急性主动脉夹层患者急诊临床恶化动态预警方案的构建及应用研究

The construction and application of dynamic warning plan for emergency clinical deterioration of patients with acute aortic dissection

目的构建急性主动脉夹层患者急诊临床恶化动态预警方案并探讨其初步应用效果。方法根据文献资料及课题组前期研究结果,借鉴并改良国家早期预警评分,构建急性主动脉夹层患者急诊临床恶化动态预警方案初稿;通过专家会议讨论形成方案终稿。便利选取北京市某三级甲等心血管病专科医院急诊留观的26例急性主动脉夹层患者,采用随机数字表法分为试验组12例与对照组14例,试验组应用新构建的方案进行护理,对照组实施常规护理。结果共14名专家参与会议,专家的权威系数为0.89。急性主动脉夹层患者急诊临床恶化动态预警方案评估指标包括收缩压、心率、呼吸、SpO_(2)、意识水平及疼痛程度,临床响应措施根据评估指标得分分3级进行响应。应用该方案后,护士对试验组的意识水平及疼痛程度评估频率高于对照组(P<0.001);试验组通知医生的频率更高、病死率更低,但差异无统计学意义(P>0.05)。结论该研究构建的预警方案根据不同评估指标的变化情况为临床护理策略提供建议,有助于进一步规范急性主动脉夹层患者的急诊护理工作。

Objective To construct a dynamic warning plan for emergency clinical deterioration of patients with acute aortic dissection and evaluate the application effect.Methods Based on the literature and the previous research results,the research group improved the National Early Warning Score to construct the first draft of the plan for dynamic waning of emergency clinical deterioration in patients with acute aortic dissection.Through the expert meeting,the final draft was formed.26 patients with acute aortic dissection in the emergency department from a tertiary class A cardiovascular hospital in Beijing were selected by convenient sampling.The patients were divided into the control group(14 cases)and the intervention group(12 cases)by random number table method.The control group was given routine care,and the intervention group received the dynamic waning plan of emergency clinical deterioration.Results A total of 14 clinical and nursing experts participated in the expert meeting,and the authority coefficient of the experts was 0.89.Dynamic warning scheme of the emergency clinical deterioration in patients with acute aortic dissection consisted of evaluation index and the clinical response of nursing measures,evaluation index included systolic blood pressure,heart rate,breathing,SpO_(2),consciousness level and the degree of pain,clinical response nursing measures were responded according to three levels from low to high graded by the score of evaluation index.After the application of this plan,the frequency of consciousness and pain assessment of nurses in the experimental group was higher than that in the control group(P<0.001),and the frequency of informing doctors in the experimental group was higher and the mortality rate was lower,but the differences were not statistically significant(P>0.05).Conclusion The dynamic warning plan constructed in this research provided suggestions for clinical nursing strategies according to the change of different assessment indicators,which can further improve emergency nursing for acute aortic dissection patients.