高龄患者紧急心脏移植的循证护理实践

Evidence-based nursing practice of emergency heart transplantation for an elderly patient

目的为1例高龄暴发性心肌炎合并急性心肌梗死患者制订并实施抢救性心脏移植循证护理方案。方法在多学科协作基础上,针对护理重点和难点提出问题,计算机检索PubMed、Cochrane Library、JBI循证卫生保健数据库、英国国家临床医学研究所指南库、国际指南协作网、美国指南网、中国生物医学文献数据库、中国知网、维普数据库及万方数据库查找相关文献,对证据进行评价和整合后,将其应用于患者围手术期护理与康复。结果最终纳入9篇文献,其中诊疗规范2篇,指南1篇,专家意见及共识4篇,系统评价2篇。结合患者实际临床问题及多学科团队建议制订针对性的护理方案,包括出血预警管理、循环目标导向性管理、排异预控管理及康复个体化管理。经过68 d的治疗及康复,患者各项功能恢复良好出院。结论针对高龄紧急心脏移植患者,运用循证方法为患者提供针对、科学、有效的护理措施,在成功救治和顺利康复中起到了关键作用。

Objective To develop and implement an evidence-based nursing plan of emergency heart transplantation for an elderly patient with fulminant myocarditis combined with acute myocardial infarction.Methods On the basis of multidisciplinary collaboration,questions were raised on the focus and difficulty of nursing.Computer search was conducted in PubMed,Cochrane Library,JBI Evidence-based Health Care Database,National Institute for Health and Care Excellence,Guidelines International Network,the National Guideline Clearinghouse,CBM,CNKI,VIP and Wanfang to find the relevant literature.The evidences were evaluated for feasibility,suitability,clinical significance and effectiveness,then applied to the perioperative nursing and rehabilitation of the patients.Results 9 articles were included,including 2 diagnosis and treatment guidelines,1 guideline,4 expert opinions and consensus,and 2 systematic reviews.Based on the actual clinical problems of patients and the suggestions of the multidisciplinary team,targeted nursing plans were developed,including bleeding warning management,circulation-target-oriented management,rejection and pre-control management and individual rehabilitation management.After 68 days of treatment and rehabilitation,the patient recovered well and was discharged from hospital.Conclusion For the elderly patient with emergency heart transplant,we provided targeted,scientific and effective nursing measures through evidencebased methods,which play a key role in the successful treatment and rehabilitation.