经皮冠状动脉介入术围术期护理质量敏感性指标的构建

doi:10.16138/j.1673-6087.2025.06.07

摘要/Abstract

摘要：

目的：构建一套科学合理的经皮冠状动脉介入术（percutaneous coronary intervention, PCI）围术期护理质量敏感性指标。 方法：检索国内外文献，采用约翰霍普金斯循证护理方法对文献和证据等级进行评价，并筛选、整合指标，形成PCI围术期护理质量敏感性指标条目池。基于Donabedian三维质量模型的理论依据，采用德尔菲法进行专家函询，构建PCI围术期护理质量敏感性指标。 结果： 2轮专家函询问卷回收率均为100%。专家权威系数均为0.889。总体肯德尔和谐系数分别为0.496和0.523（P<0.001）。最终构建的PCI围术期护理质量敏感性指标体系包含一级指标3项、二级指标13项、三级指标36项。 结论： PCI围术期护理质量敏感性指标涵盖人力资源、管理制度、专科培训、护理服务能力、药品和设施管理、健康教育、术前-术中-术后管理以及患者满意度、不良事件发生率、护理效率与延续性护理等多个维度。该指标体系可全面衡量PCI围术期护理质量，对提升PCI围术期护理服务整体水平具有显著推动作用。

关键词: 经皮冠状动脉介入治疗, 围术期, 护理质量, 质量评价, 敏感性指标

Abstract:

Objective To develop a scientifically reasonable set of sensitivity indicators for perioperative nursing quality in percutaneous coronary intervention (PCI). Methods Domestic and international literature was retrieved, and the Johns Hopkins evidence-based nursing practice model was employed to appraise the literature and grade the evidence. Indicators were screened and integrated to form a preliminary pool of sensitivity indicators for PCI perioperative nursing quality. Based on the theoretical basis of the Donabedian three-dimensional quality model, the Delphi method was utilized for expert consultation to construct the final indicator set. Results The response rates for both rounds of the expert consultation were 100%. The expert authority coefficients were both 0.889. The overall Kendall’ s coefficient of concordance were 0.496 and 0.523, respectively (P < 0.001). The final set of PCI perioperative nursing quality sensitivity indicators comprises 3 first-level, 13 second-level and 36 third-level indicators.Conclusions The developed sensitivity indicators for PCI perioperative nursing quality encompass multiple dimensions, including human resources, management systems, medical specialty training, nursing competency, medication and facility management, health education, preoperative/intraoperative/postoperative management, patient satisfaction, incidence of adverse events, nursing efficiency, and continuity of care. This indicator system can comprehensively measure PCI perioperative nursing quality and serves as a valuable tool for improving the overall standard of PCI perioperative nursing services.

Key words: Percutaneous coronary intervention, Perioperative period, Nursing quality, Quality evaluation, Sensitivity indicators

中图分类号:

R540.5

吴圣佳, 黄锶朝, 康磊, 朱唯一, 查庆华, 倪雪萍. 经皮冠状动脉介入术围术期护理质量敏感性指标的构建[J]. 内科理论与实践, 2025, 20(06): 469-476.

WU Shengjia, HUANG Sichao, KANG Lei, ZHU Weiyi, ZHA Qinghua, NI Xueping. Construction of sensitivity indicators for perioperative nursing quality in percutaneous coronary intervention[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(06): 469-476.

图/表 4

表1

表2

表3

表4

经皮冠状动脉介入围术期护理质量敏感性指标($ \stackrel{-}{x} $±s)

