目的 将颅脑损伤患者肺部并发症预防与管理的最佳证据应用于临床,并评价其应用效果,为临床制订相关规范提供参考依据。方法 2024年3-8月,采用方便抽样法选取安徽省某三级甲等医院神经外科的80例颅脑损伤患者为研究对象。采用非同期临床对照试验设计将2024年3-5月入住的患者设为对照组,2024年6-8月入住的患者设为循证实践组,两组均40例。通过证据获取、现状审查、证据引入和效果评价4个阶段将证据应用于临床,比较两组患者肺部并发症的发生率、指标落实率。结果 基于证据共制订9条临床审查指标,循证实践组患者肺部并发症发生率低于对照组(25.00% vs. 45.00%,χ2=7.501,P=0.006)。所有审查指标落实率均显著提高,差异均有统计学意义(均P<0.05)。结论 颅脑损伤患者肺部并发症预防与管理最佳证据实践方案应用于临床,能够有效降低术后肺部并发症发生率,提高神经外科护理质量。

Objective To apply the best evidence for the prevention and management of pulmonary complications in patients with traumatic brain injury (TBI) to clinical practice,evaluate its application effect,and provide a reference for developing relevant clinical standards.Methods From March to August 2024,80 patients with craniocerebral injury admitted to the Department of Neurosurgery of a Grade A tertiary hospital in Anhui Province were selected by convenience sampling.A non-concurrent controlled trial design was adopted:patients admitted from March to May 2024 served as the control group,and those admitted from June to August 2024 as the evidence-based practice group,with 40 cases in each group.The evidence was applied through four stages:evidence retrieval,baseline audit,evidence implementation,and effect evaluation.The incidence of pulmonary complications and the compliance rates of audit indicators were compared between the two groups.Results Nine clinical audit indicators were developed based on the evidence.The incidence of pulmonary complications in the evidence-based practice group was significantly lower than that in the control group(25.00% vs. 45.00%,χ2=7.501,P=0.006).The compliance rates of all audit indicators were significantly improved,with statistically significant differences (all P<0.05).Conclusions The application of the best-evidence practice protocol for the prevention and management of pulmonary complications in patients with TBI can effectively reduce the incidence of postoperative pulmonary complications and improve the quality of neurosurgical nursing.

R47;R473.6

国家自然科学基金(82101424)；上海市第六人民医院安徽医院课题项目(ZYYB26-04)