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)

402

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] 夏碧芸, 陈瑜, 吴彦妍, 胡雁. 降低经桡动脉冠状动脉介入术后老年患者桡动脉闭塞发生的循证实践[J]. 护理学报, 2025, 32(2): 37-43.
[2] 李春萍, 张兰萍, 王晓辉, 钟乐欣, 杨薇, 赵青, 吕森森, 李嘉琪, 谢昀筠, 黄婉晴, 陈晓珊, 徐东. 实施理论—常态化过程理论的解读[J]. 护理学报, 2024, 31(5): 39-43.
[3] 张淑珍, 余文汝, 张俊峰, 江佳瑶, 罗美, 林碧玉, 麦敏雯, 杨梦婷. 肿瘤放疗患者放射性皮炎预防与管理的循证护理实践[J]. 护理学报, 2024, 31(16): 62-66.
[4] 刘瑶, 詹欣, 谢亭平, 陈炜, 胡依阳, 杨翠娜, 张国忠. 脑血管造影术后使用股动脉压迫止血器患者早期活动的循证实践[J]. 护理学报, 2024, 31(15): 29-33.
[5] 邓颖一, 程露颖, 龚喜燕, 王敏, 廖冬霞, 张翠翠, 丁娟, 古清鹭, 廖常菊. 临床护理交接班循证实践的范围综述[J]. 护理学报, 2024, 31(14): 57-62.
[6] 黄宇星, 刘宁, 黄婷. 基于核心能力构建适宜中低资源地区护理本科循证实践教学指标体系[J]. 护理学报, 2023, 30(13): 24-28.
[7] 张兰萍, 吕森森, 何文俊, 陈江芸, 蔡毅媛, 李春萍, 刘思源, 钟冬梅, 李嘉琪, 谢昀筠, 黄婉晴, 陈晓珊, 徐东. 实施性研究综合框架（CFIR）更新版的解析和应用[J]. 护理学报, 2023, 30(11): 47-52.
[8] 魏大琼, 龙春花, 吴丝丝, 胡雁. 急性心肌梗死患者早期运动康复的循证护理实践[J]. 护理学报, 2023, 30(11): 53-58.
[9] 姚晶晶, 刘颖, 许汇娟, 孙思敏, 陈敏, 江雪杰. 急性白血病患者化疗相关便秘预防和管理的循证护理实践[J]. 护理学报, 2022, 29(8): 40-45.
[10] 付艳芬, 王春青, 胡雁. 证据临床转化中障碍因素和促进因素的内容分析[J]. 护理学报, 2022, 29(5): 64-68.
[11] 林俏, 刘梅娟, 张广清, 赵芯梅, 夏燕飞, 施燕, 曾依婷, 赖女珍, 周丽华, 李秀梅. 成人炎症性肠病患者饮食与营养方案的循证实践[J]. 护理学报, 2022, 29(4): 27-33.
[12] 周毅峰, 杨继平, 彭瑶丽, 袁浩, 石泽亚. 体外循环心脏手术中体温管理循证实践[J]. 护理学报, 2022, 29(3): 40-45.
[13] 侯香传, 伍艳婷, 周凯琪, 莫怡坚, 黄丽香, 刘伊莎. 提高呼吸系统疾病患者痰标本采集合格率的循证实践[J]. 护理学报, 2022, 29(24): 43-48.
[14] 张俊峰, 陈妙婷, 黄雪玲, 李美连, 蔡莹莹, 吴艳妮, 全守波, 刘兴玲. 胃肠肿瘤根治术后患者自控镇痛管理的循证实践[J]. 护理学报, 2022, 29(23): 50-55.
[15] 黎紫艳, 温秀兰, 黄海英, 张立力, 张智英, 张晓红, 何梦雪, 沈南平, 吴玮哲. 肿瘤患儿化疗相关性恶心呕吐症状管理的循证实践[J]. 护理学报, 2022, 29(14): 43-47.
Viewed
Full text


Abstract

Cited
  Shared   
No Suggested Reading articles found!