促进剖宫产术后产妇早期离床活动的循证实践

Best evidence-based practice for promoting early mobilization in maternal women after cesarean:an interrupt time series study

目的基于剖宫产术后产妇早期离床活动的证据,实施循证实践,并验证其在改善剖宫产术后产妇早期离床活动中的作用。方法以基于证据的持续质量改进模型为研究框架,于2019年2月—2020年1月通过证据获取、现况审查、证据引入和效果评价4个阶段将循证实践应用于剖宫产术后产妇,并采用中断时间序列设计,比较循证实践应用前后两组疼痛情况、首次离床活动时间、术后24 h离床率、肠梗阻发生率及术后住院时间。结果最终纳入8条证据,共12条审查指标。循证实践后,剖宫产术后产妇疼痛评分<3分的人数百分比由74.37%提升至83.68%,两组比较,差异具有统计学意义(χ^(2)=1.77,P=0.041);首次离床活动时间从(31.89±9.50)h缩短至(20.01±4.65)h,两组比较,差异具有统计学意义(t=11.48,P<0.001);术后24 h离床率由30.94%提高至91.21%,两组比较,差异具有统计学意义(χ^(2)=17.28,P<0.001);肠梗阻发生率由5.31%下降至1.70%,两组比较,差异具有统计学意义(χ^(2)=2.17,P=0.015);术后住院时间由(5.06±1.99)d下降至(3.51±0.99)d,两组比较,差异具有统计学意义(t=10.74,P<0.001)。结论基于证据的循证实践能够促进剖宫产术后产妇的早期离床活动,有效降低术后肠梗阻发生率,缩短术后住院天数。

Objective This study aims to implement the best evidence of early mobilization in maternal women after cesarean in China’s clinical settings and to evaluate the effectiveness of the evidence-based nursing protocol.Methods The Evidence-based Continuous Quality Improvement Framework was used as the conceptual model.The process consisted of 4 steps including evidence acquisition,baseline evaluation,evidence introduction,and after-effect evaluation.From February 2019 to January 2020,an interruption time series design was applied in postpartum women to assess the changes of length of out-of-bed mobilization,24-hour out-of-bed rate,incidence of intestinal obstruction,and length of post-operative hospitalization.Results We finally included 8 pieces of evidence in protocol.The percentage of people with a pain score of<3 increased from 74.37%to 83.68%(χ^(2)=1.77,P=0.041);The length of out-of-bed mobilization decreased from 31.89±9.50 hours to 20.01±4.65 hours(t=11.48,P<0.001).The24-hour out of bed rate increased from 30.94%to 91.21%(χ^(2)=17.28,P<0.001);the incidence of intestinal obstruction decreased from 5.31%to 1.70%(χ^(2)=2.17,P=0.015)and the average days of postoperative hospital stay decreased from 5.06±1.99 days to 3.51±0.99 days(t=10.74,P<0.001).Conclusion The best evidence-based practice can promote early mobilization in maternal women after cesarean section,reduce the incidence of intestinal obstruction effectively,and shorten hospital stay significantly.