目的 制定和应用麻醉后恢复室(PACU)内全麻患者经口气管导管拔除的最佳循证实践方案.方法 结合最佳证据和情景分析,制定“PACU内经口气管导管拔除最佳循证实践方案”,整合证据进入临床实践.根据复旦大学护理学院JBI循证中心证据实践应用程序,对22名麻醉护士进行培训,通过对104例在PACU内拔除经口气管导管患者拔管护理执行情况的基线审查,分析障碍因素并通过实践变革将最佳证据应用于102例拔管患者护理并进行质量再审查.结果 与基线审查结果比较,推进最佳循证护理实践方案后,6条质量审查指标的执行率均有显著提高;麻醉护士拔管相关知识掌握程度明显提高(P＜0.05);干预后接受质量审查的102例患者的呼吸系统异常事件发生率明显低于基线审查的104例患者(P＜0.05).结论 应用经口气管导管拔除循证护理实践方案有利于规范PACU内麻醉护士的护理行为,提高临床护理质量,降低拔管后异常事件发生率,提高患者在PACU内的舒适度.%Objective To develop and implement an evidence-based protocol for standardize the behavior of extubation after general anesthesia in post anesthetic care unit(PACU).Method Based on best evidence and scenario analysis,An evidence-based protocol of procedures and strategies was developed,and evidence was integrated into clinical practice.According to the practical application of Fudan Joanna Briggs Institute,22 nurse anesthetists was trained.By review the baseline of extubtion for 104 patients in PACU to find the gap between the clinical and evidence.Then reexamine the extubation for 102 patients after practical reformation.Result Compared with the baseline,all implementation rates of the six examination standards and the nurse anesthetists' knowledge about extubation improved was significantly (P＜0.05).The incidence of respiratory abnormal events after extubation was reduced significantly(P＜0.05).Conclusion The nursing management protocol of extubation after general anesthesia in PACU can help to standardize the nurse anesthetists' behavior of extubation,improve the quality of clinical nursing,reduce the incidence of respiratory abnormal events,and improve patient's comfort in PACU.
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