促进剖宫产术后产妇早期离床活动的循证实践

doi:10.3761/j.issn.0254-1769.2021.05.001

摘要/Abstract

摘要：

目的基于剖宫产术后产妇早期离床活动的证据,实施循证实践,并验证其在改善剖宫产术后产妇早期离床活动中的作用。方法以基于证据的持续质量改进模型为研究框架,于2019年2月—2020年1月通过证据获取、现况审查、证据引入和效果评价4个阶段将循证实践应用于剖宫产术后产妇,并采用中断时间序列设计,比较循证实践应用前后两组疼痛情况、首次离床活动时间、术后24 h离床率、肠梗阻发生率及术后住院时间。结果最终纳入8条证据,共12条审查指标。循证实践后,剖宫产术后产妇疼痛评分<3分的人数百分比由74.37%提升至83.68%,两组比较,差异具有统计学意义（ χ²=1.77,P=0.041）;首次离床活动时间从（31.89±9.50） h缩短至（20.01±4.65） h,两组比较,差异具有统计学意义（t=11.48,P<0.001）;术后24 h离床率由30.94%提高至91.21%,两组比较,差异具有统计学意义（ χ²=17.28,P<0.001）;肠梗阻发生率由5.31%下降至1.70%,两组比较,差异具有统计学意义（ χ²=2.17,P=0.015）;术后住院时间由（5.06±1.99） d下降至（3.51±0.99） d,两组比较,差异具有统计学意义（t=10.74,P<0.001）。结论基于证据的循证实践能够促进剖宫产术后产妇的早期离床活动,有效降低术后肠梗阻发生率,缩短术后住院天数。

关键词: 剖宫产术, 术后, 早期离床, 产科护理, 循证护理

Abstract:

Objective This study aims to implement the best evidence of early mobilization in maternal women after cesarean in China’s clinical settings and to evaluate the effectiveness of the evidence-based nursing protocol.Methods The Evidence-based Continuous Quality Improvement Framework was used as the conceptual model. The process consisted of 4 steps including evidence acquisition,baseline evaluation,evidence introduction,and after-effect evaluation. From February 2019 to January 2020,an interruption time series design was applied in postpartum women to assess the changes of length of out-of-bed mobilization,24-hour out-of-bed rate,incidence of intestinal obstruction,and length of post-operative hospitalization.Results We finally included 8 pieces of evidence in protocol. The percentage of people with a pain score of <3 increased from 74.37% to 83.68%（ χ ²=1.77,P=0.041）;The length of out-of-bed mobilization decreased from 31.89±9.50 hours to 20.01±4.65 hours（t=11.48,P<0.001）. The 24-hour out of bed rate increased from 30.94% to 91.21%（ χ²=17.28,P<0.001）;the incidence of intestinal obstruction decreased from 5.31% to 1.70%（ χ²=2.17,P=0.015） and the average days of postoperative hospital stay decreased from 5.06±1.99 days to 3.51±0.99 days（t=10.74,P<0.001）.Conclusion The best evidence-based practice can promote early mobilization in maternal women after cesarean section,reduce the incidence of intestinal obstruction effectively,and shorten hospital stay significantly.

Key words: Cesarean Section, Postoperative, Early Mobilization, Obstetrical Nursing, Evidence-Based Nursing

陈云,万静,朱政,苏春宏,梅峥嵘,王寿平,谭湘萍,孔颖诗. 促进剖宫产术后产妇早期离床活动的循证实践[J]. 中华护理杂志, 2021, 56(5): 645-651.

CHEN Yun,WAN Jing,ZHU Zheng,SU Chunhong,MEI Zhengrong,WANG Shouping,TAN Xiangping,KONG Yingshi. Best evidence-based practice for promoting early mobilization in maternal women after cesarean：an interrupt time series study[J]. Chinese Journal of Nursing, 2021, 56(5): 645-651.

图/表 3

表1 促进剖宫产术后产妇早期离床活动的证据内容、审查指标及审查方法

Table 1 evidence content,examination index and examination method of promoting early ambulation of parturients after cesarean section

表2 循证实践前后剖宫产术后产妇早期离床活动审查指标执行情况比较（%）

Table 2 Comparison of the implementation of early out of bed activity review indicators before and after evidence-based practice（%）

表3 循证实践前后剖宫产术后产妇疼痛情况、首次离床活动时间、术后24 h离床率、肠梗阻发生率及术后住院时间比较

Table 3 Comparison of pain, first time out of bed time,24 hour out of bed rate, incidence of intestinal obstruction and length of hospital stay after cesarean section before and after evidence-based practice

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