股动脉穿刺介入术后制动时间的循证证据研究
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摘要
目的检索分析经股动脉穿刺介入术后最佳的卧床制动时间的相关证据,为医护人员临床决策提供依据。方法依据约翰霍普金斯护理循证实践(JHNEBP)模型的流程实施证据研究组建研究团队,确立循证实践问题;系统检索相关数据库,对检索到的文献应用约翰霍普金斯证据等级与质量评价标准、研究证据评估工具及非研究证据评估工具等进行评价筛选并汇总证据,提出循证实践建议。结果从检索到的文献中筛选出与主题密切相关的11条证据,证据等级ⅠA级～ⅢB级,提示经皮股动脉穿刺介入术后卧床制动3～4 h可以减轻患者腰背不适、尿潴留、焦虑等不良反应,且不增加出血或血肿风险。结论高等级的证据推荐经皮股动脉穿刺介入术后卧床制动3～4 h,可以减少不适且不增加相关出血风险,但应注意结合临床情景、专业人员判断和患者意愿。
Objective To search and analyze the best evidence related to optimal bed rest time after femoral artery puncture and interventional procedures so as to provide the basis for medical workers to make clinical decision. Methods Based on the process of the Johns Hopkins Nursing Evidence-based Practice(JHNEBP) model, an evidence study was conducted. The study included the following contents: to form a research team and to establish an evidence-based practice issue; systematic retrieval of relevant databases;using Johns Hopkins evidence level and quality evaluation standards to assess the retrieved literature; using research evidence assessment tool as well as non-research evidence assessment tool to make evaluation screening and to summarize evidence of retrieved documents aggregation of evidence; to propose evidence-based practice recommendations. Results A total of 11 evidences, which were closely related to the study subject, were selected from the retrieved literature, and the level of evidences was ⅠA to ⅢB. These evidences suggested that bed rest time of 3-4 hours after femoral artery puncture and interventional procedures could relieve the discomfort of the patient's waist and back, and improve the adverse reactions such as urinary retention, anxiety, etc., meanwhile the risks of bleeding or hematoma would not be increased. Conclusion High level evidences indicate that bed rest time of 3-4 hours after femoral artery puncture and interventional procedures can reduce discomfort of waist and back, meanwhile, it won't increase the risks of procedure-related bleeding, but in execution the clinical circumstances, professional judgment and patient's own will should be taken into consideration.
Objective To search and analyze the best evidence related to optimal bed rest time after femoral artery puncture and interventional procedures so as to provide the basis for medical workers to make clinical decision. Methods Based on the process of the Johns Hopkins Nursing Evidence-based Practice(JHNEBP) model, an evidence study was conducted. The study included the following contents: to form a research team and to establish an evidence-based practice issue; systematic retrieval of relevant databases;using Johns Hopkins evidence level and quality evaluation standards to assess the retrieved literature; using research evidence assessment tool as well as non-research evidence assessment tool to make evaluation screening and to summarize evidence of retrieved documents aggregation of evidence; to propose evidence-based practice recommendations. Results A total of 11 evidences, which were closely related to the study subject, were selected from the retrieved literature, and the level of evidences was ⅠA to ⅢB. These evidences suggested that bed rest time of 3-4 hours after femoral artery puncture and interventional procedures could relieve the discomfort of the patient's waist and back, and improve the adverse reactions such as urinary retention, anxiety, etc., meanwhile the risks of bleeding or hematoma would not be increased. Conclusion High level evidences indicate that bed rest time of 3-4 hours after femoral artery puncture and interventional procedures can reduce discomfort of waist and back, meanwhile, it won't increase the risks of procedure-related bleeding, but in execution the clinical circumstances, professional judgment and patient's own will should be taken into consideration.
引文
[1]李红霞,左秀兰,刘延军,等.介入诊疗术后股动脉穿刺点并发症的诱因及预防[J].医学影像学杂志, 2012, 22:1739-1741.
[2]彭碧文,陈殷琴,王丽娅,等.肝癌介入术后患者卧床体位及卧床时间研究[J].黑龙江医学, 2017, 41:900-901.
