Bakri球囊管理循证实践在前置胎盘产后出血患者中的应用效果
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摘要
目的 :寻找目前与Bakri球囊相关的前置胎盘产后出血防治管理的最佳证据,并将最佳证据应用于护理实践中,探讨循证护理在Bakri球囊防治前置胎盘产后出血中应用的效果。方法 :运用循证方法得出最佳证据,结合团队临床经验及患者需求制订Bakri球囊护理审查标准、临床护理规范、风险预警流程,对所有医护人员进行最佳证据的培训,并将其应用于Bakri球囊护理管理,比较循证实践前后患者止血成功率、置管并发症(生殖道感染、脱管、移位、拔管后出血)发生率以及住院时间、24 h出血量情况。结果 :最佳证据应用后患者止血成功率由84.0%上升为100.0%;生殖道感染、脱管、堵管、移位等并发症的发生率由24.0%下降为4.0%,差异有统计学意义(P<0.05);同时循证实践后的患者24 h出血量及住院时间均少于循证实践前的患者,差异存在统计学意义(P<0.05)。结论 :对前置胎盘患者应用Bakri球囊防治出血疗效显著,术后采用循证护理实践,可明显提高球囊止血成功率,降低球囊脱管、堵管、移位等并发症发生率,同时降低患者24h出血量及缩短住院时间。
Objective: To search evidence-based nursing practices relevant to Bakri balloons in prevention and management of postpartum hemorrhage caused by placental previa at present and their effectiveness, and apply those practices to clinical nursing. Methods: Evidence-based methods were adopted to figure out the best evidence, which was then combined with the medical team members' clinical experience and patients' requirement to make review standards and clinical nursing norms of Bakri balloons and risk warning processes of postpartum hemorrhage. All medical staff were trained about the best practice as well as the above mentioned standards, norms and processes to ensure their application to Bakri balloons usage management. Indicators collected before and after the application of Bakri balloons, including the success rate of hemostasis, incidence of relevant complications(such as genital tract infection, balloons knockout and displacement, and hemorrhage after extubation), hospital stay and hemorrhage within 24 hours were compared and analyzed. Results: The success rate of hemostasis increased from 84.0% to 100.0% since the implementation of the evidence-based practice, with the incidence of complications decreased from 24.0% to 4.0%, which was significantly lower than before(P<0.05). Meanwhile, patients' s hospital stays and the amount of hemorrhage within 24 hours both decreased after the implementation of the evidence-based practice with the differences being statistically significant(P<0.05). Conclusion: Bakri balloons were significantly useful in controlling hemorrhage caused by placenta previa, and application of evidence-based practices to women after their operations can obviously improve the success rate of hemostasis, reduce the incidence of complications and hemorrhage within 24 hours, and shorten their hospital stays.
Objective: To search evidence-based nursing practices relevant to Bakri balloons in prevention and management of postpartum hemorrhage caused by placental previa at present and their effectiveness, and apply those practices to clinical nursing. Methods: Evidence-based methods were adopted to figure out the best evidence, which was then combined with the medical team members' clinical experience and patients' requirement to make review standards and clinical nursing norms of Bakri balloons and risk warning processes of postpartum hemorrhage. All medical staff were trained about the best practice as well as the above mentioned standards, norms and processes to ensure their application to Bakri balloons usage management. Indicators collected before and after the application of Bakri balloons, including the success rate of hemostasis, incidence of relevant complications(such as genital tract infection, balloons knockout and displacement, and hemorrhage after extubation), hospital stay and hemorrhage within 24 hours were compared and analyzed. Results: The success rate of hemostasis increased from 84.0% to 100.0% since the implementation of the evidence-based practice, with the incidence of complications decreased from 24.0% to 4.0%, which was significantly lower than before(P<0.05). Meanwhile, patients' s hospital stays and the amount of hemorrhage within 24 hours both decreased after the implementation of the evidence-based practice with the differences being statistically significant(P<0.05). Conclusion: Bakri balloons were significantly useful in controlling hemorrhage caused by placenta previa, and application of evidence-based practices to women after their operations can obviously improve the success rate of hemostasis, reduce the incidence of complications and hemorrhage within 24 hours, and shorten their hospital stays.
