以质量求发展，以服务铸品牌

护理学报 ›› 2021, Vol. 28 ›› Issue (4): 31-35.doi: 10.16460/j.issn1008-9969.2021.04.031

• 循证护理 • 上一篇    下一篇

神经外科患者腰椎穿刺术后最佳卧床时间的循证实践

王晓艳a, 李牧玲b, 谢亭平a, 庄卓洵a, 何水秀a, 郑晓霞a, 祝静雯a, 陆云涛a, 周宏珍b   

  1. 南方医科大学南方医院 a.神经外科; b.护理部,广东 广州 510515
  • 收稿日期:2020-07-14 出版日期:2021-02-25 发布日期:2021-03-12
  • 通讯作者: 周宏珍（1960-）,女,江苏扬州人,博士研究生,主任护师,博士研究生导师,护理部副主任。E-mail:zhouhz2005@126.com
  • 作者简介:王晓艳（1971-）,女,江西新余人,本科学历,副主任护师,护士长。
  • 基金资助:
    2019年南方医院护理创优循证实践专项（2019EBNb001）

Evidence-based Practice of Optimal Bed Rest Time after Lumbar Puncture for Neurosurgcial Patients

WANG Xiao-yana, LI Mu-lingb, XIE Ting-pinga, ZHUANG Zhuo-xuna, HE Shui-xiua, ZHEN Xiao-xiaa, ZHU Jing-wena, LU Yun-taoa, ZHOU Hong-zhenb   

  1. a. Dept. of Neurosurgery; b. Dept. of Nursing Administration, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
  • Received:2020-07-14 Online:2021-02-25 Published:2021-03-12

PDF (PC)

288

赞

摘要： 目的 探讨基于最佳证据的缩短神经外科腰椎穿刺术后卧床休息时间方案的临床实践并评价其效果。方法 采用JBI证据应用模式,检索关于腰椎穿刺术后卧床的相关证据,采用JBI证据预分级及证据推荐级别系统（2014版）进行证据等级及推荐级别的划分,并运用FAME结构从可行性、适宜性、临床意义和有效性4个方面对证据进行评价。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。比较证据应用前后腰椎穿刺术后患者的舒适度、头痛和腰背部疼痛率、压疮风险及护士知晓率。结果 证据应用后,腰椎穿刺术后患者舒适度高于证据应用前（P<0.001）;术后头痛及腰背部疼痛率无统计学差异（P>0.05）;压疮风险较证据应用前降低（P=0.005）;6项审查指标中,指标1~2在证据应用前执行率已是100%,其余4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 将基于循证的最佳证据应用于临床实践,缩短神经外科患者腰椎穿刺术后卧床休息时间,可降低患者不适感,减少并发症的发生,从而提升临床护理质量。

关键词: 腰椎穿刺术, 卧床休息, 循证实践

Abstract: Objective To explore the best evidence-based clinical practice of shortening bed rest time after lumbar puncture in neurosurgery and evaluate its effect. Methods The JBI clinical evidence practice application mode was used to retrieve the relevant evidence about bed rest time after lumbar puncture. The JBI evidence recommendation level system (2014) was used to evaluate the quality evidence. The review indicators were evaluated from four aspects of feasibility, suitability, clinical significance and effectiveness by using fame structure. The adopted evidence was transformed into clinical examination indicators, and the data were collected from the nursing records, on-site review and questionnaire. Comfort, headache and back pain rate, pressure ulcer risk and nurses' awareness rate were compared before and after the application of the evidence. Results After the application of evidence, patients felt more comfortable after lumbar puncture (P<0.05). There was no significant difference in terms of rate of headache and back pain(P>0.05). Nurses' knowledge of lumbar puncture was significantly improved (P<0.05) and the risk of pressure ulcers decreased(P=0.005). Among the six review indicators, the implementation rate of the first two was 100% before the application of evidence, and that of the remaining four after evidence application was higher than that before evidence application, and the difference was statistically significant (P<0.001). Conclusion It is effective for reducing patient discomfort and complications, thereby improving the quality of clinical care by applying the best evidence-based evidence and shortening the time of bed rest after lumbar puncture for neurosurgery patients.

