基于证据的持续质量改进模式在肿瘤患儿化疗所致恶心呕吐管理中的应用

doi:10.3969/j.issn.1006-9143.2025.05.005

天津护理 ›› 2025, Vol. 33 ›› Issue (5): 526-533.DOI: 10.3969/j.issn.1006-9143.2025.05.005

基于证据的持续质量改进模式在肿瘤患儿化疗所致恶心呕吐管理中的应用

杨玉云蔡瑞卿刘龙珍吴思莹管惠捷邓军

（中山大学肿瘤防治中心华南恶性肿瘤防治全国重点实验室广东省恶性肿瘤临床医学研究中心，广东广州 510060）

出版日期:2025-10-28 发布日期:2025-10-27
基金资助:
中山大学肿瘤防治中心循证护理实践改善项目

The application of evidence-based continuous quality improvement models in the management of chemotherapy-induced nausea and vomiting in pediatric oncology patients

YANG Yuyun, CAI Ruiqing, LIU Longzhen, WU Siying, GUAN Huijie, DENG Jun

(Sun Yat-sen University Cancer Center, Guangzhou Guangdong 510060)

Online:2025-10-28 Published:2025-10-27

摘要/Abstract

摘要： 目的：依据肿瘤患儿化疗所致恶心呕吐（CINV）症状管理的最佳证据进行临床持续质量改进。方法：以基于证据的持续质量改进模式为框架，于2024年3月至10月进行证据获取、现状审查、证据引入和效果评价。比较证据应用前后患儿急性和延迟性CINV 发生率和严重程度、各审查指标执行情况和医护人员CINV知信行评分。结果：证据应用后，患儿急性和延迟性 CINV 的发生率和严重程度均下降（P<0.05）；除审查指标11在2次审查中执行率比较差异无统计学意义外（P>0.05），其余审查指标均得到改善（P<0.05），且预防性止吐方案的指南依从性从 35.9%提升至 66.5%；证据应用前后医护人员CINV知信行评分比较差异有统计学意义（P<0.05）。结论：基于证据的持续质量改进模式能够降低肿瘤患儿CINV的发生率和严重程度，提升医护人员对儿童CINV管理最佳证据的知晓率和执行率，从而改善患儿的临床结局。

关键词: 肿瘤, 患儿, 化疗所致恶心呕吐, 持续质量改进, 循证护理

Abstract: Objective: To conduct continuous clinical quality improvement based on the best evidence for the management of chemotherapy-induced nausea and vomiting (CINV) in pediatric oncology patients. Methods: According to the implementation framework of the evidence-based continuous quality improvement model, we obtained the best evidence, conducted situation analysis, developed review indicators, analyzed barrier factors, constructed and implemented an evidence-based practice from March to October 2024. The incidence and severity of acute and delayed CINV, implementation of each review indicator, and the scores of healthcare providers' knowledge, attitude, and practice regarding CINV before and after the application of the evidence for CINV in pediatric oncology patients were compared. Results: The incidence and severity of both acute and delayed CINV decreased significantly (P<0.05). Except for review indicator 11, which showed no significant difference in two reviews (P>0.05), the remaining review indicators were significantly improved (P<0.05). The guideline compliance rate of antiemetic regimens increased from 35.9% to 66.5%. The healthcare providers' CINV knowledge, attitude, and practice score increased with statistically significant differences before and after the intervention (P<0.05). Conclusion: The evidence-based continuous quality improvement model can effectively reduce the incidence and severity of CINV, improve the awareness and implementation rates of healthcare providers regarding the best evidence for the management of CINV, and thus improve the clinical outcomes of pediatric patients.

Key words: Oncology, Pediatric patients, Chemotherapy-induced nausea and vomiting, Continued quality improvement, Evidence-based nursing

杨玉云蔡瑞卿刘龙珍吴思莹管惠捷邓军. 基于证据的持续质量改进模式在肿瘤患儿化疗所致恶心呕吐管理中的应用[J]. 天津护理, 2025, 33(5): 526-533.

YANG Yuyun, CAI Ruiqing, LIU Longzhen, WU Siying, GUAN Huijie, DENG Jun. The application of evidence-based continuous quality improvement models in the management of chemotherapy-induced nausea and vomiting in pediatric oncology patients[J]. Tianjin Journal of Nursing, 2025, 33(5): 526-533.

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基于证据的持续质量改进模式在肿瘤患儿化疗所致恶心呕吐管理中的应用

The application of evidence-based continuous quality improvement models in the management of chemotherapy-induced nausea and vomiting in pediatric oncology patients

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