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Article(id=1322936797784846921, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.11.006, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1754064000000, receivedDateStr=2025-08-02, revisedDate=1772899200000, revisedDateStr=2026-03-08, acceptedDate=null, acceptedDateStr=null, onlineDate=1793342311568, onlineDateStr=2026-10-30, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793342311568, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793342311568, creator=13701087609, updateTime=1793342311568, updator=13701087609, issue=Issue{id=1322936785516503921, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='11', pageStart='1809', pageEnd='2000', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793342308644, creator='13701087609', updateTime=1793343121351, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940194344796237, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940194344796238, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1849, endPage=1859, ext={EN=ArticleExt(id=1322936799835861578, articleId=1322936797784846921, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Construction of a multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage based on chain management theory, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To construct a multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage based on chain management theory.

Methods

The preliminary pathway was developed with chain management theory as the framework,combined with literature analysis and case review,and structured around hospitalization days.Two rounds of expert consultation were conducted using the Delphi method among 15 experts.Expert opinions were analyzed and integrated to form the final clinical nursing pathway.

Results

The effective response rates of the two rounds of expert consultation were both 100%.The authority coefficients of experts were 0.852 and 0.920.The Kendall's coefficients of concordance were 0.11 and 0.21(both P<0.05),respectively.The final clinical nursing pathway was organized into five phases:the first day of hospitalization,day 2 to preoperative day,day of cesarean section,postoperative days 1-3,and postoperative day 4 to discharge.Under this framework,there were 48 primary indicators and 196 secondary indicators.

Conclusions

The multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage constructed in this study based on chain management theory clarifies the core contents and collaborative processes of maternal and neonatal care during each perioperative stage,standardizes the multidisciplinary management of high-risk pregnant women,and has good scientific rigor and clinical application value.It could provide reference for relevant nursing practice.

, authors=Na WANG, Juanjuan NIU, Shuai TAO, authorsList=Na WANG, Juanjuan NIU, Shuai TAO, authorCompany=null, correspAuthors=Na WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322936812016120400, articleId=1322936797784846921, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=基于链式管理理论构建妊娠合并脑出血病人剖宫产围术期多学科护理路径, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

基于链式管理理论构建妊娠合并脑出血病人剖宫产围术期多学科护理路径。

方法

以链式管理理论为框架，结合文献分析与病例回顾，制定以住院时间为主线的妊娠合并脑出血病人剖宫产围术期多学科护理路径初稿。采用德尔菲法对15名专家进行2轮函询，分析和整合专家意见，形成最终临床护理路径。

结果

2轮专家函询问卷有效回收率均为100%，专家权威系数分别为0.852和0.920，肯德尔协调系数分别为0.11和0.21（均P<0.05）。最终临床护理路径以住院第1天、住院第2天至术前1 d、剖宫产手术日、术后1~3 d、术后4 d至出院日5个阶段为时间轴，共包括48项一级指标、196项二级指标。

结论

构建的基于链式管理理论的妊娠合并脑出血病人剖宫产围术期多学科护理路径，明确了围术期各阶段母婴护理的核心内容与协作流程，规范了高危孕产妇多学科管理路径，具有良好的科学性和临床应用价值，可为相关护理实践提供参考。

, authors=王娜, 牛娟娟, 陶帅, authorsList=王娜, 牛娟娟, 陶帅, authorCompany=null, correspAuthors=王娜, authorNote=null, correspAuthorsNote=
WANG Na, E-mail:
王娜，副主任护师，本科，E-mail：
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of perioperative chain management pathway for cesarean section in pregnant women with intracerebral hemorrhage, figureFileSmall=6jBBqG3pu66uN6ZuahFHvw==, figureFileBig=PIKfLImxrB3hZwSr675Krg==, tableContent=null), ArticleFig(id=1322936835516805749, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936797784846921, language=CN, label=图1, caption=妊娠合并脑出血病人剖宫产围术期链式管理路径框架, figureFileSmall=6jBBqG3pu66uN6ZuahFHvw==, figureFileBig=PIKfLImxrB3hZwSr675Krg==, tableContent=null), ArticleFig(id=1322936837995639414, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936797784846921, language=EN, label=Table 1, caption=

The multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage based on chain management theory

