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护理学报 ›› 2021, Vol. 28 ›› Issue (21): 41-46.doi: 10.16460/j.issn1008-9969.2021.21.041

• 循证护理 • 上一篇    下一篇

基于循证构建介入诊疗医务人员辐射防护规范

韦清1a, 柏晓玲2, 逄锦1b, 张家兴1c, 楼婷1b, 梁青龙1d, 杨曾桢1b   

  1. 1.贵州省人民医院 a.急诊科;b.护理部;c.药剂科;d.心导管室,贵州 贵阳550002;
    2.贵州护理职业技术学院,贵州 贵定550025
  • 收稿日期:2021-07-15 出版日期:2021-11-10 发布日期:2021-12-13
  • 通讯作者: 柏晓玲（1977-）,女,四川达川人,博士,主任护师,副院长。E-mail:baixiaoling2003@163.com
  • 作者简介:韦清（1993-）,女,贵州清镇人,硕士,护师。
  • 基金资助:
    贵州省卫生健康委科学技术基金（gzwjkj2019-1-017）

TEvidence-based Radiation Protection Standard of Medical Staff in Interventional Diagnosis and Treatment

WEI Qing1a, BAI Xiao-ling2, PANG Jin1b, ZHANG Jia-xing1c, LOU Ting1b, LIANG Qing-long1d, YANG Zeng-zhen1b   

  1. 1a. Dept. of Emergency; 1b.Dept. of Nursing Administration; 1c. Dept. of Pharmacy; 1d. Dept. of Cardiac Catheterization Room, Guizhou Provincial People's Hospital, Guiyang 550002, China;
    2. Guizhou Nursing Vocational College, Guiding 550025, China
  • Received:2021-07-15 Online:2021-11-10 Published:2021-12-13

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摘要： 目的 基于循证构建介入诊疗医务人员辐射防护规范,为临床介入诊疗医务人员合理选择和维护辐射防护用具提供参考依据。方法 以JBI循证卫生保健模式为框架,通过文献检索、质量评价、专家咨询构建介入诊疗医务人员辐射防护规范。结果 2轮专家咨询积极系数、权威系数较高,专家意见一致性较好,经2轮专家咨询确立了包括介入诊疗医务人员在诊疗过程中应选用合适的辐射防护用具,医疗机构应为介入诊疗医务人员提供相应的辅助辐射防护设备,辐射防护用具的放置、清洁及消毒要求,辐射防护用具的检测要求共4个维度、31个条目的规范。结论 介入诊疗医务人员辐射防护规范根据最佳证据、临床情境、专业人员判断而确立,具有较好的科学性和现实意义,为避免其盲目选择和维护辐射防护用具提供借鉴,规范介入诊疗医务人员辐射防护行为。

关键词: 介入诊疗, 医务人员, 辐射防护, 规范, 循证, 专家咨询

Abstract: Objective To construct evidence-based radiation protection standard for medical staff in interventional diagnosis and treatment,and to provide reference for medical staff to rationally choose and maintain radiation protection equipment. Methods Based on the JBI model of evidence-based healthcare, the radiation protection standard for medical staff in interventional diagnosis and treatment were constructed through literature review, quality evaluation and expert consultation. Results Expert consultation positive coefficient, higher authority coefficient and expert opinion consistency in the two-round expert consultation were good. After two rounds of expert consultation, the final standard consisted of 31 items grouped into 4 dimensions including available appropriate radiation protection appliance in the process of diagnosis and treatment, corresponding auxiliary radiation protection equipment, the placement cleaning and disinfection of radiation protection equipment, and the detection of radiation protection equipment. Conclusion The radiation protection standard for medical staff in interventional diagnosis and treatment is formed according to the best evidence, clinical situation and professional judgment and it has good scientific and practical significance, which provides reference for regulating the radiation protection behavior of medical staff in interventional diagnosis and treatment.

Key words: interventional diagnosis and treatment, medical worker, radiation protection, standard, evidence-based, Delphi expert consultation

中图分类号: 

