[27] 徐良, 叶长青, 王静, 等. 银杏叶提取物注射液联合单硝酸异山梨酯对经桡动脉穿刺冠脉介入后桡动脉闭塞和血流动力学的影响[J]. 现代生物医学进展, 2022,22(16):3148-3152.DOI:10.13241/j.cnki.pmb.2022.16.030.

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