, figureFileSmall=null, figureFileBig=null, tableContent=
阶段一级指标二级指标重要性（分）变异系数
住院第1天评估5.00±0.000.00
病史收集5.00±0.000.00
现病史4.93±0.260.05
孕妇评估4.87±0.350.07
胎儿评估5.00±0.000.00
检验5.00±0.000.00
血常规+血型4.93±0.260.05
血生化4.93±0.260.05
凝血象及D-二聚体4.87±0.350.07
血栓弹力图5.00±0.000.00
动脉血气分析5.00±0.000.00
尿常规4.93±0.260.05
便常规5.00±0.000.00
检查5.00±0.000.00
头颅CT5.00±0.000.00
下肢静脉超声5.00±0.000.00
心电图4.73±0.590.13
头颅其他相关影像学检查4.93±0.260.05
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
控制血压治疗5.00±0.000.00
止血治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养5.00±0.000.00
处置4.87±0.520.11
吸氧4.87±0.350.07
多参数心电监护4.73±0.590.13
外周/中心静脉置管5.00±0.000.00
留置尿管5.00±0.000.00
留置胃管（必要时）4.87±0.350.07
留置引流管（必要时）5.00±0.000.00
护理5.00±0.000.00
护理级别4.67±0.720.16
绝对卧床4.87±0.350.07
记录出入量5.00±0.000.00
控制体温4.93±0.260.05
监测生命体征5.00±0.000.00
氧合指数4.93±0.260.05
管路护理5.00±0.000.00
预防压力性损伤4.53±0.830.18
预防跌倒/坠床4.73±0.590.13
监测血糖变化5.00±0.000.00
观察有无颅内压增高症状4.87±0.350.07
疾病并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作5.00±0.000.00
静脉血栓/栓塞5.00±0.000.00
胎儿宫内窘迫5.00±0.000.00
预防误吸5.00±0.000.00
健康教育5.00±0.000.00
入院须知5.00±0.000.00
安全教育5.00±0.000.00
疾病知识5.00±0.000.00
用药宣教4.93±0.260.05
饮食宣教4.93±0.260.05
康复护理5.00±0.000.00
良肢位摆放5.00±0.000.00
体位变换5.00±0.000.00
住院第2天至术前1 d评估5.00±0.000.00
现病史5.00±0.000.00
孕妇评估5.00±0.000.00
胎儿评估5.00±0.000.00
检验5.00±0.000.00
复查异常化验5.00±0.000.00
依病情需要5.00±0.000.00
检查5.00±0.000.00
复查头颅CT（必要时）4.87±0.350.07
经颅多普勒超声（transcranial doppler，TCD）检查（必要时）4.73±0.590.13
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
控制血压治疗5.00±0.000.00
止血治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养5.00±0.000.00
处置5.00±0.000.00
备皮（术前1 d）5.00±0.000.00
吸氧5.00±0.000.00
多参数心电监护5.00±0.000.00
外周/中心静脉置管5.00±0.000.00
多学科会诊5.00±0.000.00
需手术者转神经外科5.00±0.000.00
护理5.00±0.000.00
护理级别5.00±0.000.00
绝对卧床5.00±0.000.00
记录出入量4.87±0.350.07
控制体温4.93±0.260.05
监测生命体征4.87±0.350.07
氧合指数4.93±0.260.05
管路护理4.73±0.590.13
预防压力性损伤5.00±0.000.00
预防跌倒/坠床5.00±0.000.00
监测血糖变化5.00±0.000.00
监测有无颅内压增高症状5.00±0.000.00
疾病并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作5.00±0.000.00
静脉血栓/栓塞4.87±0.350.07
胎儿宫内窘迫5.00±0.000.00
预防误吸5.00±0.000.00
健康教育5.00±0.000.00
并发症宣教5.00±0.000.00
管路护理宣教5.00±0.000.00
术前宣教4.93±0.260.05
康复护理5.00±0.000.00
良肢位摆放4.87±0.350.07
体位变换5.00±0.000.00
剖宫产手术日评估5.00±0.000.00
现病史4.73±0.590.13
产妇评估4.67±0.620.13
胎儿评估5.00±0.000.00
检验5.00±0.000.00
复查异常化验5.00±0.000.00
依病情需要4.93±0.260.05
检查5.00±0.000.00
依病情需要4.93±0.260.05
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
缩宫素5.00±0.000.00
控制血压治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养5.00±0.000.00
处置5.00±0.000.00
吸氧5.00±0.000.00
多参数心电监护5.00±0.000.00
外周/中心静脉置管5.00±0.000.00
腹部加压沙袋6 h4.93±0.260.05
产妇护理5.00±0.000.00
护理级别5.00±0.000.00
绝对卧床5.00±0.000.00
记录出入量4.80±0.410.09
控制体温5.00±0.000.00
监测生命体征5.00±0.000.00
氧合指数5.00±0.000.00
管路护理4.93±0.260.05
预防压力性损伤4.93±0.260.05
预防跌倒/坠床5.00±0.000.00
监测血糖变化4.87±0.350.07
监测有无颅内压增高症状5.00±0.000.00
乳房护理5.00±0.000.00
皮肤接触（病情允许时）5.00±0.000.00
新生儿护理5.00±0.000.00
一般情况5.00±0.000.00
新生儿窒息监测5.00±0.000.00
血糖监测4.93±0.260.05
用药/治疗5.00±0.000.00
新生儿疫苗接种5.00±0.000.00
维生素K1肌内注射5.00±0.000.00
脐部护理5.00±0.000.00
油浴5.00±0.000.00
疾病并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作4.87±0.350.07
静脉血栓/栓塞4.87±0.350.07
产后出血4.87±0.350.07
产褥感染5.00±0.000.00
健康教育5.00±0.000.00
饮食宣教4.93±0.260.05
术后卧位宣教5.00±0.000.00
术后活动宣教5.00±0.000.00
产科用药宣教5.00±0.000.00
母乳喂养及三早宣教5.00±0.000.00
康复护理5.00±0.000.00
体位变换5.00±0.000.00
术后1~3 d评估5.00±0.000.00
现病史5.00±0.000.00
产妇评估4.93±0.260.05
检验5.00±0.000.00
血常规4.87±0.350.07
凝血象及D-二聚体4.87±0.350.07
血生化4.87±0.350.07
动脉血气分析（必要时）4.73±0.590.13
尿常规4.53±0.640.14
检查5.00±0.000.00
依病情需要4.87±0.350.07
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
缩宫素5.00±0.000.00
控制血压治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养4.93±0.260.05
处置5.00±0.000.00
吸氧4.93±0.260.05
多参数心电监护5.00±0.000.00
外周/中心静脉置管5.00±0.000.00
腹部切口换药4.93±0.260.05
产妇护理5.00±0.000.00
护理级别5.00±0.000.00
绝对卧床5.00±0.000.00
记录出入量4.93±0.260.05
控制体温5.00±0.000.00
监测生命体征5.00±0.000.00
氧合指数5.00±0.000.00
管路护理4.87±0.350.07
预防压力性损伤5.00±0.000.00
预防跌倒/坠床4.93±0.260.05
监测血糖变化4.73±0.460.10
监测有无颅内压增高症状5.00±0.000.00
会阴擦洗5.00±0.000.00
乳房护理5.00±0.000.00
母乳喂养（病情允许时）5.00±0.000.00
新生儿护理4.93±0.260.05
维生素K1肌内注射5.00±0.000.00
新生儿沐浴5.00±0.000.00
脐部护理5.00±0.000.00
抚触5.00±0.000.00
出入量计算4.73±0.460.10
经皮胆红素测量5.00±0.000.00
新生儿疾病筛查及听力筛查（出生后72 h)5.00±0.000.00
产妇并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作5.00±0.000.00
静脉血栓/栓塞4.93±0.260.05
产后出血5.00±0.000.00
产褥感染4.87±0.350.07
健康教育5.00±0.000.00
产妇伤口护理宣教5.00±0.000.00
新生儿疫苗接种宣教5.00±0.000.00
新生儿疾病筛查、耳聋基因筛查宣教5.00±0.000.00
新生儿沐浴、抚触、脐部护理4.93±0.260.05
康复护理5.00±0.000.00
肢体/言语功能训练4.93±0.260.05
术后4 d至出院日评估5.00±0.000.00
现病史5.00±0.000.00
产妇评估4.93±0.260.05
检验5.00±0.000.00
依病情需要4.67±0.490.10
检查5.00±0.000.00
头颅CT(出院前复查）4.73±0.590.13
产妇护理5.00±0.000.00
护理级别4.67±0.620.13
监测生命体征4.87±0.350.07
监测有无颅内压增高症状5.00±0.000.00
乳房护理5.00±0.000.00
喂养指导5.00±0.000.00
健康教育5.00±0.000.00
出院宣教5.00±0.000.00
安全教育5.00±0.000.00
合并症随诊4.93±0.260.05
康复护理5.00±0.000.00
肢体/言语功能训练5.00±0.000.00
), ArticleFig(id=1322936838377321079, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936797784846921, language=CN, label=表1, caption=

