【摘要】 目的 基于肝癌患者肝动脉化疗栓塞术（TACE）围术期自控镇痛（PCA）管理的最佳证据开展循证实践，并评价其应用效果。方法 采用临床证据实践应用模式，根据最佳证据制订审查指标，进行基线审查，分析障碍因素，制订最佳临床决策，细化自控镇痛管理实施步骤，包括培训、监测、教育等，再进行2轮临床审查。比较证据应用前后审查中50名医护人员PCA管理的知信行水平和审查指标执行情况，159例患者疼痛评分及PCA使用不良反应发生率、满意度的变化。结果 通过循证实践方案实施、证据应用后，患者多时间点疼痛评分及不良反应发生率降低（P<0.05）、满意度提高（P<0.01），医护人员审查指标执行率提高（P<0.01）、PCA管理知信行水平显著提高（P<0.01）。结论 肝癌TACE患者围术期PCA管理循证实践，有助于降低患者围术期疼痛水平，改善患者不适感，提高患者满意度，提高了医护人员PCA管理和循证实践能力。更多还原

【Abstract】 Objective To evaluate the application of evidence-based perioperative patient-controlled analgesia(PCA) management in patients with liver cancer receiving transcatheter arterial chemoembolization(TACE)treatment.Methods By using the application model of clinical evidencebased practice,the review indicators were formulated based on the best evidence.The baseline assessment was conducted,the barrier factors were analyzed,the best clinical decision was made,the implementation steps of PCA management,including training,monitoring,education,etc.were refined,and two rounds of clinical review were carried out.The knowledge-belief-practice level and the implementation of review indicators in 50 medical and nursing staff engaged in PCA management,as well as the changes in pain scores,the incidence of adverse reactions due to PCA management,and the patient′s satisfaction in 159 patients after the application of evidence were compared with their corresponding values determined before the application of evidence.Results After implementing the evidence-based practice plan and applying the evidence,at multiple time points the pain scores and the incidences of adverse reactions were decreased significantly(P<0.05),the patient′s satisfaction increased remarkably(P <0.01),the execution rate of medical and nursing staff for the review indicators were strikingly increased(P<0.01),and the knowledge-belief-practice level concerning PCA management was prominently improved(P<0.01).Conclusion The implementation of perioperative PCA management in patients with liver cancer receiving TACE treatment can help to reduce the perioperative pain level,improve the patient discomfort,increase the patient′s satisfaction degree,and improve the ability of medical staff in performing PCA management and evidence-based practices.更多还原