[3]郭啊玲.经股动脉穿刺介入术后不同卧床时间对患者术后并发症及舒适度的影响分析[J].实用临床护理学电子杂志,2017, 2:65-66.
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[5] Wentworth LJ, Bechtum EL, Hoffman JG, et al. Decreased bed rest post-percutaneous coronary intervention with a 7-French arterial sheath and its effects on vascular complications[J]. J Clin Nurs, 2018, 27:e109-e115.
[6]陈琼珍.脑血管造影及介入治疗术后卧床时间的探讨[J].微创医学, 2015, 10:219-220.
[7]靳英辉,王云云,王国豪,等.循证护理实践类文献撰写中存在的问题及建议[J].中国循证心血管医学杂志, 2016, 8:1153-1155.
[8]孙文茜,赵晨,高维洁,等.循证护理实践中的证据检索方法及资源[J].中国循证心血管医学杂志, 2016, 8:263-266.
[9]德尔霍尔特,黛博拉·丹格.约翰·霍普金斯护理循证实践:模型与指南(第二版)[M].北京:中国经济出版社, 2017:190-201.
[10] Chair SY, Fernandez R, Lui MH, et al. The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation[J]. Int J Evid Based Healthc,2008, 6:352-390.
[11] Mohammady M, Atoof F, Sari AA, et al. Bed rest duration after sheath removal following percutaneous coronary interventions:a systematic review and meta-analysis[J]. J Clin Nurs, 2014, 23:1476-1485.
[12] Tongsai S, Thamlikitkul V. The safety of early versus late ambulation in the management of patients after percutaneous coronary interventions:a meta-analysis[J]. Int J Nurs Stud,2012, 49:1084-1090.
[13] Biancari F, D'andrea V, Di Marco C, et al. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty[J]. Am Heart J, 2010,159:518-531.
[14]顾婕,史冬梅,许艳玲.股动脉穿刺PCI术后沙袋压迫时间和卧床时间的探讨[J].护士进修杂志, 2015, 30:2090-2091.
[15]林琳,李颖,迟秀文.股动脉穿刺PCI术后早期活动对舒适和出血的影响[J].当代护士, 2012, 6:7-8.
[16]王丽,蔡颖,葛幼文,等.改进型护理措施在全穿刺技术治疗腹主动脉瘤围术期中的应用[J].护士进修杂志, 2015,30:911-912.
[17]陈进莲,陈郁芬,叶国燕,等.经股动脉全脑血管介入术后术肢解除制动时机的研究[J].黑龙江医学, 2014, 38:1211-1212.
[18]袁金丹.经股动脉穿刺介入术后早期体位及制动时间的护理干预[J].齐齐哈尔医学院学报, 2013, 34:1991-1992.
[19]李艳红,朱玮玮,刘红云,等.不同压迫时间对经皮股动脉穿刺术后并发症发生的影响[J].中国实用护理杂志, 2016, 32:84-85.
[20]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, 30:964-967.
[21]郑萍,蒋辉,吴智强,等.股动脉穿刺术后穿刺点包扎时间与止血效果观察[J].实用医院临床杂志, 2009, 6:59-60.
[22]蒋妮,蒋蕾,邱燕,等.环形弹性加压带在肝癌介入治疗术后的应用及效果[J].介入放射学杂志, 2016, 25:360-362.
[23]李渊妹,彭筠昀,沈小芳.经股动脉穿刺行全脑血管造影术后患者穿刺点去除沙袋“十字”加压包扎止血的效果[J].解放军护理杂志, 2016, 33:62-64.
[24]甘解华,陈勇,赵嘉林.脑血管介入术后假性动脉瘤形成的原因及治疗分析[J].现代实用医学, 2017, 29:1572-1573.
[25]胡雁,邢唯杰.循证护理的概念与步骤[J].上海护理, 2015,15:89-93.
[2]彭碧文,陈殷琴,王丽娅,等.肝癌介入术后患者卧床体位及卧床时间研究[J].黑龙江医学, 2017, 41:900-901.