  • R473.6
[1] Valgimigli M, Gagnor A, Calabro P, et al.Radial Versus Femoral Access in Patients with Acute Coronary Syndromes Undergoing Invasive Management:A Randomised Multicentre Trial[J].Lancet, 2015, 385(9986):2465-2476. DOI:10.1016/S0140-6736(15)60292-6.
[2] Andreassi M, Piccaluga E, Guagliumi G, et al.Occupational Health Risks in Cardiac Catheterzation Laboratory Workers[J]. Circ Cardiovasc Interv, 2016,9(4):32-73.DOI:10.1161/CIRCINTERVENTIONS.115.003273.
[3] Bang HS, Choi MH, Kim CS, et al.Gene Expression Profiling in Undifferentiated Thyroid Carcinoma Induced by High-dose Radiation[J].J Radiat Res,2016,57(3):238-249.DOI:10.1093/jrr/rrw002.
[4] Leuraud K, Richardson DB, Cardis E,et al.Ionising Radiation and Risk of Death from Leukaemia and Lymphoma in Radiation-monitored Workers (INWORKS): An International Cohort Study[J]. Lancet Haematol,2015,2(7):276-281.DOI:10.1016/S2352-3026(15)00094-0.
[5] 覃志英,唐孟俭,韦宏旷,等.2016年广西51家医院介入放射工作人员辐射防护现状调查结果分析[J].应用预防医学,2017, 23(5):404-406.DOI:10.3969/j.issn.1673-758X.2017.05.017.
[6] 陈秀梅,张容,赖敏华,等.三级医院介入放射防护能力及个人防护现状调查[J].介入放射学杂志,2017,26(2):176-179.DOI:10.3969/j.issn.1008-794X.2017.02.019.
[7] Miller DL, Vano E, Bartal G, et al.Occupational Radiation Protection in Interventional Radiology:A Joint Guideline of the Cardiovascular and Interventional Radiology Society of Europe and the Society of Interventional Radiology[J]. Cardiovasc Intervent Radiol,2010,33(2):230-239.DOI:10.1016/j.jvir.2014.11.026.
[8] 国家卫生和计划生育委员会. GBZ130-2013医用X射线诊断放射防护要求[S].北京:中国标准出版社,2013.
[9] López PO, Dauer LT, Loose R, et al.ICRP Publication 139: Occupational Radiological Protection in Interventional Procedures[M].Washington DC:SAGE Publications,2018.DOI:10.1177/0146645317750356.
[10] 杜世正, Gawlinski A, Rutledge D.循证护理实践模式及应用启示[J]. 护理学杂志, 2016,31(2):87-91.DOI:10.3870/j.issn.1001-4152.2017.03.081.
[11] 韦清,柏晓玲,罗忠琛,等.贵阳市介入诊疗医务人员辐射防护用具使用现状及分析[J].介入放射学杂志,2020,29(4):61-64.DOI:10.3969/j.issn.1008-794X.2020.04.013.
[12] 王春青,胡雁.JBI 证据预分级及证据推荐级别系统(2014 版)[J].护士进修杂志, 2015, 30(11):964-967. DOI:10.16821/ j.cnki.hsjx.2015.11.002.
[13] 詹昱新,杨中善,李素云,等. 基于循证构建住院患者肠内营养护理质量评价指标体系[J]. 护理学报, 2019,26(10):26-31.DOI:10.16460/j.issn1008-9969.2019.10.026.
[14] 郑钧正. 放射诊疗防护始终是国际放射防护领域新进展的重点[J].中国职业医学, 2019,46(5):537-541.DOI:10.11763/j.issn.2095-2619.2019.05.003.
[15] ICRP. Radiological Protection in Cardiology.ICRP Publication 120[R].Ann ICRP,2013,42(1):1-125.DOI:10.1016/j.icrp.2012.09.001.
[16] Christopoulos G,Makke L,Kotsia A,et al.Optimizing Radiation Safety in the Cardiac Catheterization Laboratory: A Practical Approach[J]. Catheter Cardiovasc Interv,2016,87(2):291-301.DOI:10.1002/ccd.25959.
[17] Tavares JB, Sacadura-Leite E, Matoso T, et al.The Importance of Protection Glasses During Neuroangiographies: A Study on Radiation Exposure at the Lens of the Primary Operator[J]. Interv Neuroradiol, 2016,22(3):368-371.DOI:10.1177/1591019916628322.
[18] Honorio DSE, Vanhavere F, Struelens L, et al.Effect of Protective Devices on the Radiation Dose Received by the Brains of Interventional Cardiologists[J]. EuroIntervention,2018,13(15):1778-1784.DOI:10.4244/EIJ-D-17-00759.
[19] 陈政,沈毓,陆清声.机器人辅助血管介入治疗研究进展[J]. 介入放射学杂志,2018,27(1):1-4.DOI:10.3969/j.issn.1008-794X.2018.01.001.
