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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

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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
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