基于链式管理理论的妊娠合并脑出血病人剖宫产围术期多学科护理路径

, figureFileSmall=null, figureFileBig=null, tableContent=
阶段一级指标二级指标重要性（分）变异系数
住院第1天评估5.00±0.000.00
病史收集5.00±0.000.00
现病史4.93±0.260.05
孕妇评估4.87±0.350.07
胎儿评估5.00±0.000.00
检验5.00±0.000.00
血常规+血型4.93±0.260.05
血生化4.93±0.260.05
凝血象及D-二聚体4.87±0.350.07
血栓弹力图5.00±0.000.00
动脉血气分析5.00±0.000.00
尿常规4.93±0.260.05
便常规5.00±0.000.00
检查5.00±0.000.00
头颅CT5.00±0.000.00
下肢静脉超声5.00±0.000.00
心电图4.73±0.590.13
头颅其他相关影像学检查4.93±0.260.05
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
控制血压治疗5.00±0.000.00
止血治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养5.00±0.000.00
处置4.87±0.520.11
吸氧4.87±0.350.07
多参数心电监护4.73±0.590.13
外周/中心静脉置管5.00±0.000.00
留置尿管5.00±0.000.00
留置胃管（必要时）4.87±0.350.07
留置引流管（必要时）5.00±0.000.00
护理5.00±0.000.00
护理级别4.67±0.720.16
绝对卧床4.87±0.350.07
记录出入量5.00±0.000.00
控制体温4.93±0.260.05
监测生命体征5.00±0.000.00
氧合指数4.93±0.260.05
管路护理5.00±0.000.00
预防压力性损伤4.53±0.830.18
预防跌倒/坠床4.73±0.590.13
监测血糖变化5.00±0.000.00
观察有无颅内压增高症状4.87±0.350.07
疾病并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作5.00±0.000.00
静脉血栓/栓塞5.00±0.000.00
胎儿宫内窘迫5.00±0.000.00
预防误吸5.00±0.000.00
健康教育5.00±0.000.00
入院须知5.00±0.000.00
安全教育5.00±0.000.00
疾病知识5.00±0.000.00
用药宣教4.93±0.260.05
饮食宣教4.93±0.260.05
康复护理5.00±0.000.00
良肢位摆放5.00±0.000.00
体位变换5.00±0.000.00
住院第2天至术前1 d评估5.00±0.000.00
现病史5.00±0.000.00
孕妇评估5.00±0.000.00
胎儿评估5.00±0.000.00
检验5.00±0.000.00
复查异常化验5.00±0.000.00
依病情需要5.00±0.000.00
检查5.00±0.000.00
复查头颅CT（必要时）4.87±0.350.07
经颅多普勒超声（transcranial doppler，TCD）检查（必要时）4.73±0.590.13
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
控制血压治疗5.00±0.000.00
止血治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养5.00±0.000.00
处置5.00±0.000.00
备皮（术前1 d）5.00±0.000.00
吸氧5.00±0.000.00
多参数心电监护5.00±0.000.00
外周/中心静脉置管5.00±0.000.00
多学科会诊5.00±0.000.00
需手术者转神经外科5.00±0.000.00
护理5.00±0.000.00
护理级别5.00±0.000.00
绝对卧床5.00±0.000.00
记录出入量4.87±0.350.07
控制体温4.93±0.260.05
监测生命体征4.87±0.350.07
氧合指数4.93±0.260.05
管路护理4.73±0.590.13
预防压力性损伤5.00±0.000.00
预防跌倒/坠床5.00±0.000.00
监测血糖变化5.00±0.000.00
监测有无颅内压增高症状5.00±0.000.00
疾病并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作5.00±0.000.00
静脉血栓/栓塞4.87±0.350.07
胎儿宫内窘迫5.00±0.000.00
预防误吸5.00±0.000.00
健康教育5.00±0.000.00
并发症宣教5.00±0.000.00
管路护理宣教5.00±0.000.00
术前宣教4.93±0.260.05
康复护理5.00±0.000.00
良肢位摆放4.87±0.350.07
体位变换5.00±0.000.00
剖宫产手术日评估5.00±0.000.00
现病史4.73±0.590.13
产妇评估4.67±0.620.13
胎儿评估5.00±0.000.00
检验5.00±0.000.00
复查异常化验5.00±0.000.00
依病情需要4.93±0.260.05
检查5.00±0.000.00
依病情需要4.93±0.260.05
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
缩宫素5.00±0.000.00
控制血压治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养5.00±0.000.00
处置5.00±0.000.00
吸氧5.00±0.000.00
多参数心电监护5.00±0.000.00
外周/中心静脉置管5.00±0.000.00
腹部加压沙袋6 h4.93±0.260.05
产妇护理5.00±0.000.00
护理级别5.00±0.000.00
绝对卧床5.00±0.000.00
记录出入量4.80±0.410.09
控制体温5.00±0.000.00
监测生命体征5.00±0.000.00
氧合指数5.00±0.000.00
管路护理4.93±0.260.05
预防压力性损伤4.93±0.260.05
预防跌倒/坠床5.00±0.000.00
监测血糖变化4.87±0.350.07
监测有无颅内压增高症状5.00±0.000.00
