妊娠劇吐病人循證護理的最佳臨床實踐

Best clinical practice for evidence-based nursing care of patients with hyperemesis gravidarum

FU Shaoli，WANG Huarong，YANG Xiaoqing，CAO MingyingChongqing University of" Chinese Medicine，Chongqing 402760 ChinaCorresponding Author CAO Mingying，E-mail：254324844@qq.com

Abstract Objective：To apply a clinical nursing plan for the prevention and management of nausea and vomiting during pregnancy based on the best evidence available，and to observe the clinical outcomes of evidence-based nursing for patients with hyperemesis gravidarum.Methods：This study used the PIPOST model from the Fudan University Evidence-Based Nursing Center to establish evidence-based questions.Relevant evidence on the nursing of hyperemesis gravidarum was collected through searches of databases such as BMJ Best Practice，PubMed，WanFang Database，CNKI，ACOG，NGC，NICE.An evidence-based nursing plan for hyperemesis gravidarum was developed and applied to cases.A total of 60 patients with hyperemesis gravidarum who were admitted to a hospital between October 2018 and February 2021 were selected as study subjects and randomly divided into an experimental group and a control group.Both groups received basic fluid therapy，with the experimental group implementing the evidence-based nursing practice plan for hyperemesis gravidarum and the control group receiving conventional specialized nursing care.The clinical outcomes of the two groups were observed.Results：After implementing the evidence-based nursing plan for hyperemesis gravidarum，patient compliance in the experimental group improved，and the frequency of vomiting and the time for urine ketone bodies to turn negative at discharge were better than those in the control group，with statistically significant differences （Plt;0.05）.Additionally，the execution of care by medical staff also improved.Conclusion：The evidence-based nursing plan for hyperemesis gravidarum can enhance the execution by medical staff and patient compliance，reduce the severity of nausea and vomiting in hyperemesis gravidarum patients，and improve their quality of life.

Keywords hyperemesis gravidarum;evidence-based nursing;clinical practice

摘要 目的：應用在循證基礎上的妊娠期惡心嘔吐預防及管理的最佳證據(jù)臨床護理方案，觀察妊娠劇吐病人的循證護理臨床實施效果。方法：通過運用復旦大學循證護理中心的PIPOST模型來確立循證問題；通過檢索BMJ Best Practice、PubMed、萬方數(shù)據(jù)庫、中國知網(wǎng)、美國婦產(chǎn)科醫(yī)師學會、美國國立指南數(shù)據(jù)庫、英國國家衛(wèi)生與臨床優(yōu)化研究所等數(shù)據(jù)庫收集妊娠劇吐護理的相關證據(jù)，構(gòu)建妊娠劇吐的循證護理方案，并應用該方案。選取2018年10月—2021年2月在某院收治的妊娠劇吐病人作為研究對象，按隨機數(shù)字表法將其分為試驗組和對照組。兩組病人均接受基礎補液治療，試驗組實施妊娠劇吐循證護理實踐方案，對照組行常規(guī)專科護理，觀察兩組病人的臨床效果。結(jié)果：實施妊娠劇吐循證護理方案后，試驗組病人的依從性提高，出院時嘔吐頻次及尿酮體轉(zhuǎn)陰時間均優(yōu)于對照組，差異均有統(tǒng)計學意義（P＜0.05）；同時醫(yī)護人員的執(zhí)行力也有所提升。結(jié)論：基于循證的妊娠劇吐護理方案可提高醫(yī)護人員的執(zhí)行力和病人的依從性，并能改善妊娠劇吐病人的惡心嘔吐程度等癥狀，提高病人的生活質(zhì)量。

關鍵詞 妊娠劇吐；循證護理；臨床實踐

doi：10.12102/j.issn.2095-8668.2024.19.008

在妊娠早期，50%～80%的孕婦會經(jīng)歷惡心和嘔吐等典型的妊娠相關癥狀，在這些癥狀中，91%的孕婦在懷孕20周后癥狀可能會得到緩解，然而，大約10%的孕婦會在整個孕期持續(xù)出現(xiàn)這些癥狀，其中0.3%～3.0%的孕婦可能會發(fā)展為妊娠劇吐［1-4］。醫(yī)護人員與病人往往由于對孕期藥物安全的擔憂而導致治療不當或延遲就醫(yī)，這可能引起孕婦及胎兒嚴重的并發(fā)癥，如韋尼克腦病、脾破裂等，低出生體重兒、小于胎齡兒及早產(chǎn)兒發(fā)生率增加［5］。……