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

doi:10.16460/j.issn1008-9969.2022.08.040

摘要/Abstract

摘要： 目的制定恶性肿瘤患者化疗相关便秘（chemotherapy-induced constipation, CIC）的最佳预防和管理策略,结合急性白血病化疗患者的临床特点、个体需求及本院当前的医疗资源等,将最佳证据应用于临床以改善患者化疗后排便情况。方法遵循JBI 临床证据实践应用模式,包括证据应用前基线审查、证据应用实践变革及证据应用后效果再审查3 个阶段。将最佳证据转化成8条审查指标,应用于急性白血病患者。比较证据应用前后护士对最佳证据的执行率,患者化疗前1周和化疗后1周内排便次数以及排便形态为Bristol I、II型的次数。结果证据应用后,护士对CIC预防和管理的各项证据的执行率显著升高（P<0.001）;患者化疗开始后1周内排便次数、出现Bristol Ⅰ和Ⅱ型粪便形态的次数较化疗前1周均无显著差异（P>0.05）。结论基于最佳证据的CIC预防和管理策略应用于急性白血病患者后,能够提高护士对各项审查指标依从性,可预防和改善急性白血病患者化疗后排便状况。

关键词: 急性白血病, 化疗, 便秘, 循证实践

Abstract: Objective To develop the best prevention and management strategies for chemotherapy-induced constipation (CIC) in patients with malignant tumors, to apply the best evidence in clinical practice to enhance the outcome of CIC in acute leukemia patients based on the clinical characteristics of the patients, individual needs and current medical resources of the hospital. Methods The JBI clinical evidence practice application model was followed, including baseline audit, evidence application practice reform and effect assessment after evidence application. The best evidence was translated into eight review indicators and applied to patients with acute leukemia. The compliance rate of the best evidence by nurses before and after evidence application, the patient's compliance with self-assessment of symptoms, the number of patients defecating 1 week before and 1 week after chemotherapy, as well as the number of Bristol I and II defecation patterns were compared. Results After evidence application, nurses' compliance rates of the precautions and management strategies of CIC were significantly improved (P<0.001); there were no significant differences in the number of defecation and the number of Bristol I and II fecal morphology within 1 week after chemotherapy when compared with that before chemotherapy (P>0.05). Conclusion Best evidence-based strategies for the prevention and management of CIC in patients with acute leukemia can enhance the compliance of nurses with all of the audits and improve defecation after chemotherapy in patients with acute leukemia.

Key words: acute leukemia, chemotherapy, chemotherapy-induced constipation, evidence-based practice

中图分类号:

R473.55

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.

YAO jing-jing, LIU Ying, XU Hui-juan, SUN Si-min, CHEN Min, JIANG Xue-jie. Prevention and Management of Chemotherapy-induced Constipation in Patients with Acute Leukemia: A Evidence-based Nursing Practice Project[J]. Journal of Nursing, 2022, 29(8): 40-45.

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