[20] 杨伟霞,张勤. 介入诊疗中心X射线防护用品的感染管理[J]. 现代医院,2015,15(9):113.DOI:10.3969/j.issn.1671-332X.2015.09.042.
[21] 陈露,袁聚祥,徐应军,等. 骨科手术铅衣消毒干预措施的研究[J]. 中国感染控制杂志, 2018(6):535-538.DOI:10.3969/j.issn.1671-9638.2018.06.015.
[22] 周英凤,胡雁,朱政,等. JBI循证卫生保健模式的更新及发展[J].护理学杂志,2017,32(3):81-83.DOI:10.3870/j.issn.1001-4152.2017.03.081.
[23] 沈莹. PCI术中护士有效辐射剂量的测量及DNA损伤研究[D].吉林:吉林大学, 2016.
[24] 刘霓. 介入手术工作人员对辐射危害认知程度及其防护行为调查研究[J].预防医学情报杂志, 2017(8):823-826.
[25] Feierabend S, Siegel G.Potential Infection Risk from Thyroid Radiation Protection[J]. J Orthop Trauma, 2015,29(1):18-20.DOI:10.1097/BOT.0000000000000161.
[26] Kirkwood ML, Arbique GM, Guild JB, et al.Radiation Brain Dose to Vascular Surgeons During Fluoroscopically Guided Interventions Is not Effectively Reduced by Wearing Lead Equivalent Surgical Caps[J]. J Vasc Surg, 2018,68(2):567-571.DOI:10.1016/j.jvs.2017.12.054.
[27] Miller T R, Zhuo J, Jindal G, et al.The Efficacy of Shielding Systems for Reducing Operator Exposure during Neurointerventional Procedures: A Real-world Prospective Study[J]. Am J Neuroradiol,2017, 38(3):450-454.DOI:10.3174/ajnr.A5038.
[28] Kherad B, Jerichow T, Blaschke F, et al.Efficacy of RADPAD Protective Drape During Coronary Angiography[J]. Herz,2018,43(4):310-314.DOI:10.1007/s00059-017-4560-7.
[29] 程俊卿,吕明,马彦超,等.移动式介入治疗防护装置的效果评价[J].医疗装备,2016,29(20):39-40.DOI:10.3969/j.issn.1002-2376.2016.20.028.
[30] Vlastra W, Delewi R, Sjauw KD, et al.Efficacy of the RADPAD Protection Drape in Reducing Operators' Radiation Exposure in the Catheterization Laboratory: A Sham-controlled Randomized Trial[J]. Circ Cardiovasc Interv, 2017, 10(11):6-58. DOI:10.1161/CIRCINTERVENTIONS.117.006058.
[31] Grabowicz W, Domienik-Andrzejewska J, Masiarek K, et al.Effectiveness of Pelvic Lead Blanket to Reduce the Doses to Eye Lens and Hands of Interventional Cardiologists and Assistant Nurses[J].J Radiol Prot,2017,37(3):715-727.DOI:10.1088/1361-6498/aa7a70.
[32] 邹翼霜. 基于循证和德尔菲法构建成人危重患者院内转运规范的研究[D].杭州:浙江大学,2017.
[33] 刘晓,何桂娟,俞梦盈,等.基于循证方法和德尔菲专家咨询法构建老年护理院护理安全质量敏感性指标[J].护理研究,2017,31(29):3667-3671.DOI:10.3969/j.issn.1009-6493.2017.29.013.
[34] Dutt A,Tan M,Alagumalai S,et al.Development and Validation of the Ability in Behavior Assessment and Interventions for Teachers Using Delphi Technique and Rasch Analysis[J].J Autism Dev Disord, 2019,49(5):1976-1987.DOI:10.1007/s10803-019-03887-4.
[35] 孙晋洁,孙永强.基于德尔菲法和分层研究法的胃肠外科专科护理敏感监测指标的构建[J].护理学报,2018,25(18):30-33.DOI:10.16460/j.issn1008-9969.2018.18.030.
[36] Adragao PP, Cavaco D, Ferreira AM,et al.Safety and Long Term Outcomes of Catheter Ablation of Atrial Fibrillation Using Magnetic Navigation Versus Manual Conventional Ablation:A Propensity-score Analysis[J]. J Cardiovasc Electrophysiol,2016,27(1):11-16.DOI:10.1111/jce.12900.
[37] Weiss JP, May HT, Bair TL, et al.A Comparison of Remote Magnetic Irrigated Tip Ablation Versus Manual Catheter Irrigated Tip Catheter Ablation with and without Force Sensing Feedback[J]. J Cardiovasc Electrophysiol,2016,27(1):5-10.DOI:10.1111/jce.12901.
[38] 郝玉芳,王斗,晏利姣,等.近5年我国护理证据总结类论文的方法学质量分析[J].中国护理管理,2020, 20(4):501-505.DOI:10.3969/j.issn.1672-1756.2020.04.006.
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