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骨科围手术期患者静脉血栓栓塞症物理预防的最佳证据总结
发布人：yaot 发布时间：2022/8/26 10:51:05 浏览次数：1841次
——南星羽 马靓 李海红
【摘要】目的 总结骨科围手术期患者静脉血栓栓塞症（VTE）物理预防的证据，提高护理人员VTE物理预防措施实施依从性。方法 根据澳大利亚JBI循证卫生保健中心证据总结方法学，检索骨科围手术期患者VTE物理预防相关文献，根据纳入文献类型，由研究人员独立进行质量评价，并提取、汇总最佳证据。结果 共纳入文献17篇，包含10篇指南、1篇证据总结、2篇专家共识、4篇系统评价。经过分析，总结出7类共30条骨科围手术期患者VTE物理预防最佳证据。结论 最佳证据可为护士提供循证依据。但在应用时，还需评估具体临床情境，结合专业判断和患者意愿，针对性选择证据，以促进护理质量的持续改进。
【关键词】骨科；静脉血栓栓塞症；物理预防；循证护理；证据总结
中图分类号：R68；R47文献标识码：A
Summary of the Best Evidence for Physical Prevention of Venous Thromboembolism in Perioperative Orthopedic Patients/NAN Xingyu，MA Liang，LI Haihong.//Chinese Health Quality Management，2022,29(8):72-76
Abstract Objective To study the evidence of physical prevention of Venous Thromboembolism (VTE) in perioperative orthopedic patients, and to provide reference for improving the compliance of nursing staff with physical prevention of VTE.Methods According to the evidence summary methodology of JBI Evidence-Based Health Care Center in Australia, literatures related to physical prevention of VTE in perioperative orthopedic patients were searched. According to the literature type, researchers independently conducted quality evaluation, and extracted and summarized the best evidence.Results A total of 17 articles were included, which included 10 guidelines, 1 evidence summary, 2 expert consensus, and 4 systemic reviews. After analysis, a total of 30 pieces of best evidence for physical prevention of VTE in perioperative orthopedic patients in 7 categories were summarized.Conclusion The best evidence provides the nurse with evidence-based evidence. However, in the application, it is necessary to evaluate the specific clinical situation, combine professional judgment and patient's willness, and select targeted evidence to promote the continuous improvement of nursing quality.
Key words Orthopedics Department; Venous Thromboembolism; Physical Prevention; Evidence-Based Nursing; Summary of Evidence
First-author's address Xuzhou Medical University Affiliated Hospital of Lianyungang/The First People's Hospital of Lianyungang,Lianyungang,Jiangsu, 222002, China
静脉血栓栓塞症（Venous Thromboembolism，VTE）包括深静脉血栓形成（Deep Vein Thrombosis，DVT）和肺动脉血栓栓塞症（Pulmonary Thromboembolism，PTE）。它是造成骨科围手术期患者死亡的重要因素之一［1］。近年来，中华医学会骨科学分会［1］及英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence，NICE）［2］出版的指南均表明，有效预防骨科大手术患者VTE发生，需要基础预防、物理预防、药物预防三者联合应用。然而，有研究［3］表明，护士缺乏VTE预防知识导致其物理预防措施实施依从性差。因此，需要依据大量证据制定骨科围手术期患者物理预防策略，以规范医护人员的预防行为。
根据澳大利亚循证卫生保健中心（Joanna Briggs Institute，JBI）的模式，循证实践包括证据的生成、综合、传播和应用4个步骤［4］。缩小证据与临床实践之间的差距，制定有效的临床决策，是护理人员需要思考的问题［5-6］。本研究对预防骨科围手术期患者VTE的相关证据进行总结，以期规范骨科围手术期患者VTE物理预防辅助药物预防流程，提高护士VTE物理预防措施实施依从性，促进护理质量的持续改进。