杂交手术室治疗颅内动脉瘤围术期的循证护理标准化流程的构建与应用 [中文引用][英文引用]

目的  构建杂交手术室（hybrid operating room ，HOR）治疗颅内动脉瘤围术期的循证护理标准化流程（evidencebased nursing standardized process，EBNSP）并评价其应用效果。方法  基于澳大利亚乔安娜布里格斯研究所（Joanna BriggsInstitute，JBI）循证卫生保健模式，系统检索数据库，经文献筛选、质量评价整合证据；通过德尔菲专家函询形成方案；采用非同期对照设计，选取 2024 年 1 月— 6 月江西某三级甲等医院神经外科在 HOR 行颅内动脉瘤治疗的 43 例患者作为研究组，采用EBNSP，回顾性选取 2023 年 7 月— 12 月该院神经外科的 43 例行常规护理流程的同类患者作为对照组。比较两组手术时间、不良事件及外科医师满意度。结果  构建的 EBNSP 包含 3 项一级条目，即术前管理（以颅内动脉瘤杂交手术风险前置管控为核心，搭建多学科术前风控一体化准备体系）、术中管理（聚焦双模式切换难点，规范监测体温、分区配合、感控及管路皮肤一体化管理）和术后管理（聚焦双创面评估、器械闭环清点、设备自检及多学科交接，构建术后护理安全闭环管控），共 16 项二级条目、48 项三级条目；研究组患者手术通知至患者入室、入室到麻醉完成时间以及开台到穿刺或切皮耗时方面均短于对照组，研究组患者不良事件发生率低于对照组，研究组外科医生满意度高于对照组，两组比较，差异具有统计学意义（均 P<0.05）。结论  构建的治疗杂交手术室治疗颅内动脉瘤围术期 EBNSP 贴合临床实际，紧扣杂交手术室颅内动脉瘤杂交手术专科特点，融入多学科分区协作、风险前置管控与信息化物资管理，可提升手术室护理效率，降低围术期风险，并提升外科医生满意度。

Objective To establish a standardised evidence?based nursing procedure（SEBNP）for perioperative patients undergoing intracranial aneurysm surgery in a hybrid operating room（HOR），and to evaluate its effectiveness. Methods Based on an evidence?based healthcare model of Joanna Briggs Institute（JBI），relevant evidence about this kind of operation was systematically retrieved，screened，quality-assessed and synthesised. A preliminary process was developed and finalised after three rounds of Delphi expert consultation. A non?concurrent controlled study was then conducted. A total of 43 patients who underwent intracranial aneurysm surgery in the HOR of the Department of Neurosurgery of a tertiary general hospital in Jiangxi Province between January and June 2024 were recruited as the study group with SEBNP. Another 43 same patients in the same department between July and December 2023 were retrospectively selected as the control group with routine nursing care. The two groups were compared in terms of operation duration， incidence of adverse events and surgeons’satisfaction. Results The established SEBNP consisted of 3 phase-based components （preoperative，intraoperative and postoperative），encompassing 16 dimensions and 48 items in total. The 3 phase-based components were:（1）the preoperative management-included the establishment of an integrated multidisciplinary preoperative risk control system focusing on proactive risk management in hybrid surgery for intracranial aneurysms.（2）the intraoperative management-focused on the challenges of dual?mode switching to standardise integrated management in temperature monitoring，team coordination，infection control and tube/skin care.（3）the postoperative management-established a closed-loop safety control system for postoperative nursing by focusing on dual-wound assessment，closed-loop instrument count，equipment self-check and multidisciplinary handover. The study group demonstrated significantly shorter time from surgical notice to patient's entering into the operating room，significantly shorter time from operating room admission to completion of anaesthesia and significantly shorter time from patient preparation to puncture or skin incision，as well as a significantly lower overall incidence of adverse event and significantly higher surgeons’satisfaction compared to those in the control group（all P<0.05）. Conclusion The EBNSP developed for perioperative patients undergoing intracranial aneurysm surgery in a hybrid operating room is clinically practical and tailored to the unique characteristics of hybrid surgery of the disease. With incorporation of multidisciplinary collaboration，proactive risk control and information?based material management，EBNSP can improve nursing efficiency in operating room，reduce perioperative risks and improve surgeons’satisfaction.