基于循证医学的临床护理路径对肝硬化合并上消化道出血患者营养状况及预后的影响

Effects of clinical nursing pathway based on evidence-based medicine on nutritional status and prognosis of patients with liver cirrhosis complicated with upper gastrointestinal bleeding

目的探讨基于循证医学的临床护理路径对肝硬化合并上消化道出血患者营养状况及预后的影响。方法选取我院消化内科收治的110例肝硬化合并上消化道出血患者为研究对象,根据随机数字表法将其分为对照组和研究组,各55例。对照组接受常规护理,研究组在对照组基础上开展基于循证医学的临床护理路径。比较两组的干预效果。结果干预后,研究组的白蛋白/球蛋白(A/G)、血红蛋白(Hb)、白蛋白(ALB)、淋巴细胞百分比(LYM%)、转铁蛋白(TF)、载脂蛋白A-Ⅰ(ApoA-Ⅰ)水平及体重指数高于对照组,谷丙转氨酶(ALT)、总胆红素(TBIL)水平及并发症总发生率低于对照组(P<0.05)。研究组的再出血次数少于对照组,血小板-白蛋白-胆红素(PALBI)评分低于对照组,生活质量综合评定问卷-74(GQOLI-74)评分及病情好转出院率高于对照组(P<0.05)。结论基于循证医学的临床护理路径可有效改善机体营养状况,降低并发症发生率,提高预后效果,在肝硬化合并上消化道出血患者护理中具有较高的应用价值。

Objective To explore the effects of clinical nursing pathway based on evidence-based medicine on nutritional status and prognosis of patients with liver cirrhosis complicated with upper gastrointestinal bleeding.Methods A total of 110 patients with liver cirrhosis complicated with upper gastrointestinal bleeding admitted in the gastroenterology department of our hospital were selected as the research objects.According to the random number table method,the patients were divided into control group and study group,with 55 cases in each group.The control group received routine nursing,and the study group carried out clinical nursing pathway based on evidence-based medicine on the basis of the control group.The intervention effects of the two groups were compared.Results After intervention,the levels of albumin/globulin(A/G),hemoglobin(Hb),albumin(ALB),lymphocyte percentage(LYM%),transferrin(TF),apolipoprotein A-Ⅰ(ApoA-Ⅰ)and body mass index in the study group were higher than those in the control group,while the levels of alanine aminotransferase(ALT),total bilirubin(TBIL)and the total incidence of complications were lower than those in the control group(P<0.05).The number of rebleeding in the study group was less than that in the control group,the platelet-albumin-bilirubin(PALBI)score was lower than that in the control group,and the Generic Quality of Life Inventory-74(GQOLI-74)score and discharge rate of improved condition were higher than those in the control group(P<0.05).Conclusion The clinical nursing pathway based on evidence-based medicine can effectively improve the nutritional status of the body,reduce the incidence of complications and improve the prognosis,it has high application value in the nursing of patients with cirrhosis complicated with upper gastrointestinal bleeding.