椎管内分娩镇痛护理循证实践方案的构建
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摘要
目的构建基于循证的椎管内分娩镇痛护理实践方案。方法以Stetler证据应用模式为理论框架,通过典型机构的现场观察,梳理焦点问题,系统检索文献,提取证据及推荐意见,构建方案草案,进行专家论证,确定推荐等级,形成最终方案。结果方案包括分娩疼痛的评估及初步处理、椎管内分娩镇痛开始时机、镇痛前准备、镇痛期间的监护与管理、镇痛产妇的活动管理、饮食管理、镇痛结束时机7个方面共41条推荐意见,其中38条强推荐,3条弱推荐。结论构建椎管内分娩镇痛护理循证实践方案,有利于多学科助产团队在临床实践过程中达成一致,为下一步临床实施奠定基础。
Objective To develop an evidence-based practice protocol for intrathecal labor analgesia.Methods Using the Stetler Model of research utilization as theoretical framework,we developed draft protocol based on field observation,identification of focus problems,literature reviewing,and extraction of evidence and recommendations.Then expert consultation was conducted to identify recommendation grade and to formulate the final protocol.Results The protocol included seven dimensions and 41 recommendations(38 strong recommendations and 3 weak recommendations) :assessment and preliminary management of labor pain,commencement of intrathecal labor analgesia,preparation before intrathecal labor analgesia,monitoring and management during intrathecal labor analgesia,activity management,dietary management,and termination of intrathecal labor analgesia.Conclusion The development of evidence-based practice protocol for intrathecal labor analgesia facilitates the achievement of multidisciplinary team agreement,thus to provide foundation for clinical practice.
Objective To develop an evidence-based practice protocol for intrathecal labor analgesia.Methods Using the Stetler Model of research utilization as theoretical framework,we developed draft protocol based on field observation,identification of focus problems,literature reviewing,and extraction of evidence and recommendations.Then expert consultation was conducted to identify recommendation grade and to formulate the final protocol.Results The protocol included seven dimensions and 41 recommendations(38 strong recommendations and 3 weak recommendations) :assessment and preliminary management of labor pain,commencement of intrathecal labor analgesia,preparation before intrathecal labor analgesia,monitoring and management during intrathecal labor analgesia,activity management,dietary management,and termination of intrathecal labor analgesia.Conclusion The development of evidence-based practice protocol for intrathecal labor analgesia facilitates the achievement of multidisciplinary team agreement,thus to provide foundation for clinical practice.
引文
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[21]黄绍强.椎管内阻滞分娩镇痛的研究进展[J].复旦学报(医学版),2007,34(4):630-633.
[22]Torvaldsen S,Roberts C L,Bell J C,et al.Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia[J].Cochrane Database Syst Rev,2004(4):CD004457.
[23]张新春,王义海,葛玉红,等.多学科合作延续护理对乳腺癌患者心理状态和生活质量的影响[J].中华现代护理杂志,2018,24(2):199-202.
[24]陈春英,刘冬梅,汤鸿鹰.多学科团队合作式自我管理教育对初诊冠心病患者情绪障碍的影响[J].心脑血管病防治,2018,18(1):69-71.
[25]Landry A,Erwin C.Perspectives on multidisciplinary team processes among healthcare executives:processes that facilitate team effectiveness[J].J Health Hum Serv Adm,2015,38(3):350-380.
[26]张伟,朱宁宁,雷婷婷,等.胃癌患者术后肠内营养喂养不足循证预防护理方案构建[J].护理学杂志,2018,33(11):1-4.
[27]王树欣,韩文军,张丽君.基于循证的气管插管全麻导管拔除管理方案的构建与应用[J].护理学杂志,2017,32(10):41-44.(本文编辑王菊香)
[2]徐惠芳,王丽娟.分娩镇痛降低会阴切口疼痛指数效果观察[J].中国乡村医药,2012,19(18):26-27.
[3]WHO.WHO recommendations-intrapartum care for a po-sitive childbirth experience[R].Geneva:World Health Organization,2018.
[4]徐铭军,吴新民.分娩镇痛的现状和临床应用[J].中国实用妇科与产科杂志,2006,22(7):548-550.