乳房护理5.00±0.000.00
皮肤接触（病情允许时）5.00±0.000.00
新生儿护理5.00±0.000.00
一般情况5.00±0.000.00
新生儿窒息监测5.00±0.000.00
血糖监测4.93±0.260.05
用药/治疗5.00±0.000.00
新生儿疫苗接种5.00±0.000.00
维生素K1肌内注射5.00±0.000.00
脐部护理5.00±0.000.00
油浴5.00±0.000.00
疾病并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作4.87±0.350.07
静脉血栓/栓塞4.87±0.350.07
产后出血4.87±0.350.07
产褥感染5.00±0.000.00
健康教育5.00±0.000.00
饮食宣教4.93±0.260.05
术后卧位宣教5.00±0.000.00
术后活动宣教5.00±0.000.00
产科用药宣教5.00±0.000.00
母乳喂养及三早宣教5.00±0.000.00
康复护理5.00±0.000.00
体位变换5.00±0.000.00
术后1~3 d评估5.00±0.000.00
现病史5.00±0.000.00
产妇评估4.93±0.260.05
检验5.00±0.000.00
血常规4.87±0.350.07
凝血象及D-二聚体4.87±0.350.07
血生化4.87±0.350.07
动脉血气分析（必要时）4.73±0.590.13
尿常规4.53±0.640.14
检查5.00±0.000.00
依病情需要4.87±0.350.07
药物治疗5.00±0.000.00
抗生素5.00±0.000.00
甘露醇5.00±0.000.00
缩宫素5.00±0.000.00
控制血压治疗5.00±0.000.00
营养5.00±0.000.00
肠内/肠外营养4.93±0.260.05
处置5.00±0.000.00
吸氧4.93±0.260.05
多参数心电监护5.00±0.000.00
外周/中心静脉置管5.00±0.000.00
腹部切口换药4.93±0.260.05
产妇护理5.00±0.000.00
护理级别5.00±0.000.00
绝对卧床5.00±0.000.00
记录出入量4.93±0.260.05
控制体温5.00±0.000.00
监测生命体征5.00±0.000.00
氧合指数5.00±0.000.00
管路护理4.87±0.350.07
预防压力性损伤5.00±0.000.00
预防跌倒/坠床4.93±0.260.05
监测血糖变化4.73±0.460.10
监测有无颅内压增高症状5.00±0.000.00
会阴擦洗5.00±0.000.00
乳房护理5.00±0.000.00
母乳喂养（病情允许时）5.00±0.000.00
新生儿护理4.93±0.260.05
维生素K1肌内注射5.00±0.000.00
新生儿沐浴5.00±0.000.00
脐部护理5.00±0.000.00
抚触5.00±0.000.00
出入量计算4.73±0.460.10
经皮胆红素测量5.00±0.000.00
新生儿疾病筛查及听力筛查（出生后72 h)5.00±0.000.00
产妇并发症预防5.00±0.000.00
脑疝5.00±0.000.00
癫痫发作5.00±0.000.00
静脉血栓/栓塞4.93±0.260.05
产后出血5.00±0.000.00
产褥感染4.87±0.350.07
健康教育5.00±0.000.00
产妇伤口护理宣教5.00±0.000.00
新生儿疫苗接种宣教5.00±0.000.00
新生儿疾病筛查、耳聋基因筛查宣教5.00±0.000.00
新生儿沐浴、抚触、脐部护理4.93±0.260.05
康复护理5.00±0.000.00
肢体/言语功能训练4.93±0.260.05
术后4 d至出院日评估5.00±0.000.00
现病史5.00±0.000.00
产妇评估4.93±0.260.05
检验5.00±0.000.00
依病情需要4.67±0.490.10
检查5.00±0.000.00
头颅CT(出院前复查）4.73±0.590.13
产妇护理5.00±0.000.00
护理级别4.67±0.620.13
监测生命体征4.87±0.350.07
监测有无颅内压增高症状5.00±0.000.00
乳房护理5.00±0.000.00
喂养指导5.00±0.000.00
健康教育5.00±0.000.00
出院宣教5.00±0.000.00
安全教育5.00±0.000.00
合并症随诊4.93±0.260.05
康复护理5.00±0.000.00
肢体/言语功能训练5.00±0.000.00
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基于链式管理理论构建妊娠合并脑出血病人剖宫产围术期多学科护理路径
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王娜 , 牛娟娟 , 陶帅
护理研究 | 科研论著 2026,40(11): 1849-1859
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护理研究 |科研论著 2026 , 40 (11) : 1849 -1859
基于链式管理理论构建妊娠合并脑出血病人剖宫产围术期多学科护理路径
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王娜 , 牛娟娟, 陶帅
作者信息
  • 1首都医科大学附属北京天坛医院，北京 100070
通讯作者:
WANG Na, E-mail:
王娜，副主任护师，本科，E-mail：
Construction of a multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage based on chain management theory
Na WANG , Juanjuan NIU, Shuai TAO
Affiliations
  • 1Beijing Tiantan Hospital, Capital Medical University, Beijing 100070 China
出版时间: 2026-06-10 doi: 10.12102/j.issn.1009-6493.2026.11.006
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摘要
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目的

