【摘要】目的对自体动静脉内瘘血栓(autogenous arteriovenous fistula thrombus,AVFT)集束化护理策略进行优化，以期提高医护人员临床依从性，降低AVFT 发生率，提高患者“带瘘生存”的生活质量。方法邀请10 名不同领域的临床经验丰富的专家对多准则决策分析法(multi-criteria decision analysis,MCDA)的每项准则及筛选出的高质量证据赋予相应的权重和分值，根据最终评分排序形成AVFT 集束化护理策略的推荐意见。结果适合纳入AVFT 集束化护理策略的推荐意见及相应得分：指导患者自我管理(1482.56 分)，个性化预防低血压(1478.52 分)，精细化远红外线照射(1435.35 分)，系统化规划穿刺点(1397.86 分)，个性化超声检测(1368.11 分)，通路内动脉压监测(1325.79 分)。结论AVFT 集束化护理措施优化后还需经过临床应用检验其使用效果，并在应用过程中不断完善和优化，以期推广后降低广大透析患者AVFT的发生率,提高患者的生活质量。
【Abstract】Objective To optimize the clustered nursing strategy for patients with autologous arteriovenous fistula thrombus (AVFT) so as to improve clinical compliance with medical workers, reduce the incidence of AVFT, and increase the quality of life in patients with the fistulas. Methods We invited 10 clinically experienced experts from different fields to score every criterion and to screen out high-quality evidences in the multi-criteria decision analysis (MCDA), and thus to form the recommendations to clustered nursing strategy for AVFT based on the final rank of scoring. Results The recommended opinions suitably contained in the clustered nursing strategy for AVFT and their corresponding scores were as follows: guiding patient self-management
(1482.56), personalized prevention of low blood pressure (1478.52), fine regulation of far- infrared exposure (1435.35), systematic planning puncture points (1397.86), personalized ultrasound examinations (1368.11), and intra- path arterial pressure monitoring (1325.79). Conclusion After optimization, the clustered nursing strategy for AVFT needs to be refined and upgraded and its effects should be further inspected during clinical applications, so as to reduce the incidence of AVFT and promote the quality of life in hemodialysis patients with fistulas.
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