[5]费菲.无痛分娩时代真的来了?---中华医学会麻醉学分会产科麻醉学组组长姚尚龙一席谈[J].中国医药科学,2016,6(16):1-6.
[6]成磊,胡雁.证据应用在循证护理实践的研究现状[J].护理学杂志,2016,31(3):101-105.
[7]Stetler C B.Updating the Stetler Model of research utilization to facilitate evidence-based practice[J].Nurs Outlook,2001,49(6):272-279.
[8]Hadorn D C,Baker D,Hodges J S,et al.Rating the quality of evidence for clinical practice guidelines[J].J Clin Epidemiol,1996,49(7):749-754.
[9]王子君,姚亮,刘练,等.推荐分级的评估、制订与评价(GRADE)方法学家的培训与认证[J].中国循证儿科杂志,2017,12(5):388-391.
[10]Schünemann H,Broek J,Guyatt G.The GRADE handbook[EB/OL].(2013-10-04)[2016-09-06].https://training.cochrane.org/resource/grade-handbook.
[11]National Institute For Health and Care Excellence.Intrapartum care for healthy women and babies[EB/OL].(2014-12-03)[2016-09-10].https://www.nice.org.uk/guidance/cg190.
[12]Hawkins J,Arens J,Bucklin B.Practice guidelines for obstetric anesthesia[J].Anesthesiology,2016,124(2):270-300.
[13]Association of Women's Health,Obstetric and Neonatal Nurses.Nursing care of the woman receiving regional analgesia/anesthesia in labor.Second edition.Evidence-based clinical practice guideline[M].Washington DC:Stryker Medical,2011:19-43.
[14]中华医学会麻醉学分会产科学组.分娩镇痛专家共识(2016版)[J].临床麻醉学杂志,2016,32(8):816-818.
[15]Association of Anaesthetists of Great Britain,Ireland Obstetric Anaesthetists'Association.Guidelines for Obstetric Anaesthetic Services[M].London:AAGBI,2013:2-28.
[16]Dobson G,Chong M,Chow L,et al.Guidelines to the practice of anesthesia-revised edition 2017[J].Can J Anesth,2017,64(1):65-91.
[17]Van De Velde M,Vercauteren M,Stockman W,et al.Recommendations and guidelines for obstetric anesthesia in Belgium[J].Acta Anaesthesiol Belg,2013,64(3):97-104.
[18]李一美,邵慧静,方晓红,等.第二产程延迟屏气对硬膜外分娩镇痛初产妇分娩结局的影响[J].中国护理管理,2016,16(3):319-322.
[19]Committee on Obstetric Practice.Committee Opinion No.687:approaches to limit intervention during labor and birth[J].Obstet Gynecol,2017,129(2):e20-e28.
[20]连庆泉,姚尚龙,胡品明.Chestnut产科麻醉学:理论与实践[M].4版.北京:人民卫生出版社,2013:417-419.
[21]黄绍强.椎管内阻滞分娩镇痛的研究进展[J].复旦学报(医学版),2007,34(4):630-633.
[22]Torvaldsen S,Roberts C L,Bell J C,et al.Discontinuation of epidural analgesia late in labour for reducing the adverse delivery outcomes associated with epidural analgesia[J].Cochrane Database Syst Rev,2004(4):CD004457.
[23]张新春,王义海,葛玉红,等.多学科合作延续护理对乳腺癌患者心理状态和生活质量的影响[J].中华现代护理杂志,2018,24(2):199-202.
[24]陈春英,刘冬梅,汤鸿鹰.多学科团队合作式自我管理教育对初诊冠心病患者情绪障碍的影响[J].心脑血管病防治,2018,18(1):69-71.
[25]Landry A,Erwin C.Perspectives on multidisciplinary team processes among healthcare executives:processes that facilitate team effectiveness[J].J Health Hum Serv Adm,2015,38(3):350-380.
[26]张伟,朱宁宁,雷婷婷,等.胃癌患者术后肠内营养喂养不足循证预防护理方案构建[J].护理学杂志,2018,33(11):1-4.
[27]王树欣,韩文军,张丽君.基于循证的气管插管全麻导管拔除管理方案的构建与应用[J].护理学杂志,2017,32(10):41-44.(本文编辑王菊香)