心搏驟停患者的復甦後管理
循證的復甦後護理與患者出院後的生存及功能狀態之間有明確的關係。澳大利亞復甦委員會（ARC)推薦採用程序化的護理，以提高患者心搏驟停後的存活機會。衛生服務機構有義務確保程序化的復甦後護理是及時的和循證的。
重症監護環境下心搏驟停患者的復甦後管理：循證指南依從性的回顧性分析
A.Milonas A.Hutchinson D.Charlesworth A.Doric J.Green J.Considine
摘 要
目的：本研究的目的是，對於院外或在急診科發生心搏驟停經復甦後存活的患者，從急診科轉入重症監護室後，在患者自主循環恢復的首個24小時內，檢查患者的復甦後護理遵循最佳操作指南的情況。
方法：在澳大利亞墨爾本的兩家醫療機構，對滿足心搏驟停後存活標準的患者的病歷進行回顧性分析。考察的指標為：原發性心搏驟停特徵、氧合和通氣管理、心血管護理、神經系統護理和患者預後。
結果：本研究有4項主要發現：（i)在首個24小時內的復甦後管理中，吸入氣中的氧濃度分數（FIO2)為100%以及高氧血症常見；（ii)心臟護理有差異，及時給予12導聯心電圖監測，大部分患者的收縮壓（SBP)高於100 mmHg，但轉入心導管實驗室的時間延遲；（iii)神經護理不足，包括高血糖發生率高，以及高達50%的患者未提供低溫治療；（iv)患者入院後24小時內的院內病死率與復甦後護理的特定因素有關。
結論：有必要設定貫穿患者就醫全過程的循證的，適合特定環境的指南，來指導復甦後護理。在實踐中依賴國家級指南不一定能使其轉化為健康機構內的循證實踐。因此，迫切需要具體實施措施以確保指南的有效實施。
[關鍵詞]心搏驟停；心肺復甦；循證醫學；護理；急救護理；危重護理；復甦後護理
英文原文：
Post resuscitation management of cardiac arrest patients in the critical care environment: a retrospective audit of compliance with evidence based guidelines/ A. Milonas, A. Hutchinson, D. Charlesworth, A. Doric, J. Green, J. Considine // Northern Health, Epping, 3076, Victoria, Australia ///
[Abstract]
Objective:The aim of this study was to examine adherence to best practice guidelines for post resuscitation care in the first 24 h from Return of Spontaneous Circulation for patients admitted to the intensive care unit from the emergency department having suffered out of hospital or emergency department cardiac arrest and survived initial resuscitation.
Methods:A retrospective audit of medical records of patients who met the criteria for survivors of cardiac arrest was conducted at two health services in Melbourne, Australia. Criteria audited were: primary cardiac arrest characteristics, oxygenation & ventilation management, cardiovascular care, neurological care and patient outcomes.
Results:The four major findings were: (i) use of fraction of inspired oxygen (FIO2) of 1.0 and hyperoxia was common during the first 24 h of post resuscitation management, (ii) there was variability in cardiac care, with timely 12 lead Electrocardiograph and majority of patients achieving systolic blood pressure (SBP) greater than 100 mmHg, but delays in transfer to cardiac catheterisation laboratory, (iii) neurological care was suboptimal with a high incidence of hyperglycaemia and failure to provide therapeutic hypothermia in almost 50% of patients and (iv) there was an association between in-hospital mortality and specific elements of post resuscitation care during the first 24 h of hospital admission.
Conclusion:Evidence-based context-specific guidelines for post resuscitation care that span the whole patient journey are needed. Reliance on national guidelines does not necessarily translate to evidence based care at a local level, so strategies to ensure effective guideline implementation are urgently required.
[Keywords]
cardiac arrest; cardiopulmonary resuscitation; evidence-based practice; nursing care; emergency nursing; critical care nursing; post resuscitation care
作者單位：
北部健康中心，維多利亞，3076 澳大利亞（A.Milonas,A.Hutchinson,J.Green）；迪肯大學護理和助產學院（A.Hutchinson，J.Considine）；東部健康中心（D.Charlesworth，A.Doric，J.Considine）
摘要出處：
http://dx.doi.org/10.1016/j.aucc.2016.12.001
Milonas A, Hutchinson A, Charlesworth D, et al. Post resuscitation management of cardiac arrest patients in the critical care environment: a retrospective audit of compliance with evidence based guidelines. Aust Crit Care, 2017,30(6).
來源 ：《中國護理管理》2017年第12期。
為了讓廣大護理人員及時了解更多國際護理研究進展，增進我國與國際護理界學術交流，促進護理學科發展與臨床實踐水平的提升，《中國護理管理》於2017 年起開闢「國際視角」欄目，與澳大利亞知名期刊《Australian Critical Care》合作，每期刊登一篇精選原創論文的中英文摘要。該刊隸屬於愛思唯爾集團，最新影響因子為1.907，五年影響因子為2.016。該刊經過嚴格的同行評審，接受世界各地的作者來稿，刊登重症護理相關的原創性研究、新技術和新方法、案例研究和述評等類型文章。
希望本欄目的信息能為廣大護理同仁的科研和臨床工作提供參考。
TAG:中國護理管理 |