ICU俯卧位通气患者眼部并发症预防的循证护理实践 [中文引用][英文引用]

目的  将重症监护室（intensive care unit，ICU）俯卧位通气患者眼部并发症预防最佳证据应用于临床实践，以降低俯卧位通气患者眼部并发症发生率，提高护理质量。方法  以基于证据的持续质量改进模式为指导，2024 年 12 月— 2025年 3 月通过系统检索、评价并总结国内外 ICU 俯卧位通气患者眼部并发症预防的最佳证据；制定审查指标，并进行现状审查；根据以健康服务领域研究成果应用的整合性行动促进框架（integrated-promoting action on research implementation in health servicesframework，i-PARIHS）分析障碍因素和促进因素，构建针对性的变革策略和实施方案；比较证据应用前后各项审查指标执行情况，ICU 护士对俯卧位通气患者眼部并发症预防的知信行情况，以及俯卧位通气患者眼部并发症发生率。结果  ICU 俯卧位通气患者眼部并发症预防循证实践后患者眼部并发症发生率低于循证护理实践前，ICU 护士对俯卧位通气患者眼部并发症预防的知识、态度和行为得分高于循证护理实践前，各审查指标执行率高于循证实践前，前后比较，差异具有统计学意义（均P<0.05）。结论  基于证据的持续质量改进模式开展循证实践能提升 ICU 俯卧位通气患者眼部并发症预防的护理质量，改善临床护理结局，具有较强的临床应用价值与推广潜力，能够为提升重症监护环境下患者安全提供一个可复制的实践框架。

Objective To apply the best evidence for preventing ocular complications in ICU patients undergoing prone position ventilation into clinical practice,so as to reduce the incidence of such complications and improve nursing quality. Methods Guided by the evidence-based continuous quality improvement model,we systematically retrieved,evaluated,and summarized the best evidence for preventing ocular complications in prone-ventilated ICU patients both domestically and internationally from December 2024 to March 2025. Review indicators were established and a baseline audit was conducted. Based on the i-PARIHS framework, barriers and facilitators were analyzed,and tailored change strategies and implementation plans were developed. We compared the compliance rates of review indicators,ICU nurses’knowledge,attitudes,and practices regarding ocular complication prevention, and the incidence of ocular complications before and after evidence implementation. Results Through evidence-based practice, a standardized procedure and measures for preventing ocular complications in prone-ventilated patients were established,leading to a significant improvement in the compliance rates of review indicators. ICU nurses’knowledge and practice levels increased markedly. The incidence of ocular complications in prone-ventilated patients decreased with the difference being statistically significant（all P<0.05）. Conclusion Evidence-based practice guided by the continuous quality improvement model can enhance nursing care quality and clinical outcomes for ocular complication prevention in prone-ventilated ICU patients. This approach demonstrates strong clinical applicability and promotion potential,offering a replicable framework for improving patient safety in critical care settings.