基于链式管理理论构建妊娠合并脑出血病人剖宫产围术期多学科护理路径。

方法

以链式管理理论为框架，结合文献分析与病例回顾，制定以住院时间为主线的妊娠合并脑出血病人剖宫产围术期多学科护理路径初稿。采用德尔菲法对15名专家进行2轮函询，分析和整合专家意见，形成最终临床护理路径。

结果

2轮专家函询问卷有效回收率均为100%，专家权威系数分别为0.852和0.920，肯德尔协调系数分别为0.11和0.21（均P<0.05）。最终临床护理路径以住院第1天、住院第2天至术前1 d、剖宫产手术日、术后1~3 d、术后4 d至出院日5个阶段为时间轴，共包括48项一级指标、196项二级指标。

结论

构建的基于链式管理理论的妊娠合并脑出血病人剖宫产围术期多学科护理路径，明确了围术期各阶段母婴护理的核心内容与协作流程，规范了高危孕产妇多学科管理路径，具有良好的科学性和临床应用价值，可为相关护理实践提供参考。

链式管理理论  /  妊娠合并脑出血  /  临床护理路径  /  危重症孕产妇  /  护理  /  德尔菲法
Objective

To construct a multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage based on chain management theory.

Methods

The preliminary pathway was developed with chain management theory as the framework,combined with literature analysis and case review,and structured around hospitalization days.Two rounds of expert consultation were conducted using the Delphi method among 15 experts.Expert opinions were analyzed and integrated to form the final clinical nursing pathway.

Results

The effective response rates of the two rounds of expert consultation were both 100%.The authority coefficients of experts were 0.852 and 0.920.The Kendall's coefficients of concordance were 0.11 and 0.21(both P<0.05),respectively.The final clinical nursing pathway was organized into five phases:the first day of hospitalization,day 2 to preoperative day,day of cesarean section,postoperative days 1-3,and postoperative day 4 to discharge.Under this framework,there were 48 primary indicators and 196 secondary indicators.

Conclusions

The multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage constructed in this study based on chain management theory clarifies the core contents and collaborative processes of maternal and neonatal care during each perioperative stage,standardizes the multidisciplinary management of high-risk pregnant women,and has good scientific rigor and clinical application value.It could provide reference for relevant nursing practice.

