目的 了解鼻胃管非计划性拔管护理方案证据临床应用现状，分析循证实践中障碍及促进因素，并据此制订行动策略，为临床实践提供依据。方法 检索国内外数据库及指南网站关于预防鼻胃管非计划性拔管护理方案的证据并汇总，建立审查指标和审查方法，于2022年4-6月对某院进行基线审查，分析障碍和促进因素，并制订应对策略。比较证据应用前后护士对审查指标的执行情况、鼻胃管非计划性拔管的发生情况。结果 纳入11篇文献，形成15条最佳证据，制订16条审查指标。障碍因素有缺乏有效的团队组织和支持、缺乏基于证据的知识储备、患者及家属对拔管预防意识不强等；促进因素有组建循证实践小组指导工作、开展相关的培训并建立考核机制、加强患者和家属的宣教等。证据应用前后，除指标16外，护士对其他指标的执行率均有提升，差异均有统计学意义（均P＜0.001）。证据应用后，鼻胃管非计划性拔管发生率由4.45%降至2.10%，差异有统计学意义（P＜0.05）。结论 基于最佳证据，并结合临床实际，制订预防住院患者鼻胃管非计划性拔管的管理方案，可促进护士护理行为的规范，有效地降低非计划性拔管，从而优化患者的护理结局。

Objective To explore the current application status of evidence-based nursing programs for Unplanned Extubation(UEX) of Nasogastric Tube,analyze the obstacles and promoting factors in evidence-based practice,and accordingly formulate action strategies to provide a basis for clinical practice.Methods Domestic and foreign databases and guideline websites were searched and summarized for the evidence of nursing programs for the prevention of UEX of nasogastric tubes.The review indicators and review methods were established,and a baseline review of a hospital from April to June 2022 was conducted to analyze the obstacle and promoting factors,and the coping strategies were formulated.The implementation of review indicators and the occurrence of UEX of nasogastric tube were compared before and after the application of evidence.Results Eleven articles were included,15 best evidences were formed,and 16 review indicators were formulated.The obstacle factors included lack of effective team organization and support,lack of evidence-based knowledge reserve,and weak awareness of extubation prevention among patients and their family members.The promotion factors included establishing evidence-based practice group to guide the work,carrying out relevant training and establishing assessment mechanism,strengthening the education of patients and their families,etc.Before and after the application of evidence,except for index 16,the implementation rate of nurses on other indicators was improved,and the differences were statistically significant(all P＜0.001).After the application of evidence,the incidence of unplanned extubation of nasopharynx tube decreased from 4.45% to 2.10%,and the difference was statistically significant(P＜0.05).Conclusions Based on the best evidence and combined with clinical practice,a program to prevent UEX of nasogastric tube in inpatients can promote the standardization of nurses’ nursing behavior,effectively reduce UEX,and optimize the nursing outcome of patients.

R472

厦门市科技计划项目(3502Z20214ZD1053）