脑卒中气管切开患者病房电动起立床实施方案的构建及应用

关键词：脑卒中  气管切开  电动起立床  德尔菲技术  标准化  管理方案  康复

Keywords:stroke  tracheotomy  electric standing bed  Delphi technique  standardization  management program  rehabilitation

摘要：

      摘要 目的：构建脑卒中气管切开患者电动起立床实施方案，规范脑卒中气管切开患者使用电动起立床的实施流程。 方法：通过循证拟订实施方案初稿，2022年12月—2023年2月对来自江西、四川、湖南、浙江、云南、广东、湖北和山西省的15名专家进行两轮函询，形成脑卒中气管切开患者电动起立床实施清单，并验证其临床可行性及有效性。 结果：两轮专家函询有效问卷回收率均为100%，专家权威系数均为0.835，各条目的重要性评分及可行性评分均＞3.5分，变异系数均＜0.25，肯德尔W系数为0.314—0.328（均P<0.001）。脑卒中气管切开患者电动起立床实施方案包含实施前准备、实施中观察和实施后评价3个部分，包括3个一级条目、10个二级条目和23个三级条目。实施方案应用结果显示，实施过程中未发生不良事件，观察组干预后肺部感染发生率低于对照组（P=0.010），一次性拔管成功率高于对照组（P=0.012），差异具有显著性意义。 结论：本研究构建的脑卒中气管切开患者电动起立床实施方案可靠科学、安全可行，未来建议进一步扩大样本量验证其有效性。

Abstract:

      Abstract Objective： To construct the implementation plan of electric standing up bed for stroke patients with tracheotomy， and standardize the implementation process of using electric standing up bed for stroke patients with tracheotomy. Method： Based on the preliminary draft of the evidence-based implementation plan， 15 experts from Jiangxi， Sichuan， Hunan， Zhejiang， Yunnan， Guangdong， Hubei and Shanxi provinces were consulted by two rounds of letters from December 2022 to February 2023. After that, the implementation list of electric standing up bed for stroke patients with tracheotomy was form， and its clinical feasibility and effectiveness were verified. Result： The effective questionnaire returns rate of the two rounds of expert correspondence was 100%， the expert authority coefficient was 0.835， the importance score and feasibility score of each item were >3.5， the coefficient of variation was <0.25， and the Kendall W coefficient was 0.314—0.328（P<0.001 for all）. The implementation plan of electric standing up bed for stroke patients with tracheotomy included 3 parts： pre-implementation preparation， observation during implementation and post-implementation evaluation， including 3 first-level items， 10 second-level items and 23 third-level items. The application results of the implementation plan showed that no adverse events occurred during the implementation process， the incidence of pulmonary infection in the observation group after intervention was lower than that in the control group（P=0.010），and the success rate of one-time extubation was higher than that in the control group（P=0.012），with statistical significance. Conclusion： The implementation scheme of electric standing up bed for stroke patients with tracheotomy constructed by the author is reliable， scientific， safe and feasible， and it is suggested to further expand the sample size to verify its effectiveness in the future.