妊娠剧吐病人循证护理的最佳临床实践

Best clinical practice for evidence-based nursing care of patients with hyperemesis gravidarum

目的:应用在循证基础上的妊娠期恶心呕吐预防及管理的最佳证据临床护理方案,观察妊娠剧吐病人的循证护理临床实施效果。方法:通过运用复旦大学循证护理中心的PIPOST模型来确立循证问题;通过检索BMJ Best Practice、PubMed、万方数据库、中国知网、美国妇产科医师学会、美国国立指南数据库、英国国家卫生与临床优化研究所等数据库收集妊娠剧吐护理的相关证据,构建妊娠剧吐的循证护理方案,并应用该方案。选取2018年10月—2021年2月在某院收治的妊娠剧吐病人作为研究对象,按随机数字表法将其分为试验组和对照组。两组病人均接受基础补液治疗,试验组实施妊娠剧吐循证护理实践方案,对照组行常规专科护理,观察两组病人的临床效果。结果:实施妊娠剧吐循证护理方案后,试验组病人的依从性提高,出院时呕吐频次及尿酮体转阴时间均优于对照组,差异均有统计学意义(P<0.05);同时医护人员的执行力也有所提升。结论:基于循证的妊娠剧吐护理方案可提高医护人员的执行力和病人的依从性,并能改善妊娠剧吐病人的恶心呕吐程度等症状,提高病人的生活质量。

Objective:To apply a clinical nursing plan for the prevention and management of nausea and vomiting during pregnancy based on the best evidence available,and to observe the clinical outcomes of evidence-based nursing for patients with hyperemesis gravidarum.Methods:This study used the PIPOST model from the Fudan University Evidence-Based Nursing Center to establish evidence-based questions.Relevant evidence on the nursing of hyperemesis gravidarum was collected through searches of databases such as BMJ Best Practice,PubMed,WanFang Database,CNKI,ACOG,NGC,NICE.An evidence-based nursing plan for hyperemesis gravidarum was developed and applied to cases.A total of 60 patients with hyperemesis gravidarum who were admitted to a hospital between October 2018 and February 2021 were selected as study subjects and randomly divided into an experimental group and a control group.Both groups received basic fluid therapy,with the experimental group implementing the evidence-based nursing practice plan for hyperemesis gravidarum and the control group receiving conventional specialized nursing care.The clinical outcomes of the two groups were observed.Results:After implementing the evidence-based nursing plan for hyperemesis gravidarum,patient compliance in the experimental group improved,and the frequency of vomiting and the time for urine ketone bodies to turn negative at discharge were better than those in the control group,with statistically significant differences(P<0.05).Additionally,the execution of care by medical staff also improved.Conclusion:The evidence-based nursing plan for hyperemesis gravidarum can enhance the execution by medical staff and patient compliance,reduce the severity of nausea and vomiting in hyperemesis gravidarum patients,and improve their quality of life.