chain management theory  /  pregnancy complicated with intracerebral hemorrhage  /  clinical nursing pathway  /  critically ill pregnant and postpartum women  /  nursing  /  Delphi method
王娜, 牛娟娟, 陶帅. 基于链式管理理论构建妊娠合并脑出血病人剖宫产围术期多学科护理路径. 护理研究, 2026 , 40 (11) : 1849 -1859 . DOI: 10.12102/j.issn.1009-6493.2026.11.006
Na WANG, Juanjuan NIU, Shuai TAO. Construction of a multidisciplinary perioperative nursing pathway for cesarean section in pregnant women with intracerebral hemorrhage based on chain management theory[J]. Chinese Nursing Research, 2026 , 40 (11) : 1849 -1859 . DOI: 10.12102/j.issn.1009-6493.2026.11.006
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妊娠合并脑出血（intracerebral hemorrhage，ICH）是一种严重威胁孕产妇生命安全的罕见并发症，其发生率为7.18/10万，是全球孕产妇致死率较高的疾病之一[1-2]。由于妊娠期特殊的生理变化以及脑出血进展迅速，母婴死亡率分别高达10%和20%[3]。这使得妊娠合并脑出血成为产科高危孕产妇救治与管理的重点及难点。近年来，随着孕产妇健康意识的提升及医疗筛查技术的进步，如何在护理管理方面实现进一步规范与优化，已成为临床关注的方向之一[4]。研究显示，妊娠合并脑出血病人需要神经科、产科、手术室/麻醉科、重症医学、儿科等多学科协作，通过及时、高效的联合处置制定科学的临床决策，从而保障高危孕产妇及新生儿围生期安全[5-6]。多学科团队（multidisciplinary team，MDT）护理管理模式能够促进各学科间的信息沟通与资源整合，提升护理质量与病人预后[7]。临床护理路径（clinical nursing pathway，CNP）作为病种专科标准化管理工具，有助于护士规范性、系统化地开展护理工作，提升疾病管理的科学性[8-9]。然而，关于妊娠合并脑出血的临床护理路径尚缺乏统一的规范，相关临床管理标准化指导仍有待进一步完善。链式管理理论基于事物发展全过程，将环环相扣、协同联动作为管理核心，强调管理的连续性与完整性。研究表明，该模式可有效提升病人的诊疗和护理质量[10-11]。我院作为北京市妊娠合并脑疾病救治中心，积累了丰富的救治与护理经验。基于链式管理理论，本研究通过文献回顾、病例分析及专家咨询，构建适用于妊娠合并脑出血剖宫产围术期的护理路径，旨在提升危重孕产妇的母婴护理整体水平，为相关临床实践与护理研究提供参考，现将研究结果报道如下。
1　资料与方法
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1.1　成立研究小组
为确保妊娠合并脑出血病人剖宫产围术期护理路径的科学性与可行性，本研究组建了多学科研究团队，共9名成员，包括产科主任医师2人、产房护士长1人、手术室护士长1人、神经重症监护室（NICU）护士长1人、护理学研究生2人及临床经验丰富的资深护士2人。产科主任医师主要负责课题整体设计与医学方向把控，统筹各专业协作；产房护士长负责梳理产科护理各环节并制定相关护理流程；手术室护士长负责手术期间护理流程的梳理与优化，确保围术期护理措施的规范与安全；神经重症监护室护士长负责危重症护理管理的指导与优化；护理学研究生承担文献检索和资料整理等基础工作；资深护士参与路径条目的完善及临床可行性评估。本研究已通过首都医科大学附属北京天坛医院伦理委员会审查（伦理批号：KY2023-288-02）。
1.2　拟定妊娠合并脑出血病人剖宫产围术期护理路径初稿
1.2.1　构建路径框架
依据链式管理理论，结合前期文献分析及专家意见，将妊娠合并脑出血病人剖宫产围术期护理管理划分为组织管理链及环节管理链2条主线。1）组织管理链：以多学科协作为基础，由妇产科、神经内科、神经重症医学科、儿科、手术室/麻醉科及相关支持科室协同参与，保证管理的连续性与系统性；2）环节管理链：以时间节点为主轴，将围术期流程划分为住院第1天、住院第2天至术前1 d、剖宫产手术日、术后1~3 d、术后4 d至出院日共5个阶段。各阶段重点包括疾病评估、护理干预、并发症预防、健康宣教及康复指导，有助于提升护理管理的规范性与连续性，详见图1。
1.2.2　路径初稿制订过程
1.2.2.1　文献回顾与资料收集
系统检索中国知网、万方数据库、PubMed等中英文数据库，查阅近5年国内外关于脑出血诊治指南、妊娠合并脑出血护理文献及国家临床路径相关文献[12-15]。检索关键词为“脑出血”“妊娠合并脑出血”“护理路径”等，检索时限为建库至2024年12月31日。同时结合本院2016—2023年69例妊娠合并脑出血病人的电子病历数据，对主要诊疗方法及护理措施进行归纳与整理。
1.2.2.2　路径初稿制订流程
依据帕累托最优理论，统计上述病例中各类医嘱的使用频率，纳入频率≥80%的医嘱项目，并结合病人平均住院时长，为护理路径条目及时间节点设定提供依据[16]。初步将护理路径时间节点定为入院第1天、第2天、手术日、术后1~3 d及出院日。经医护专家多轮小组讨论，最终形成包括50项一级指标、158项二级指标的路径初稿。
1.2.2.3　路径纳入与出路径标准
纳入标准：1）第一诊断为妊娠合并脑出血；2）合并无需特殊处理且不影响主要护理流程的其他疾病病人。排除需针对合并疾病进行特殊处理、影响妊娠合并脑出血护理流程推进者。出路径标准：1）病人病情经治疗趋于稳定；2）达到相关诊疗指南规定的治疗目标；3）住院天数符合路径时间节点要求。