Key words: lumbar puncture, bed rest, evidence-based practice

中图分类号: 

  • R473.6
[1] Engelborghs S, Niemantsverdriet E, Struyfs H, et al.Consensus Guidelines for Lumbar Puncture in Patients with Neurological Diseases[J]. Alzheimers Dement (Amst), 2017, 8(18):111-126.DOI:10.1016/j.dadm.2017.04.007.
[2] Headache Classification Subcommittee of the International Headache Society.The International Classification of Headache Disorders: 2nd Edition[J]. Cephalalgia, 2004, 24 Suppl(1): 9-160.
[3] 尤黎明. 内科护理学[M]. 北京:人民卫生出版社, 2012.
[4] Park S, Kim K, Park M, et al.Effect of 24-Hour Bed Rest versus Early Ambulation on Headache after Spinal Anesthesia: Systematic Review and Meta-analysis[J]. Pain Manag Nurs, 2018, 19(3):267-276.DOI:10.1016/j.pmn.2017.10.012.
[5] 虎洁婷,李晓丽,章江琳,等. 缩短腰椎穿刺术后绝对卧床时间对患者术后并发症影响的Meta分析[J]. 解放军护理杂志,2018, 35(4):9-15.DOI:10.3969/j.issn.1008-9993.2018.04.002.
[6] Arevalo-Rodriguez I, Ciapponi A, Roqué i Figuls M, et al. Posture and Fluids for Preventing Post-dural Puncture Headache[J]. Cochrane Database Syst Rev, 2016, 3(3): CD009199.DOI:10.1002/14651858.CD009199.pub3.
[7] 兰大华,张曦,张诚,等. 诊断性腰椎穿刺术后卧床30分钟应用效果的Meta分析[J]. 中国输血杂志, 2016, 29(10): 1113-1115.DOI:10.13303/j.cjbt.issn.1004-549x.2016.10.009.
[8] Choi JS, Chang SJ.A Comparison of the Incidence of Post-Dural Puncture Headache and Backache After Spinal Anesthesia:A Pragmatic Randomized Controlled Trial[J]. Worldviews Evid Based Nurs, 2018,15(1):45-53.DOI:10.1111/wvn.12236.
[9] Tejavanija S, Sithinamsuwan P, Sithinamsuwan N, et al.Comparison of Prevalence of Post-dural Puncture Headache between Six Hour-supine Recumbence and Early Ambulation after Lumbar Puncture in Thai Patients: A Randomized Controlled Study[J]. J Med Assoc Thai, 2006, 89(6):814-820.
[10] 王春青,胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, 30(11):964-967.
[11] 朱丽霞,高凤莉,罗虹辉,等. 舒适状况量表的信效度测试研究[J]. 中国实用护理杂志, 2006(13):57-59.
[12] Kolcaba KY.Holistic Comfort: Operationalizing the Construct as a Nurse-sensitive Outcome[J].ANS Adv Nurs Sci, 1992, 15(1):1-10.
[13] Bergstrom N,Braden BJ,Laguzza A, et al.The Braden Scale for Predicting Pressure Sore Risk[J]. Nurs Res, 1987, 36(4):205-210.
[14] 马玉芬,成守珍,刘义兰,等. 卧床患者常见并发症护理专家共识[J]. 中国护理管理, 2018, 18(6):740-747.DOI:10.3969/j.issn.1672-1756.2018.06.006.
[15] Kim SR, Chae HS, Yoon MJ, et al.No Effect of Recumbency Duration on the Occurrence of Post-Lumbar Puncture Headache with A 22G Cutting Needle[J]. BMC Neurol, 2012(12):1.DOI:10.1186/1471-2377-12-1.
[16] 郭素云,代莹,施兰来,等. 痔疮患者术后快速康复护理循证实践[J]. 护理学报, 2020, 27(2):43-47.DOI:10.16460/j.issn1008-9969.2020.02.043.
[1] 郭汉画, 陈名桂, 孔丽丽, 张晓璇. 重症患者动脉测压导管最佳更换策略的循证实践[J]. 护理学报, 2021, 28(2): 37-41.
[2] 张煜, 张春艳, 金玉, 王淑芹, 董亮, 万娜, 贾燕瑞, 高凤莉. 内科危重症患者深静脉血栓预防审查指标的制定及障碍因素分析[J]. 护理学报, 2020, 27(4): 37-41.
[3] 曹春菊, 张兰芳, 王彩芳, 罗丹华, 徐秀平, 庄聪琼, 黄梅英, 黄炜铃, 李文英. 轻、中重症急性胰腺炎患者早期经口进食的循证实践[J]. 护理学报, 2020, 27(24): 24-30.
[4] 陈丽玲, 周春兰, 吴艳妮, 赵慧慧. 临床护士参与循证实践培训体验的质性研究[J]. 护理学报, 2020, 27(23): 49-52.
[5] 单亚维, 陈维佳, 金丽娟, 冯海萍, 陈茹, 冯程程. 全膝关节置换术加速康复循证护理实践方案的构建[J]. 护理学报, 2020, 27(21): 33-39.
[6] 刘巧艳, 步红兵, 尹卫, 黄贤凤, 朱丽群, 宦迎春, 杨玲, 严丽荣, 于明, 许步慧, 祖后娟. 基于JBI证据转化模式的住院老年2型糖尿病患者多学科联合低血糖管理的循证实践[J]. 护理学报, 2020, 27(20): 38-43.
[7] 郭素云, 代莹, 施兰来, 奚润, 颜景颖, 叶秀娟. 痔疮患者术后快速康复护理循证实践[J]. 护理学报, 2020, 27(2): 43-47.
[8] 许妮娜, 杨中善, 刘宁, 乐格芬, 詹昱新, 吴艳妮, 汪欢. 神经外科患者规范化身体约束管理的循证护理实践[J]. 护理学报, 2020, 27(19): 41-46.
[9] 黄培培, 史平, 米元元, 张琼, 吴白女, 杨喜群, 鲍映雪, 陈肖敏. 肝肿瘤患者术中非计划性低体温的循证护理实践[J]. 护理学报, 2019, 26(5): 30-34.
[10] 陈名桂, 侯春怡, 王芳芳, 张晓璇. 预防ICU患者获得性衰弱最佳早期活动策略的循证护理实践[J]. 护理学报, 2019, 26(23): 45-49.
[11] 覃彦珠, 江锦芳, 刘鑫, 周帅, 刘凌, 李永强, 廖小莉. 肠造口患者造口周围刺激性皮炎防治的循证实践[J]. 护理学报, 2019, 26(15): 36-40.
[12] 单亚维, 陈维佳, 李玉霞. 基于循证实践指南的膝关节骨关节炎患者健康教育指导模块的构建[J]. 护理学报, 2019, 26(10): 32-37.
[13] 钟慧群,罗晨玲,赵洁,刘颖,向丽,廖璐,吴娟娟,张立力. 血液病患者外周静脉留置针最佳拔管策略的循证实践[J]. 护理学报, 2018, 25(18): 49-55.
[14] 刘鑫,江锦芳,覃彦珠,黄英凡,唐忠敏,韦丹丹,覃学燕,陈龙. 鼻咽癌放化疗患者口腔黏膜炎防护策略的循证实践[J]. 护理学报, 2018, 25(11): 26-30.
[15] 邱新香,夏丽华,郑倩玲,梁伟辉,郭卫军,陈慈珊. 职业性手臂振动病患者基于循证的护理干预[J]. 护理学报, 2014, (11): 59-62.
Viewed
Full text