[3]郭啊玲.经股动脉穿刺介入术后不同卧床时间对患者术后并发症及舒适度的影响分析[J].实用临床护理学电子杂志,2017, 2:65-66.
[4]林惠,刘燕.冠脉介入治疗股动脉穿刺术后制动时间调查分析[J].护理实践与研究, 2009, 6:6-8.
[5] Wentworth LJ, Bechtum EL, Hoffman JG, et al. Decreased bed rest post-percutaneous coronary intervention with a 7-French arterial sheath and its effects on vascular complications[J]. J Clin Nurs, 2018, 27:e109-e115.
[6]陈琼珍.脑血管造影及介入治疗术后卧床时间的探讨[J].微创医学, 2015, 10:219-220.
[7]靳英辉,王云云,王国豪,等.循证护理实践类文献撰写中存在的问题及建议[J].中国循证心血管医学杂志, 2016, 8:1153-1155.
[8]孙文茜,赵晨,高维洁,等.循证护理实践中的证据检索方法及资源[J].中国循证心血管医学杂志, 2016, 8:263-266.
[9]德尔霍尔特,黛博拉·丹格.约翰·霍普金斯护理循证实践:模型与指南(第二版)[M].北京:中国经济出版社, 2017:190-201.
[10] Chair SY, Fernandez R, Lui MH, et al. The clinical effectiveness of length of bed rest for patients recovering from trans-femoral diagnostic cardiac catheterisation[J]. Int J Evid Based Healthc,2008, 6:352-390.
[11] Mohammady M, Atoof F, Sari AA, et al. Bed rest duration after sheath removal following percutaneous coronary interventions:a systematic review and meta-analysis[J]. J Clin Nurs, 2014, 23:1476-1485.
[12] Tongsai S, Thamlikitkul V. The safety of early versus late ambulation in the management of patients after percutaneous coronary interventions:a meta-analysis[J]. Int J Nurs Stud,2012, 49:1084-1090.
[13] Biancari F, D'andrea V, Di Marco C, et al. Meta-analysis of randomized trials on the efficacy of vascular closure devices after diagnostic angiography and angioplasty[J]. Am Heart J, 2010,159:518-531.
[14]顾婕,史冬梅,许艳玲.股动脉穿刺PCI术后沙袋压迫时间和卧床时间的探讨[J].护士进修杂志, 2015, 30:2090-2091.
[15]林琳,李颖,迟秀文.股动脉穿刺PCI术后早期活动对舒适和出血的影响[J].当代护士, 2012, 6:7-8.
[16]王丽,蔡颖,葛幼文,等.改进型护理措施在全穿刺技术治疗腹主动脉瘤围术期中的应用[J].护士进修杂志, 2015,30:911-912.
[17]陈进莲,陈郁芬,叶国燕,等.经股动脉全脑血管介入术后术肢解除制动时机的研究[J].黑龙江医学, 2014, 38:1211-1212.
[18]袁金丹.经股动脉穿刺介入术后早期体位及制动时间的护理干预[J].齐齐哈尔医学院学报, 2013, 34:1991-1992.
[19]李艳红,朱玮玮,刘红云,等.不同压迫时间对经皮股动脉穿刺术后并发症发生的影响[J].中国实用护理杂志, 2016, 32:84-85.
[20]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, 30:964-967.
[21]郑萍,蒋辉,吴智强,等.股动脉穿刺术后穿刺点包扎时间与止血效果观察[J].实用医院临床杂志, 2009, 6:59-60.
[22]蒋妮,蒋蕾,邱燕,等.环形弹性加压带在肝癌介入治疗术后的应用及效果[J].介入放射学杂志, 2016, 25:360-362.
[23]李渊妹,彭筠昀,沈小芳.经股动脉穿刺行全脑血管造影术后患者穿刺点去除沙袋“十字”加压包扎止血的效果[J].解放军护理杂志, 2016, 33:62-64.
[24]甘解华,陈勇,赵嘉林.脑血管介入术后假性动脉瘤形成的原因及治疗分析[J].现代实用医学, 2017, 29:1572-1573.
[25]胡雁,邢唯杰.循证护理的概念与步骤[J].上海护理, 2015,15:89-93.