防治胰十二指肠切除术后消化道出血的循证护理

Evidence-based nursing care on prevention of post-pancreaticoduodenectomy hemorrhage

目的以循证护理理念为基础,制订预防胰十二指肠切除术后出血最优化的护理方案并应用临床实践。方法于2015年9月-10月采用循证护理方法检索文献,评价证据,构建防治胰十二指肠切除术(pancreaticoduodenectomy,PD)术后消化道出血(gastrointestinal hemorrhage,GIH)的相关循证证据库,并于2015年11月-2016年1月结合实际制订有证据支持的预防PD术后出血的循证护理方案。结果通过检索共获得文献79篇,获得可用文献17篇将循证护理方案应用于39例PD患者,1例于术后第3天发生GIH,发生率为2.6%,所有患者均于术后第6～7天出院。结论循证护理立足于科学、客观的临床证据,整合医疗资源以求实现临床护理实践最优化、患者获益最大化和资源分配最优化,有力促进了医疗实践的改革和护理学科的深化发展。

Objective To explore how to integrate the various sources of information in designing an evidencebased nursing care plan for preventing gastrointestinal hemorrhage（GIH） after pancreaticoduodenectomy（PD）. Method Papers and references about prevention of GIH after PD were searched between September and October 2015, and an evidence-based nursing care plan was drawn up and implemented from November 2015 to January 2016. Results A total of 79 papers were found and of which 17 were aviliable. Thirty-nine patients were cared on the basis of the effective project, of whom one was dignosed with GIH on the 3 rd postoperative day and the rate of post-PD hemorrhage was 2.6%.All patients were diacharged on the 6 th or 7 th postoperative day. Conclusion Exploring evidences under the guidance of scientific method and applying them to clinical nursing can prevent post-PD hemorrhage and improve life quality of patients.