Abstract

Cited
  Shared   
[1] 王佳瑞, 李彦丽. 腕踝针干预寒湿凝滞型原发性痛经患者的效果观察[J]. 护理学报, 2021, 28(1): 1 -3 .
[2] 杜金磊, 陈志美, 龚莉, 宋杰, 王翔, 邹晓月. 气管拔管后嗓音障碍患者系统康复训练的效果观察[J]. 护理学报, 2021, 28(1): 4 -8 .
[3] 梁红宽, 罗蔼, 宋瑜, 肖东. 降低扫描式葡萄糖监测系统传感器非预期更换率的品管圈实践[J]. 护理学报, 2021, 28(1): 9 -12 .
[4] 杨芳, 杨艳, 贺琳晰. OEC管理模式在新型冠状病毒核酸检测采集中心护理管理中的应用[J]. 护理学报, 2021, 28(1): 13 -16 .
[5] 赵明曦, 孙建华, 李若祎, 侯锦, 李尊柱, 罗红波, 奉爱萍, 李欣, 李奇. 床旁超声在重症患者肠内营养的应用进展[J]. 护理学报, 2021, 28(1): 17 -21 .
[6] 姚露, 陈雪萍, 刘欣, 陈姬, 汪梦鑫. 运动传感设备在衰弱老年人中的应用进展[J]. 护理学报, 2021, 28(1): 22 -26 .
[7] 汪梦月, 蒋园园, 陈妍, 盛少婷. 老年综合评估对预防老年患者护理不良事件发生的Meta分析[J]. 护理学报, 2021, 28(1): 27 -32 .
[8] 江丽玲, 詹梦梅, 黄秋霞, 李立群, 张淑, 龚晶晶, 王建宁. 乳腺癌患者性生活体验质性研究的Meta整合[J]. 护理学报, 2021, 28(1): 33 -37 .
[9] 路莉静, 孟爱凤, 程芳, 邾萍, 智晓旭, 汤琳, 王鹏程. 乳腺癌患者就医延迟原因质性研究的Meta整合[J]. 护理学报, 2021, 28(1): 38 -44 .
[10] 涂惠琼, 龙秀红, 沈琴庆. 148例先天性心脏病患儿术后主要照顾者的居家康复护理需求现状及影响因素分析[J]. 护理学报, 2021, 28(1): 45 -50 .