基于指南的脑卒中患者吞咽困难识别与管理循证实践方案的构建

摘要

Objectives: To develop Evidence-based Clinical Practice Program for Identification and Management of Dysphagia in Stroke patients, and to ensure the implementation of clinical guidelines, and to promote the scientific, standardized and uniifed clinical identiifcation and management of dysphagia in stroke patients. Methods: In this study, we used the Iowa model of evidence-based practice as a guide, established a clinical problems, formed an evidence-based practice team, retrieval, screening and appraisal guidelines, maked review criteria, review methods, and completed the baseline review, according to the audit results and the guideline implementation barriers and promoting factors analysis results of the experimental unit, formulated the corresponding action strategy, and eventually developed appropriate clinical evidence-based practice plan. Results: This study included 5 guidelines, and the developed program includes an overview of stroke patients with dysphagia, early identiifcation and management of dysphagia, health education for patients, various processes, tools, etc. Conclusion: The developed program based on the evidence-based practice guidelines, combined with China's speciifc situation, intention and mechanism of clinical patient preferences and medical staff professional judgment, which can provide reference on identiifcation and management of dysphagia in stroke patients, and it is the premise and guarantee of evidence utilization.%目的：构建基于指南的脑卒中患者吞咽困难识别与管理的循证实践方案，以保证指南在临床的实施，促进临床脑卒中患者吞咽困难识别与管理的科学、规范与统一。方法：本研究以Iowa循证实践模式为指导，确立临床问题，成立循证实践团队，检索、筛选并评价指南，制定审查标准、审查方法，完成基线审查，根据审查结果分析试点病房指南实施的障碍因素及促进因素，制定相应的行动策略，将策略具体化，最终制定相应临床循证实践方案。结果：本研究共纳入5篇指南，构建的方案内容涉及脑卒中后吞咽困难概述、脑卒中后吞咽困难早期识别与管理相关知识、患者的健康教育、各种流程、工具等。结论：方案基于循证指南，结合我国机构具体临床情境、患者意愿和偏好以及医护人员的专业判断形成，可为临床脑卒中患者吞咽困难识别与管理提供参考，是证据在临床转化及应用的前提与保障。