慢性心力衰竭患者营养管理的循证护理实践  

Evidence-based nursing practice for nutritional management in patients with chronic heart failure

作　　者：田蕾 王蒙[2] 孙立[3] 王春华[4] 张玲玲 梁凤阳 Tian Lei;Wang Meng;Sun Li;Wang Chunhua;Zhang Lingling;Liang Fengyang(School of Nursing,Chengde Medical University,Chengde 067000,China;Department of Clinical Psychology,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;Department of Cardiology,Southern Branch,Affiliated Hospital of Chengde Medical University,Chengde 067000,China;Department of Hospital Infection Control,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院护理学院,承德067000 [2]承德医学院附属医院临床心理科,承德067000 [3]承德医学院附属医院南区心脏内科,承德067000 [4]承德医学院附属医院医院感染控制处,承德067000

出　　处：《中华现代护理杂志》2024年第21期2814-2821,共8页Chinese Journal of Modern Nursing

摘　　要：目的将慢性心力衰竭(CHF)患者营养管理的最佳证据应用于临床实践并评价其效果。方法采用便利抽样法,选取2022年10月—2023年3月承德医学院附属医院心脏内科收治的80例CHF患者及23名参与项目实施的护士为研究对象。2022年10—12月收治的40例CHF患者为基线组,2023年1—3月收治的40例CHF患者为证据应用组。应用循证护理学方法通过证据获取、现状审查、证据引入和效果评价4个阶段将证据应用于临床,比较循证实践前后审查指标的执行率、护士对于CHF患者营养管理知识掌握情况以及患者营养状况、再入院率相关结局指标。结果循证实践后审查指标的执行率从0~60.87%提升至80.00%~100.00%。护士对于CHF患者营养管理知识得分为(91.30±4.82)分,高于循证实践前知识得分[(48.48±13.09)分],差异具有统计学意义(P<0.05);CHF患者的NRS 2002评分由(3.05±0.50)分降低到(2.10±0.44)分,MNA-HF评分由(18.20±2.64)分提高到(21.24±2.94)分,白蛋白指标由(37.33±4.98)g/l提高到(39.24±3.29)g/l,差异均有统计学意义(P<0.05)。证据应用组CHF患者出院后3个月的再入院率为10.00%(4/40),基线组CHF患者出院后3个月的再入院率为27.50%(11/40),差异有统计学意义(P<0.05)。结论CHF患者营养管理循证护理实践可以提高护士对于患者的营养管理知识水平,改善患者的营养状况,降低再入院率,提高护理质量。Objective To apply the best evidence for nutritional management in patients with chronic heart failure(CHF)into clinical practice and evaluate its effectiveness.Methods Totally 80 CHF patients admitted to the Department of Cardiology at the Affiliated Hospital of Chengde Medical University from October 2022 to March 2023 and 23 nurses involved in the project were selected by convenience sampling.The 40 CHF patients admitted from October to December 2022 formed the baseline group,while those admitted from January to March 2023 constituted the evidence application group.Evidence-based nursing methods were implemented in four stages:evidence retrieval,current status review,evidence implementation,and effectiveness evaluation.The compliance rates of review indicators,nurses'knowledge of nutritional management for CHF patients,and patient outcomes related to nutrition status and readmission rates were compared before and after evidence-based practice.Results After evidence-based practice,the compliance rates of review indicators increased from 0-60.87%to 80.00%-100.00%.Nurses'scores on nutritional management knowledge for CHF patients increased significantly from(48.48±13.09)to(91.30±4.82),with a statistically significant difference(P<0.05).The NRS 2002 scores of CHF patients decreased from(3.05±0.50)to(2.10±0.44),MNA-HF scores increased from(18.20±2.64)to(21.24±2.94),and albumin levels increased from(37.33±4.98)g/L to(39.24±3.29)g/L,all with statistically significant differences(P<0.05).The 3-month readmission rate for CHF patients in the evidence application group was 10.00%(4/40),significantly lower than the 27.50%(11/40)in the baseline group(P<0.05).Conclusions Evidence-based nursing practice for nutritional management in CHF patients can enhance nurses'knowledge,improve patients'nutritional status,reduce readmission rates,and improve the quality of nursing care.

关 键 词：心力衰竭 营养管理 营养评价 循证护理学 

分 类 号：R473.5[医药卫生—护理学]