肝癌患者术后胃肠功能障碍预防和护理的循证实践  

Evidence-based practice for the prevention and management of gastrointestinal dysfunction in patients with liver cancer after surgery

作　　者：郭雪娥 卞丽芳[2] 李鹤[2] 李春艳[2] 施晓兰[2] 李琰[2] 陈佳萍 卢芳燕 张华芳[1] GUO Xue’e;BIAN Lifang;LI He;LI Chunyan;SHI Xiaolan;LI Yan;CHEN Jiaping;LU Fangyan;ZHANG Huafang(Department of Nursing,The First Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou,310003,China)

机构地区：[1]浙江大学医学院附属第一医院护理部,杭州市310003 [2]浙江大学医学院附属第一医院肝胆胰外科,杭州市310003

出　　处：《中华护理杂志》2024年第6期645-653,共9页Chinese Journal of Nursing

基　　金：浙江大学医学院附属第一医院护理学科建设科研项目(2022ZYHL002)。

摘　　要：目的基于最佳证据构建肝癌患者术后胃肠功能障碍预防和护理的循证实践方案,并评价其应用效果。方法应用循证护理学方法,系统检索、评价、总结肝癌患者术后胃肠功能障碍预防和护理的最佳证据。2022年9月—10月,以知识转化模式为指导,结合临床情境对最佳证据进行筛选,制订循证实践方案,并于2022年11月—2023年3月在浙江省杭州市某三级甲等综合医院肝胆胰外科中心进行实施,比较证据应用前后医护人员各项审查指标的执行率、围手术期胃肠功能障碍管理知识合格率和肝癌患者术后胃肠功能障碍发生率、首次排气时间、首次排便时间、术后住院时间、出院BMI及血清白蛋白相关结局指标的差异。结果该研究制订了18项审查指标,循证实践后医护人员11项审查指标执行率提高、知识合格率提高,差异有统计学意义(P<0.05)。患者术后胃肠功能障碍的发生率从11.9%下降至4.0%(P=0.037),首次排气时间、首次排便时间及术后住院时间均缩短,差异具有统计学意义(P<0.05)。结论肝癌患者术后胃肠功能障碍预防和护理循证实践的开展为临床决策提供了支持,提高了医护人员的知识水平和审查指标的执行率,有效降低了肝癌患者术后胃肠功能障碍的发生率,加速了康复进程。Objective To develop an evidence-based practice program for the prevention and management of postoperative gastrointestinal dysfunction in patients with hepatocellular carcinoma,based on the best available evidence,and to evaluate the effectiveness of its application.Methods An evidence-based nursing approach was conducted for systematical search,appraisal and summary of the best evidence for the prevention and management of postoperative gastrointestinal dysfunction in postoperative hepatectomy patients.From September 2022 to October 2022,under the guidance of Knowledge to Action Framework,and in combination with clinical scenarios,the best evidence was screened and adjusted,and an evidence-based practice plan was formulated.From November 2022 to March 2023,the plan was implemented in the Department of Hepatobiliary and Pancreatic Surgery of a tertiary A hospital in Hangzhou City,Zhejiang Province,China.We compared the rate of implementation of the measures by healthcare personnel before and after the application of the evidence,the qualified rate of knowledge of perioperative management of gastrointestinal dysfunction,and the incidence of postoperative gastrointestinal dysfunction in postoperative hepatectomy patients,the first time to flatus and bowel,the length of hospital postoperative stays,the BMI and serum albumin level on discharge.Results After evidence-based practice,the implementation of 11 review indicators and knowledge pass rate increased,and the difference was statistically significant(P<0.05).The incidence of postoperative gastrointestinal dysfunction in patients decreased from 11.9%to 4.0%(P=0.037).First time to gas and bowel,and the length of hospital postoperative stays were shortened,and the differences were statistically significant(P<0.05).Conclusion The implementation of clinical evidence-based practice for the prevention and management of postoperative gastrointestinal dysfunction in postoperative hepatectomy patients provided support for clinical decision-making,improved healthcare profe

关 键 词：肝癌 肝切除术 术后胃肠功能障碍 知识转化模式 循证护理学 

分 类 号：R473.73[医药卫生—护理学]