一项基于证据的护理实践对急诊科上消化道出血患者的应激状态、凝血功能、并发症和生活质量的影响：一项回顾性观察研究。

An evidence-based nursing practice affects stress state, coagulation, complications and quality of life in patients with upper gastrointestinal bleeding in the emergency department: a retrospective observational study.

机构信息

The Emergency Medicine Department, Affiliated Hospital of Southwest Medical University, Luzhou, 646000, P.R. China.

出版信息

BMC Gastroenterol. 2024 Nov 27;24(1):435. doi: 10.1186/s12876-024-03507-1.

DOI:10.1186/s12876-024-03507-1

PMID:39604901

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11600764/

Abstract

BACKGROUND

Acute gastrointestinal bleeding (GIB) is a common surgical emergency digestive system disorder with high morbidity and mortality.

AIM

This study sought to explore effects of evidence-based nursing practice (ENP) procedures on stress state, coagulation function, complications in patients with upper GIB (UGIB) and quantify of life in emergency department.

METHODS

This study was a retrospective analysis and a total of 120 patients with UGIB were enrolled and divided into an experimental group with ENP interventions and a reference group with traditional nursing according to different nursing programs. The physiological stress indicators (epinephrine, norepinephrine, plasma cortisol), psychological stress indicators [anxiety self-assessment scale (SAS), depression self-assessment scale (SDS)], coagulation function indicators [prothrombin time (PT), prothrombin time (TT), D-dimer (D-D), fibrinogen (FIB)], complication rate and quality of life were analyzed.

RESULTS

After nursing intervention, epinephrine, norepinephrine and plasma cortisol, SDS and SAS scores were decreased in the experimental group relative to the reference group (all P < 0.001). After nursing intervention, the levels of PT, TT and D-D in both groups were lower and the FIB was higher than before intervention (all P < 0.001), and the improvement of coagulation function indexes in experimental group after nursing was better than that in reference group (P < 0.001). The incidence of complications in the experimental group was lower than that in the reference group (P = 0.04). The higher quality of life scores after nursing intervention was validated in the experimental group relative to the reference group (P < 0.001).

CONCLUSION

ENP improved stress response, coagulation function, quality of life, and reduced incidence of complications in UGIB patients, indicating potential for clinical application.

摘要

背景

急性胃肠道出血（GIB）是一种常见的外科急症消化系统疾病，具有较高的发病率和死亡率。

目的

本研究旨在探讨循证护理实践（ENP）程序对上消化道出血（UGIB）患者应激状态、凝血功能、并发症和生活质量的影响。

方法

本研究为回顾性分析，共纳入 120 例 UGIB 患者，根据不同护理方案分为接受 ENP 干预的实验组和接受传统护理的对照组。分析生理应激指标（肾上腺素、去甲肾上腺素、血浆皮质醇）、心理应激指标[焦虑自评量表（SAS）、抑郁自评量表（SDS）]、凝血功能指标[凝血酶原时间（PT）、凝血酶时间（TT）、D-二聚体（D-D）、纤维蛋白原（FIB）]、并发症发生率和生活质量。

结果

护理干预后，实验组肾上腺素、去甲肾上腺素和血浆皮质醇、SDS 和 SAS 评分均低于对照组（均 P<0.001）。护理干预后，两组 PT、TT 和 D-D 水平均低于干预前，FIB 高于干预前（均 P<0.001），实验组护理干预后凝血功能指标改善优于对照组（P<0.001）。实验组并发症发生率低于对照组（P=0.04）。实验组护理干预后的生活质量评分高于对照组（P<0.001）。