一级指标	二级指标	三级指标	重要性（分）
Ⅰ结构指标	Ⅰ-1人力资源	Ⅰ-1-1病区护患比例	4.906±0.225
		Ⅰ-1-2不同年资层次护理人员占比	4.889±0.345
		Ⅰ-1-3不同职称层次护理人员占比	4.904±0.221
	Ⅰ-2管理制度	Ⅰ-2-1核心制度与护理规范掌握率	4.912±0.314
		Ⅰ-2-2护理不良事件处理流程掌握率	4.869±0.479
	Ⅰ-3专科培训	Ⅰ-3-1 PCI相关专科知识掌握率	4.696±0.252
		Ⅰ-3-2专科操作掌握率	4.852±0.233
	Ⅰ-4护理服务能力	Ⅰ-4-1 24 h平均护理时数	4.711±0.227
	Ⅰ-5药品和设施管理	Ⅰ-5-1抢救设备完备率	4.816±0.232
		Ⅰ-5-2监护设备完备率	4.771±0.233
		Ⅰ-5-3药品管理合格率	4.867±0.224
Ⅱ过程指标	Ⅱ-1健康教育	Ⅱ-1-1患者PCI相关健康宣教知晓率	4.956±0.515
	Ⅱ-2专科护理	Ⅱ-2-1 PCI术转运交接正确率	4.956±0.613
	Ⅱ-3术前管理	Ⅱ-3-1术前血管通路准备完成率	4.800±0.513
		Ⅱ-3-2术前检查完善率	4.800±0.513
		Ⅱ-3-3术前胃肠道准备完成率	4.985±0.546
		Ⅱ-3-4术前出血风险评估完成率	4.951±0.505
		Ⅱ-3-5术前桡尺动脉情况评估完成率	4.949±0.519
		Ⅱ-3-6术前急性肾损伤风险评估完成率	4.962±0.611
		Ⅱ-3-8术前双联抗血小板药物给药执行率	5.000±0.000
	Ⅱ-4术中管理	Ⅱ-4-1术中抗凝给药准确率	4.912±0.225
		Ⅱ-4-2术中低体温发生率	4.962±0.214
		Ⅱ-4-3术中血流动力监测合格率	4.824±0.416
		Ⅱ-4-4术中生命体征评估合格率	4.870±0.201
	Ⅱ-5术后管理	Ⅱ-5-1 PCI术后水化落实率	4.900±0.511
		Ⅱ-5-2水化后尿量监测完成率	4.886±0.509
		Ⅱ-5-3术后穿刺部位加压包扎与减压正确率	4.909±0.484
		Ⅱ-5-4运动康复前评估正确率	4.563±0.513
		Ⅱ-5-5术后心脏康复运动执行率	4.952±0.413
		Ⅱ-5-6术后血压监测完成率	4.600±0.496
Ⅲ结果指标	Ⅲ-1患者满意	Ⅲ-1-1患者对护理服务满意度	4.961±0.226
	Ⅲ-2不良事件发生率	Ⅲ-2-1 PCI术后血肿率	4.553±0.503
		Ⅲ-2-2 PCI术后碘造影剂肾病的发生率	4.651±0.484
	Ⅲ-3护理效率及出院延续性护理	Ⅲ-3-1 PCI术患者出院指导合格率	4.953±0.225
		Ⅲ-3-3 PCI术患者出院后准时复查率	4.889±0.343
		Ⅲ-3-4 PCI术患者出院后电话随访率	4.749±0.551

表4

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纳入文献	文献主题	来源	发表时间（年）	文献类型	文献质量
ACC：美国心脏病学会（American College of Cardiology）；AHA：美国心脏协会（American Heart Association）；SCAI：心血管造影与介入学会（Society for Cardiovascular Angiography and Intervention）；ARC-HBR：高出血风险学术研究联合会（Academic Research Consortium for High Bleeding Risk）。
郝云霞等^[5]	急诊PCI治疗护理实践指南的构建	中国知网	2019	指南	ⅣA
Lawton等^[6]	2021年 ACC/AHA/SCAI 冠状动脉血运重建指南	PubMed	2023	指南	ⅣA
中华医学会心血管病学分会介入心脏病学组^[7]	中国经皮冠状动脉介入治疗指南(2016)	中国知网	2016	指南	ⅣB
陆芸岚等^[8]	新冠肺炎疫情常态化防控下行急诊PCI治疗护理管理专家共识	中国知网	2023	专家共识	ⅤB
李宪伦等^[9]	PCI术后中西医结合心脏康复专家共识	中国知网	2022	专家共识	ⅤA
赵雪燕等^[10]	2019 ARC-HBR PCI治疗患者的高出血风险定义专家共识解读	中国知网	2019	专家共识	ⅤA
陈纪言等^[11]	PCI治疗术后运动康复专家共识	中国知网	2016	专家共识	ⅤB
中国介入心脏病学杂志^[12]	冠状动脉内斑块旋磨术护理中国专家共识	中国知网	2020	专家共识	ⅤA
武杰等^[13]	心血管介入碘对比剂使用管理护理专家共识	中国知网	2021	专家共识	ⅤA
赵连友等^[14]	PCI治疗术后血压管理中国专家共识	中国知网	2022	专家共识	ⅤB

组别	重要性
组别	评分	CV
一级指标	4.47～4.71	0.16～0.19
二级指标	3.65～4.82	0.09～0.17
三级指标	2.53～4.98	0.00～0.17

组别	重要性
组别	评分	CV
一级指标	4.53～4.77	0.14～0.17
二级指标	4.48～4.85	0.12～0.19
三级指标	3.23～4.98	0.00～0.19