1.2.2.4　路径构建结果
制定的护理路径初稿以5个时间节点为横轴，涵盖50项一级指标和158项二级指标，全面规范了妊娠合并脑出血剖宫产围术期护理流程，为后续专家咨询和路径优化奠定基础。
1.2.3　制定函询问卷
参考德尔菲专家函询流程，结合文献与课题实际需要，拟定妊娠合并脑出血病人剖宫产围术期护理路径专家咨询问卷。问卷内容包括4部分：1）说明部分，阐明研究背景、目的、意义及填写要求；2）专家基本信息，包括年龄、职务、专业领域、技术职称、工作年限等；3）专家判断依据及自评，涵盖对领域熟悉程度及判断的依据（如实践经验、理论基础或文献依据）；4）正文部分，采用Likert 5级评分法对每项条目合理性进行评分，“很不合理”至“非常合理”依次计1~5分，并留有开放性意见栏，供专家提出修改及补充建议。
1.3　德尔菲专家函询
1.3.1　遴选函询专家
采用目的抽样法，选取北京市妇幼管理体系指定的2所妊娠合并脑病救治中心，均为三级甲等综合医院。遴选多学科专家共15人，包括妇产科医疗专家3人、神经内科医疗专家3人、重症医学科护理专家2人、神经内科护理专家2人、妇产科护理专家5人，涵盖妊娠合并脑出血剖宫产围术期护理路径相关主要学科方向。专家纳入标准：1）具有中级及以上专业技术职称；2）本科及以上学历；3）从事相关专业10年以上，具备较强的理论与实践经验；4）长期参与妊娠合并脑出血等相关疾病诊治、护理及研究工作；5）自愿参加本研究，签署知情同意书。
1.3.2　实施专家函询
在征得专家知情同意的基础上，通过电子邮件及微信的形式发放、回收问卷，全程执行背对背原则，确保专家意见独立。第1轮函询问卷发放后，要求专家10 d内反馈。研究团队回收问卷后，综合专家意见对护理路径条目进行调整和完善。30 d后启动第2轮专家函询，对修订后的条目请专家再次评分。2轮函询后，专家意见基本一致，即终止函询。
1.4　统计学方法
所有资料由2名研究者独立核对录入Excel 2016软件，统计分析采用SPSS 25.0软件完成。定性资料以频数、构成比（%）描述；符合正态分布的定量资料以均数±标准差（x±s）表示。专家积极性以问卷回收率反映，权威性用专家权威系数（Cr）评价，意见协调性采用变异系数（CV）和肯德尔和谐系数（Kendall's W）进行衡量。条目筛选标准：重要性均分≥4.00分，变异系数≤0.20。以P<0.05为有统计学意义。
2　结果
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2.1　专家的一般资料
共邀请15名专家参与德尔菲法进行咨询，15名专家涵盖产科、神经内外科、重症医学、手术室及护理管理等领域。专家年龄37~54（43.8±5.1）岁；工作年限为13~34（21.0±7.3）年；博士研究生6人，本科9人；高级职称8人，中级职称7人。专家队伍结构合理，临床及管理经验丰富，具备代表性和权威性。
2.2　专家的积极程度
2轮问卷均发放15份问卷，回收15份，回收率均为100%。第1轮有12名专家提出修改意见，意见提出率为80.0%，共收到建议65条，采纳32条；第2轮有5名专家提出意见，提出率为33.3%，采纳6条。整体专家参与度和响应度较高。
2.3　专家权威程度
2轮专家权威系数分别为0.852和0.920，均>0.8，说明专家判断依据充分，对相关内容掌握度高，权威性较强。
2.4　专家意见协调程度
第1轮各条目重要性评分为4.53~5.00分，变异系数为0.00~0.22，肯德尔和谐系数为0.11（P<0.05）；第2轮条目重要性评分为4.53~5.00分，变异系数0.00~0.18，肯德尔和谐系数为0.21（P<0.05）。第2轮专家协调性较第1轮有所提高，显示专家意见趋于一致。
2.5　指标修改情况
2.5.1　第1轮专家咨询
删除指标重要性均分<4.00分或变异系数>0.20的7项。结合专家意见，对部分指标内容进行了调整，主要包括删除出院日护理路径中“药疗、膳食、处置、疾病并发症预防”等一级指标，对“疾病并发症预防”“孕产妇护理”“膳食”“检查”等二级指标及相关三级指标进行了修订；部分内容得以细化与归并，并补充增加“预防误吸”“凝血象及D-二聚体”“下肢深静脉超声”“产妇伤口护理宣教”“合并症随诊”“安全教育”“血糖监测”“术后卧位宣教”等内容，实现指标体系的完善和优化。
2.5.2　第2轮专家咨询
各指标重要性均分均≥4.00分，变异系数均≤0.20，全部予以保留。采纳专家意见，对个别条目进行了表述调整，如将“血气”补充为“动脉血气分析（必要时）”，“备皮”明确为“备皮（术前1 d）”，“降压治疗”统一为“控制血压治疗”。“康复护理”中专家建议增加“康复训练专科内容”，经讨论因与既有内容重复，未予采纳。
经2轮德尔菲法专家咨询，最终形成基于链式管理理论的妊娠合并脑出血病人剖宫产围术期多学科护理路径，包括48项一级指标、196项二级指标，详见表1。
3　讨论
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3.1　基于链式管理理论的妊娠合并脑出血病人剖宫产围术期多学科护理路径构建的科学性与可靠性
本研究在链式管理理论指导下，严格遵循循证指南、专家共识及临床实际需求，系统检索并分析了国内外相关文献，充分结合妊娠合并脑出血病人的特殊病理特征和多学科协作需求，科学制定出剖宫产围术期多学科链式护理路径初稿，夯实了理论与实践基础[17]。在路径设计过程中，注重参考以往研究成果和现行多学科管理模式，弥补国内相关护理路径以单学科为主、环节衔接不畅等局限，力求创新和完善[18]。路径构建过程中，采用德尔菲法进行2轮专家咨询，邀请了来自北京市妊娠合并脑病救治中心的专家，涵盖产科、神经内外科、重症医学、手术室及护理管理等领域。其中高级职称专家8人，确保了专家队伍的代表性与权威性。2轮专家问卷回收率均为100%；专家权威系数分别为0.852和0.920，均>0.8，表明咨询专家具备较高的权威性和可靠性。2轮肯德尔协调系数分别为0.11和0.21（均P<0.05），显示专家意见协调性可接受。在具体指标遴选和重要性评分中，一级和二级指标的均分高于4.8分，绝大多数指标变异系数低于0.10。在问卷函询过程中，第1轮中有12名专家提出65条意见，主要集中在评估节点细化、多学科职责明确以及高危预警措施完善等方面。研究团队积极采纳了其中32条建议，并对方案内容进行了修订。第2轮中仅有5名专家提出补充建议，采纳6条建议，专家对修订后的方案认可度较高。最终，经过专家反馈与优化，形成了内容科学、结构严谨、可操作性强的路径方案。
