医护一体化模式下的长期必要时医嘱对心脏瓣膜置换术后补钾的临床观察及护理影响  

Clinical Effect of pro re nata(PRN)Medication on Oral Potassium Supplementation After Heart Valve Replacement and Its Influence on Nursing Under Integrated Medical Care Model

作　　者：黄丽[1,2] 徐英 Huang Li;Xu Ying(General Ward of Cardiovascular Disease,West China Hospital,Sichuan University,Chengdu 610041,China;West China School of Nursing,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院心血管疾病综合病房,成都610041 [2]四川大学华西护理学院,成都610041

出　　处：《成都医学院学报》2023年第3期385-388,共4页Journal of Chengdu Medical College

摘　　要：目的 探讨在医护一体化模式下根据长期必要时医嘱对心脏瓣膜置换术后口服补钾的临床效果观察及护理影响。方法 选取2020年2月至2021年6月四川大学华西医院心脏大血管外科行心脏瓣膜置换手术的患者165例,随机分为试验组(n=83)和对照组(n=82)。根据医嘱,试验组每400 mL尿量口服10%氯化钾溶液10 mL;对照组按常规补钾方法即10%氯化钾溶液10 mL,3次/d,口服;两组患者术后均口服氢氯噻嗪25 mg,2次/d。不同时间段抽血查血钾浓度,观察两组患者发生低钾血症的发生率。结果 试验组发生低钾血症3例,对照组发生低钾血症13例,试验组低钾血症的发生率低于对照组(P=0.008)。多因素Logistic回归分析表明,采用长期必要时医嘱下补钾是患者出院后1周发生低钾血症的保护性因素(OR=0.103,P=0.027);而补钾后患者有呕吐反应(OR=36.110,P=0.007)和患者依从性差(OR=17.225,P=0.026)是出院后1周发生低钾血症的独立危险因素。结论 医护一体化模式下,采用长期必要时医嘱补钾在心脏瓣膜置换术患者中安全、可行,同时可以提高医护合作性,丰富医护一体化内涵,减少患者并发症。Objective To investigate the clinical effect of"as and when required"(pro re nata,PRN)medication on oral potassium supplementation after heart valve replacement and its influence on nursing under the model of integrated medical care.Methods A total of 165 patients who underwent heart valve replacement surgery in the Department of Cardiac and Macrovascular Surgery of West China Hospital of Sichuan University from February 2020 to June 2021 were selected and randomly divided into experimental group(n=83)and control group(n=82).According to medical prescription,the experimental group took 10%potassium chloride solution(10 mL,po)for every 400 mL of urine volume,while the control group took 10%potassium chloride solution(10 mL,tid,po)according to the conventional potassium supplementation method.In addition,both groups took hydrochlorothiazide(25 mg,bid,po).Blood samples were taken at different times for the detection of potassium concentration.The incidence of hypokalemia in the two groups was observed.Results Hypokalemia occurred in 3 patients in the experimental group and 13 patients in the control group.The incidence of hypokalemia in the experimental group was lower than that in the control group(P=0.008).Multivariate Logistic regression analysis showed that the administration of PRN potassium supplementation was a protective factor for the occurrence of hypokalemia in patients one week after discharge(OR=0.103,P=0.027),while the presence of vomiting reaction in patients after potassium supplementation(OR=36.110,P=0.007)and poor patient compliance(OR=17.225,P=0.026)were the independent risk factors for hyperkalemia in patients one week after discharge.Conclusion Under the model of integrated medical care,the administration of PRN potassium supplementation in patients after heart valve replacement is clinically observed to be safe and feasible,which also improves doctor-nurse cooperation,enriches the connotation of integrated medical care,and reduces patient complications.

关 键 词：医护一体化 心脏瓣膜置换术 口服补钾 

分 类 号：R542.5[医药卫生—心血管疾病]