兰州大学学报（医学版）2024，Vol.50Issue(8)：78-86,9.DOI:10.13885/j.issn.1000-2812.2024.08.011
ICU气管插管患者拔管后吞咽障碍康复干预的证据审查与障碍因素分析
Evidence review and analysis of barriers to post-extubation dysphagia rehabilitation interventions for tracheally intubated patients in ICU
摘要
Abstract
Objective To understand the current state of evidence-based clinical application of rehabilitation interventions for post-extubation dysphagia in tracheally intubated patients in the intensive care unit(ICU),to analyze the barriers and facilitators of evidence-based practice using the 4M1E Factor Analysis of the Cause&Effect/Fishbone Diagram,and to explore change strategies to inform the clinical translation of evidence.Methods Using the evidence-based continuous quality improvement model as a theoretical guide,evidence was retrieved,evaluated and summarized,and review indicators were developed.A convenience sampling method was used to select 20 patients with post-extubation dysphagia and all 30 ICU healthcare workers as study subjects who met the inclusion and exclusion criteria in the ICU of a tertiary hospital in Lanzhou,Gansu Province,from June to July 2023.Barriers and facilitators were analyzed and change strategies were devel-oped based on the results of the baseline review.Results A total of 35 review indicators were developed.The results of the baseline review showed that only 8 had an implementation rate of more than 60%and 11 had rate of 0.Barriers mainly included a wide range of departments,large number of staff,and two difficulties,that is,the department's current training content did not yet include content related to post-extraction dyspha-gia,and the healthcare staff were faced with a high intensity of work.Facilitating factors included a strong learning atmosphere in the practice unit,and the availability of training equipment such as a demonstration room and an electronic projector in the practice unit.Strategies for change included the formation of a multi-disciplinary team and the development of a post-extraction dysphagia training program.Conclusion There is still a large gap between the evidence of postextubation dysphagia in patients with tracheal intubation in the ICU and that of clinical practice;scientific and comprehensive assessment of barriers and facilitators in prac-tice and development of appropriate strategies for change can effectively facilitate the translation of evidence into clinical practice.关键词
气管插管/拔管/吞咽障碍/循证医学/审查指标/障碍因素分析Key words
tracheal intubation/extubation/dysphagia/evidence-based medicine/review indicator/barrier analysis分类
医药卫生引用本文复制引用
陶蕾,王恒阳,孙珊珊,王倩,李文瑞,王瑞,张志刚..ICU气管插管患者拔管后吞咽障碍康复干预的证据审查与障碍因素分析[J].兰州大学学报（医学版）,2024,50(8):78-86,9.基金项目
甘肃省卫生健康行业科研计划资助项目(GSWSHL2022-24) （GSWSHL2022-24）
