基于全视角风险预控及循证理论的护理干预对心脏瓣膜置换术患者术后谵妄及并发症的效果评价-现代医学

基于全视角风险预控及循证理论的护理干预对心脏瓣膜置换术患者术后谵妄及并发症的效果评价

单位：山东省立医院菏泽医院/菏泽市立医院心脏大血管外科, 山东菏泽 274000

分类号：R453

出版年·卷·期（页码）：2025·53·第三期（438-443）

摘要：

目的：探讨基于全视角风险预控及循证理论的护理干预对心脏瓣膜置换术患者术后谵妄及并发症的影响。方法：纳入2021年11月至2023年2月在本院就诊的60例心脏瓣膜置换术患者为对照组，2023年3月至2024年6月就诊的60例心脏瓣膜置换术患者为研究组。对照组接受常规护理，研究组在常规护理基础上采用基于全视角风险预控及循证理论的护理干预。比较两组患者术后谵妄发生率、并发症发生情况及首次发生谵妄时间等指标。结果：研究组术后谵妄发生率显著低于对照组(31.67% vs.55.00%)，差异有统计学意义(P＜0.05)。研究组患者首次发生谵妄时间晚于对照组[(2.65±0.19) d vs.(2.03±0.28) d]；谵妄时长少于对照组[(2.26±0.21)d vs.(2.89±0.30)d]，差异均有统计学意义(均P＜0.05)。研究组患者并发症发生总人数显著少于对照组(P＜0.05)。性别和疾病类型的分层分析显示，男性患者的谵妄发生率和并发症发生率均高于女性患者(P＜0.05)；二尖瓣疾病患者谵妄发生率和并发症发生率均低于主动脉瓣狭窄患者(P＜0.05)。结论：基于全视角风险预控及循证理论的护理干预有效降低心脏瓣膜置换术患者术后谵妄的发生率及并发症的发生率，缩短发生谵妄的时间。

Objective: To explore the impact of nursing interventions based on comprehensive risk prevention and evidence-based theory on postoperative delirium and complications in patients undergoing heart valve replacement surgery. Methods: A total of 60 patients who underwent heart valve replacement surgery in our hospital between November 2021 and February 2023 were selected as the control group. Another 60 patients who received the same surgery between March 2023 and June 2024 were assigned to the study group. The control group received standard nursing care, while the study group received nursing interventions based on comprehensive risk prevention and evidence-based theory. The occurrence rate of postoperative delirium, complications, and the first timing of postoperative delirium were compared between the two groups. Results: The occurrence rate of postoperative delirium in the study group was significantly lower than that in the control group(31.67% vs. 55.00%), and the difference was statistically significant(P<0.05). The first occurrence rate of delirium in the study group occurred later than that in the control group [(2.65±0.19) d vs.(2.03±0.28) d]; the duration of delirium was shorter than that of the control group [(2.26±0.21) d vs.(2.89±0.30) d], and the differences were statistically significant(all P<0.05). The total number of patients with complications in the study group was significantly lower than that in the control group(P<0.05). The stratified analysis of gender and disease type showed that the incidence of delirium and complications in male patients was higher than that in female patients(P<0.05); the incidence of delirium and complications in patients with mitral valve disease was lower than that in patients with aortic valve stenosis(P<0.05). Conclusion: Nursing interventions based on comprehensive risk prevention and evidence-based theory effectively reduce the incidence of postoperative delirium and complications in patients undergoing heart valve replacement surgery, and shorten the duration of delirium.

参考文献：

[1] 向云霞,蒲文,李东锋,等.药师干预对心脏瓣膜置换术后华法林治疗患者抗凝治疗管理的影响[J].中国药物警戒,2022,19(5):545-549.
[2] 于梦佳,李立群,龚翠颖,等.晚期癌症患者谵妄评估工具的研究进展[J].中国护理管理,2024,24(6):947-951.
[3] 刘丹,陈小妃,刘海棠.基于倾向性评分匹配分析老年营养风险指数与老年重症患者并发谵妄的相关性[J].中国急救医学,2024,44(5):408-414.
[4] 张婷,严文萍,阎仿,等.全视角风险预控管理在先天性心脏病介入术患儿中的应用[J].海南医学,2022,33(21):2821-2824.
[5] 耿扬,王园园,李娟,等.同辈支持学习在临床护士循证护理培训中的应用[J].护理学杂志,2024,39(9):90-93.
[6] KOSE G,BOLU A,OZDEMIR L,et al.Reliability and validity of the intensive care delirium screening checklist in Turkish[J].Int J Nurs Knowl,2016,27(2):119-124.
[7] 曾庆玲,唐培佳,陈敬祥.右美托咪定和丙泊酚静脉镇静对心脏瓣膜置换患者血流动力学和术后谵妄影响的比较[J].岭南心血管病杂志,2020,26(3):297-301.
[8] 吴鹏涛,魏来.右美托咪定联合舒芬太尼对心脏瓣膜置换术麻醉患者心肌的保护作用及血流动力学的影响[J].中国药业,2021,30(17):46-49.
[9] 宋亚敏,杨满青,凌云,等.重症监护室预防谵妄的护理干预方案在心脏外科术后患者中的应用[J].中国护理管理,2022,22(4):507-511.
[10] SIRIPOONYOTHAI S,SINDHVANANDA W.Comparison of postoperative delirium within 24 hours between ketamine and propofol infusion during cardiopulmonary bypass machine:a randomized controlled trial[J].Ann Card Anaesth,2021,24(3):294-301.
[11] SMULTER N,LINGEHALL H C,GUSTAFSON Y,et al.Disturbances in oxygen balance during cardiopulmonary bypass:a risk factor for postoperative delirium[J].J Cardiothorac Vasc Anesth,2018,32(2):684-690.
[12] 李昆鹏,李国宏,陈进霞,等.外科病房护士对术后谵妄的评估依从性现况及影响因素分析[J].现代医学,2022,50(12):1579-1583.
[13] 李昆鹏,李国宏,吴郊锋,等.术后谵妄评估实施策略的研究进展[J].东南大学学报(医学版),2023,42(1):159-162.
[14] 刘雅楠,赵伟娣,马惠欣,等.老年心脏瓣膜置换术患者术后谵妄现状及影响因素分析[J].中华现代护理杂志,2022,28(29):4006-4010.
[15] 雷涛,刘松涛,沈斌.体外循环心脏瓣膜置换术后谵妄的危险因素及其交互效应[J].广西医科大学学报,2023,40(2):297-303.
[16] 静广建,刘照国,于飞,等.体外循环期间应用利多卡因对心脏瓣膜置换术后患者谵妄的影响[J].实用医学杂志,2022,38(13):1637-1641.
[17] KAPOOR M C.Neurological dysfunction after cardiac surgery and cardiac intensive care admission:a narrative review part 1:the problem; nomenclature; delirium and postoperative neurocognitive disorder; and the role of cardiac surgery and anesthesia[J].Ann Card Anaesth,2020,23(4):383-390.
[18] 邵燕茹,黄芳,邹美婷.早期康复护理对心脏瓣膜置换术术后并发症与康复效果的影响[J].护理实践与研究,2019,16(22):104-106.
[19] 陈波,冯凰,梁婧.心脏瓣膜置换术后并发严重室性心律失常危险因素的探讨及风险列线图模型的建立[J].临床心血管病杂志,2020,36(6):530-535.
[20] 高翠平,孙淑玲,肖茹,等.中老年心脏瓣膜置换术肺部感染危险因素调查[J].中国消毒学杂志,2023,40(4):284-286,290.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录