引文
[1] World Health Organization. Make every mother and child count:the world health report2005. Geneva:WH0, 2005:62-63.
[2] Bakri YN. Uterine tamponade—drain for hemorrhage secondary to placenta previa-accrete.Int JGynaecol Obstet, 1992(37):302-303.
[3]高羽,王子莲,张建平,等.Bakri止血球囊治疗产后出血的有效性和安全性.中华妇产科杂志,2014,9(9):670-675.Gao Y, Wang ZL, Zhang JP, et al. Efficacy and safety of intrauterine Bakri balloon tamponade in the treatment of postpartum hemorrhage:a multicenter analysis of 109 cases. Chin J Obstet Gynacol, 2014,9(9):670-675.
[4] Robin PN, Sandra LD, Stephanie SP, et al.Johns Hopkins nursing evidence-based practice model and guidelines. Indiana:Sigma Tau Intemational, 2007:204-207.
[5]付晨薇,刘俊涛,杨剑秋,等.子宫填塞球囊导管治疗产后出血的临床效果.协和医学杂志,2013,4(1):31-34.Fu CW, Liu JT, Yang JQ, et al. Role of bakri ballooninmanagementofpostpartum haemorrhage. Med JPUMCH, 2013,4(1):31-34.
[6]钱年凤,李凤秋.Bakri球囊在产后出血中的应用.生殖医学杂志,2015,5(5):409-411.Qian NF, Li FQ. Application of Bakri balloon in postpartum hemorrhage. J Reprod Med, 2015,5(5):409-411.
[7] Vintejoux E, Ulrich D, Mousty E. Success factors for Bakri TM balloon usage secondary to uterine atony:a retrospective,multicentre study.Aust N Z J Obstet Gynaecol, 2015,55(6):572-577.
[8] Raynal P. Bakri balloon. Gynecologie Obstetrique&Fertilite, 2011(39):438-441.
[9] Beckmann MM, Chaplin J. Bakri balloon during cesarean delivery for placenta previa.International Journal of Gynecology and Obstetrics, 2014(124):118-122.
[10] Ronvall M, Tikkanen M, Tallberg E, et a1.Use of Bakri balloontamponade in the treatment of postpartum hemorrhage:a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand, 2013(92):433-438.
[11] Tuncalp O, Souza JP, Gtilmezoqlu M, et a1.New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet, 2013(123):254-256.
[12]杨宁,郭惠玲,柳燕瑛.提高高危妊娠初产妇母乳喂养自我效能的循证护理.护理学杂志,2015,30(8):26-28.Yang N, Guo HL, Liu YY. Evidence-based nursing improves breastfeeding self-efficacy in primipera. Journal of Nursing Sciencs, 2015,30(8):26-28.
[13]陈林,任香娣,郑静.循证护理实践在减少冠脉搭桥手术患者尿管拔除相关并发症中的应用.中华现代护理杂志,2018,24(2):130-137.Chen L, Ren XD, Zheng J. Application of evidence based nursing practice in reducing the urinary catheter extraction related complication in coronary artery bypass surgery patients.Chin J Mod Nurs, 2018,24(2):130-137.
[14] Charoenkwan K. Effective use of the Bakri postpartum balloon for post hysterectomy pelvic for hemorrhage. Am J Obstet Gynecol, 2014,210(6):586.el-3.
[15]焦颖玉,桑美丽,王楠,等.三甲医院临床本科护士循证护理素质及培训态度现状调查.国际护理学杂志,2018,37(1):45-47.Jiao YY, Sang ML, Wang N, et al. Survey about evidence-based nursing quality and training attitude of undergraduate nurse in Grade III A hospitals. Int J Nurs, 2018,37(1):45-47.