3.2　多学科链式护理路径的实用性及管理优势
高标准、流程化和可操作性的护理路径是保障危重孕产妇母婴安全、提升护理质量的关键[19-20]。依托链式管理理论，本研究将妊娠合并脑出血病人剖宫产围术期的护理工作细化为入院评估、术前准备、术中管理、术后管理及出院日5个阶段，融入多学科协作和关键管理指标。
3.2.1　入院评估阶段的多指标联合管理
入院后，多学科团队协同开展病情评估，包括全面收集病史、体征检查及辅助检查（如血常规、凝血功能、头颅CT等），实现高危因素早识别。该环节各项指标重要性得分为4.53~5.00分，表明专家高度重视。通过标准化表单统一采集信息，为后续个性化诊疗提供科学支撑。
3.2.2　术前准备阶段的多学科闭环协作
术前通过多学科（产科、神经科、麻醉科、儿科等）定期会诊，个体化制定手术及麻醉方案，规范用药管理，细化心理护理和健康宣教内容，该阶段相关指标重要性得分为4.73~5.00分。本路径通过对生命体征、实验室检查及病人症状等多方面的动态监测与评估，实现了高危情况的早期识别与持续预警。专家的反馈促进了相关环节的规范化和优化，进一步提升了团队协作的及时性和高效性。
3.2.3　术中管理阶段的动态监控
术中环节路径将护理与麻醉协作流程细化，强调多参数生命体征、脑功能及出血量动态监控，要求护士与麻醉、手术医生实时沟通处理突发风险。多参数监护、静脉通道管理等关键环节重要性得分为4.80~5.00分。规范化的术中交接与应急预案显著提升了安全性和团队协同水平。
3.2.4　术后链式护理与并发症预防
术后管理聚焦脑疝、癫痫、血栓、出血、感染等高危并发症的预防处理，该环节条目重要性得分为4.87~5.00分。路径同时突出母婴专科护理，如乳房护理、母婴健康教育和产后康复指导，确保母婴同护、康复覆盖全方位。
3.2.5　出院指导及延续护理的协同管理
出院前评估、健康宣教及康复指导统一纳入闭环管理体系，实现了院内外护理流程的系统化和标准化管理。健康教育指标重要性得分为4.93~5.00分，持续覆盖母婴全生命周期，显著提升了服务连续性和安全性。院后随访除人工形式外，还充分依托互联网护理门诊，为病人提供互联网护理免费咨询服务，帮助解决病人出院后遇到的问题。互联网护理门诊的常态化运行，创新了院外延伸护理服务模式，也为未来信息化、智能提醒等新举措的推广应用提供了良好基础，推动院内外护理服务无缝衔接。
3.3　路径的临床可行性与推广前景展望
本研究构建的多学科链式护理路径目前尚处于理论框架与专家论证阶段，暂未在临床实践中进行系统验证。然而，鉴于该路径已获得多领域专家的积极评价，并充分考虑了妊娠合并脑出血病人的实际管理需求[21]，具备一定的临床应用潜力。随着多学科协作和护理标准化理念的不断推广，该路径有望为危重孕产妇的围术期管理提供参考范式。
未来，建议在多中心、不同层级医院开展应用研究，评估该路径的具体实施效果、可行性和推广难点。可结合信息化管理平台，将流程嵌入电子病历，实现护理环节的实时追踪与质量控制。通过大样本前瞻性研究，进一步量化该路径对临床结局（如并发症率、住院时间、病人满意度）的影响，逐步完善和优化路径内容。此外，还需关注实际推广过程中的学科间协作、人员培训和资源配置问题，为危重孕产妇护理的持续改进和标准化提供坚实依据。
4　小结
收起
本研究以链式管理理论为指导，结合文献回顾、病例分析及多学科专家咨询，系统制定了妊娠合并脑出血病人剖宫产围术期多学科链式护理路径，明确了各阶段流程及团队分工，为危重孕产妇护理管理提供了科学、系统、标准化的实践参考。路径构建过程科学、严谨，强调了多学科协作与链式闭环管理，有助于提升护理质量与临床可行性。然而，目前路径尚缺乏大规模实证验证。后续应结合多中心数据，采用住院时长、并发症发生率及病人满意度等指标对路径的有效性和可行性进行量化评估。同时可依托信息化手段和实践反馈，持续优化路径内容，不断完善多学科协作与延续性护理管理体系，为危重孕产妇的救治与护理质量提升提供更为科学、系统的依据。

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2026年第40卷第11期
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doi: 10.12102/j.issn.1009-6493.2026.11.006
  • 接收时间：2025-08-02
  • 首发时间：2026-10-30
  • 出版时间：2026-06-10
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  • 收稿日期：2025-08-02
  • 修回日期：2026-03-08
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    1首都医科大学附属北京天坛医院，北京 100070

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WANG Na, E-mail:
王娜，副主任护师，本科，E-mail：
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2种不同金属材料的力学参数
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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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