痔疮患者术后快速康复护理循证实践

Evidence-based Practice of Enhanced Recovery after Surgery for Patients with Hemorrhoids

目的探讨基于最佳证据的痔疮患者术后快速康复干预应用于临床实践并评价其效果。方法采用JBI临床证据实践应用模式,检索快速康复中有关痔疮术后康复指导的相关证据,利用JBI证据推荐级别系统(2014版)进行证据质量评价,对审查指标运用FAME结构从可行性、适宜性、临床意义和有效性4个方面对审查指标进行评价。将采纳的证据转化为临床审查指标,通过查看护理记录、现场审查和问卷法的方式收集资料。比较证据应用前后痔疮术后患者治疗效果、肛门疼痛、并发症发生率。结果证据应用后痔疮术后患者治疗效果高于证据应用前(P<0.05);证据应用后痔疮术后患者在术后1 d和5 d肛门疼痛评分低于证据应用前(P<0.05);证据应用后痔疮术后患者并发症发生率低于证据应用前(P<0.05);11项指标中,指标11证据应用前已是100%,其余10项指标证据应用后执行率高于证据应用前,差异均有统计学意义(P<0.001)。结论基于快速康复外科的循证护理实践可优化痔疮患者的术后管理,可提高患者治疗效果,减轻患者术后肛门疼痛,降低术后并发症的发生率,促进痔疮术后患者的快速康复。

Objective To explore and assess the effect of evidence-based enhanced recovery after surgery(ERAS) practice on postoperative rehabilitation of patients with hemorrhoids. Methods The standard procedure supported by the JBI-PACES program was used to retrieve relevant evidence of ERAS practice for postoperative rehabilitation of patients with hemorrhoids. JBI evidence pre-classification and evidence rank system(2014 edition) was used to evaluate the quality of evidence. FAME structure was used to evaluate the evidence from the respect of feasibility,appropriateness, clinical meaningfulness and effectiveness. The included evidence was translated into clinical audit indicators, and data were collected through reviewing nursing records, on-site examination and questionnaires. Comparisons were made in the effectiveness of treatment, anal pain, and incidence of complications before and after the implementation of the evidence-based ERAS practice. Results After the application of evidence, the effectiveness of treatment was improved(P<0.05) and patients’ anal pain score on the first and fifth day after surgery was lower than that before the application of evidence(P<0.05). The incidence of postoperative complications after evidence application was lower than that before( P<0.05).Regarding the 11 indicators, the execution rate of all the indicators, except indicator 11, the execution rate of which had already been100%, was higher after the application of evidence, indicating statistical significance(P<0.001). Conclusion Evidence-based nursing practice based on rapid rehabilitation surgery can optimize postoperative management of patients with hemorrhoids, improve therapeutic effect, reduce postoperative anal pain and the incidence of postoperative complications, and promote the rapid recovery of patients with hemorrhoids.