重症患者低价值护理清单的构建及适用性分析

doi:10.3761/j.issn.2096-7446.2026.04.014

摘要/Abstract

摘要： 目的基于循证证据构建重症患者低价值护理清单，为重症患者低价值护理项目去实施化提供参考。方法系统检索中英文数据库及指南等相关网站，检索时限2015年1月1日—2025年3月1日，由2名研究者独立进行文献质量评价，提取文献中明确不推荐的护理条目并汇总，经2轮专家函询形成重症患者低价值护理清单。结果最终纳入文献26篇，其中指南10篇，证据总结1篇，专家共识15篇；2轮函询问卷有效回收率分别为88.89%和100%，专家权威系数为0.897、0.925，条目重要性的肯德尔和谐系数分别为0.247和0.394（P<0.05），最终形成60个低价值护理条目。结论基于循证证据构建的重症患者低价值护理清单，可指引重症护理人员在工作中减少实施相关项目，提升护理质量并避免资源浪费。

关键词: 重症患者, 低价值护理, 证据总结, 专家函询, 去实施化

Abstract:

Objective To construct a list of low-value care items for critically ill patients based on evidence-based evidence，so as to provide a reference for the de-implementation of low-value care items in critically ill patients. Methods Systematic searches were conducted in Chinese and English databases，and guidelines related websites，with the search time limit from January 1，2015，to March 1，2025. Two researchers independently performed quality evaluation，extracted and summarized the nursing items explicitly not recommended in the literature. A list of low-value items in critical care was formed through two rounds of expert consultation. Results A total of 26 literatures was included，including 10 guidelines，1 evidence summary，and 15 expert consensuses. The effective response rates of the two rounds of consultation questionnaires were 88.89% and 100%，respectively，with expert authority coefficients of 0.897 and 0.925. The Kendall’s concordance coefficients for item importance were 0.247 and 0.394（P < 0.05）. Finally，60 low-value care items were formed. Conclusion The list of low-value care items for critically ill patients constructed based on evidence-based evidence can guide critical care staff to reduce the implementation of related items in their work，improve nursing quality，and avoid resource waste.

Key words: Critically Ill Patients, Low-Value Care, Summary of the Evidence, Delphi Technique, De-Implementation

王朝平, 袁薇薇, 陈俊希, 辜甜田, 袁晓丽. 重症患者低价值护理清单的构建及适用性分析[J]. 中华急危重症护理杂志, 2026, 7(4): 462-468.

WANG Chaoping, YUAN Weiwei, CHEN Junxi, GU Tiantian, YUAN Xiaoli. Construction and applicability analysis of low-value care lists for critically ill patients[J]. Chinese Journal of Emergency and Critical Care Nursing, 2026, 7(4): 462-468.

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