目的: 构建剖宫产术后患者加速康复（accelerated rehabilitation surgery,ERAS）体位管理方案。方法: 研究小组基于加速康复外科理念进行科学的文献筛选、文献评价及汇总,拟定剖宫产术后患者加速康复体位管理方案,通过专家会议对方案进行科学的论证,修正定稿。结果: 剖宫产术后患者加速康复体位管理方案共包括7个体位管理目标、7个体位管理时机和36条体位管理内容。专家会议问卷有效回收率为100%,专家权威系数（Cr）为0.94,Kendall协调系数为0.24（χ2=26.10,P<0.05）。结论: 本研究构建的剖宫产术后患者加速康复体位管理方案咨询结果可靠,专家权威系数较高,专家意见趋于一致,可为临床护士在促进剖宫产术后患者早期离床活动、减少相关并发症等方面提供参考依据,推进ERAS在产科的应用。
Abstract
Objective To construct a postoperative patient position management plan for cesarean section based on Accelerated Rehabilitation Surgery (ERAS). Methods According to the concept of accelerated rehabilitation surgery and clinical experience, the study group scientifically screened the literature, extracted and collected the evidence, and drew up the first draft of the postoperation Posture Management Plan for cesarean section patients. Through the expert meeting, verify the scientific nature of the proposal and revise the final draft. Results A total of 11 articles were screened out, 24 best evidences were extracted, and the postural management program was established by expert meeting, including 7 Management Timing, 7 management goals and 36 management content. The effective recovery rate of the expert meeting questionnaire was 100%, the expert authority coefficient (CR) was 0.94, and the Kendall coordination coefficient was 0.24(χ2=26.10, P<0.05). Conclusion The management plan of accelerating recovery posture for patients after cesarean section is reliable, the expert authority coefficient is high, the expert opinion tends to be consistent, and the contentis scientific and practical, it can provide reference for clinical nurses to guide patients’ early activities after cesarean section, and promote the application of ERAS in obstetrics.
关键词
加速康复外科 /
剖宫产患者 /
术后体位管理 /
方案构建
Key words
accelerated rehabilitation surgery /
cesarean section /
postoperative position management /
scheme for developing
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参考文献
[1] 安力彬, 陆虹. 妇产科护理学[M]. 北京: 人民卫生出版社, 2022.
[2] 李乐之, 路潜. 外科护理学[M]. 北京: 人民卫生出版社, 2021.
[3] 李霞林, 王永, 董旭东, 等. 妊娠期及产褥期孕产妇静脉血栓形成的危险因素及临床特征分析[J]. 中国实用妇科与产科杂志, 2023, 39(3): 331-335.
[4] 陈莹, 李飞, 高玉梅, 等. 河南省豫东地区产褥期感染的相关因素分析[J]. 中国基层医药, 2020, 27(16): 1970-1973.
[5] 田环环. 择期剖宫产脊髓麻醉后低血压的危险因素分析[J]. 中国当代医药, 2022, 29(17): 139-141.
[6] 马琛, 沈梅芬, 李晨曦, 等. 神经外科成年病人腰椎穿刺后腰痛的危险因素分析[J]. 全科护理, 2021, 19(18): 2567-2570.
[7] MACONES, GEORGE A. Guidelines for Postoperative care in Cesarean Delivery: Enhanced Recovery After Surgery (ERAS) Society Recommendations (Part 3)[J]. Am J Obstet Gynecol, 2019, 221(3): 247. e1-247. e9.
[8] 刘国成, 蔺莉. 产科快速康复临床路径专家共识[J]. 现代妇产科进展, 2020, 8: 561-567.
[9] 刘志强, 徐铭军. 剖宫产术后加速康复麻醉实践专家共识[J]. 中国医刊, 2022, 7: 717-722.
[10] 张彦, 余伟, 嵇秀明, 等. 剖宫产术后产妇早期拔除尿管的最佳证据总结[J]. 护士进修杂志, 2022, 16: 1472-1477.
[11] 王海燕, 王丽, 张超庭, 等. 腰麻术后最佳体位管理策略的证据总结[J]. 护理学报, 2020, 27(20): 32-37.
[12] BALUKU, MORIS, BAJUNIRWE, et al. A Randomized Controlled Trial of Enhanced Recovery After Surgery Versus Standard of Care Recovery for Emergency Cesarean Deliveries at Mbarara Hospital, Uganda[J]. Anesth Analg, 2020, 130(3): 769-776.
[13] 徐玲兰, 姬乐婷, 魏晓永. 加速康复外科理念应用于剖宫产产妇围术期管理[J]. 临床麻醉学杂志, 2021, 5: 480-483.
[14] 王华英, 姚依坤. 加速康复外科护理模式对剖宫产术后恢复的影响[J]. 护理研究, 2021, 5: 905-907.
[15] MULLMAN L, HILDEN P, GORAL J, et al.Improved Outcomes With an Enhanced Recovery Approach to Cesarean Delivery[J]. Obstet Gynecol, 2020, 136(4): 685-691.
[16] 刘小玲, 丁晓华, 马晓丽, 等. 快速康复临床路径在剖宫产中的应用效果[J]. 中国妇幼保健, 2016, 31(11): 2278-2280.
[17] 张丽姣. 体位与早期运动干预对剖宫产术后患者护理效果观察[D]. 延安: 延安大学, 2020.
[18] CHANG W.Incidence of postural headache after lumbar puncture requiring epidural blood patch: Effects of needle caliber; 2-year experience[J]. Neuroradiol J, 2021.34(5): 418-420.
[19] CHIEN-SHU·TAI. The causal-effect of bed rest and post-dural puncture headache in patients receiving diagnostic lumbar puncture: A prospective cohort study[J]. J Chin Med Assoc, 2021, 84(8): 791-794.
[20] 谢红艳, 宋丽霞, 毛秀玉, 等. 快速康复外科对创伤性骨折患者术后患肢疼痛及肿胀的影响[J]. 湖南师范大学学报 (医学版), 2022, 19(1): 54-57.
[21] 曾繁利, 王东和, 杨贺庆. ERAS在接受新辅助化疗的局部进展期胃癌患者围手术期应用效果分析[J]. 湖南师范大学学报 (医学版), 2021, 18(1): 46-49.
[22] 中国医院协会. 中国医院质量安全管理第2-24部分: 患者服务住院患者静脉血栓栓塞症防治非书资料:T/CHAS 10-2-24-2018[S]. 北京: 中国医院协会, 2018.
基金
2023年度湖南妇女儿童医院院级科研项目（FE-Y202304）
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