[2] Bakri YN. Uterine tamponade—drain for hemorrhage secondary to placenta previa-accrete.Int JGynaecol Obstet, 1992(37):302-303.
[3]高羽,王子莲,张建平,等.Bakri止血球囊治疗产后出血的有效性和安全性.中华妇产科杂志,2014,9(9):670-675.Gao Y, Wang ZL, Zhang JP, et al. Efficacy and safety of intrauterine Bakri balloon tamponade in the treatment of postpartum hemorrhage:a multicenter analysis of 109 cases. Chin J Obstet Gynacol, 2014,9(9):670-675.
[4] Robin PN, Sandra LD, Stephanie SP, et al.Johns Hopkins nursing evidence-based practice model and guidelines. Indiana:Sigma Tau Intemational, 2007:204-207.
[5]付晨薇,刘俊涛,杨剑秋,等.子宫填塞球囊导管治疗产后出血的临床效果.协和医学杂志,2013,4(1):31-34.Fu CW, Liu JT, Yang JQ, et al. Role of bakri ballooninmanagementofpostpartum haemorrhage. Med JPUMCH, 2013,4(1):31-34.
[6]钱年凤,李凤秋.Bakri球囊在产后出血中的应用.生殖医学杂志,2015,5(5):409-411.Qian NF, Li FQ. Application of Bakri balloon in postpartum hemorrhage. J Reprod Med, 2015,5(5):409-411.
[7] Vintejoux E, Ulrich D, Mousty E. Success factors for Bakri TM balloon usage secondary to uterine atony:a retrospective,multicentre study.Aust N Z J Obstet Gynaecol, 2015,55(6):572-577.
[8] Raynal P. Bakri balloon. Gynecologie Obstetrique&Fertilite, 2011(39):438-441.
[9] Beckmann MM, Chaplin J. Bakri balloon during cesarean delivery for placenta previa.International Journal of Gynecology and Obstetrics, 2014(124):118-122.
[10] Ronvall M, Tikkanen M, Tallberg E, et a1.Use of Bakri balloontamponade in the treatment of postpartum hemorrhage:a series of 50 cases from a tertiary teaching hospital. Acta Obstet Gynecol Scand, 2013(92):433-438.
[11] Tuncalp O, Souza JP, Gtilmezoqlu M, et a1.New WHO recommendations on prevention and treatment of postpartum hemorrhage. Int J Gynaecol Obstet, 2013(123):254-256.
[12]杨宁,郭惠玲,柳燕瑛.提高高危妊娠初产妇母乳喂养自我效能的循证护理.护理学杂志,2015,30(8):26-28.Yang N, Guo HL, Liu YY. Evidence-based nursing improves breastfeeding self-efficacy in primipera. Journal of Nursing Sciencs, 2015,30(8):26-28.
[13]陈林,任香娣,郑静.循证护理实践在减少冠脉搭桥手术患者尿管拔除相关并发症中的应用.中华现代护理杂志,2018,24(2):130-137.Chen L, Ren XD, Zheng J. Application of evidence based nursing practice in reducing the urinary catheter extraction related complication in coronary artery bypass surgery patients.Chin J Mod Nurs, 2018,24(2):130-137.
[14] Charoenkwan K. Effective use of the Bakri postpartum balloon for post hysterectomy pelvic for hemorrhage. Am J Obstet Gynecol, 2014,210(6):586.el-3.
[15]焦颖玉,桑美丽,王楠,等.三甲医院临床本科护士循证护理素质及培训态度现状调查.国际护理学杂志,2018,37(1):45-47.Jiao YY, Sang ML, Wang N, et al. Survey about evidence-based nursing quality and training attitude of undergraduate nurse in Grade III A hospitals. Int J Nurs, 2018,37(1):45-47.