结直肠癌术后女性患者盆底康复管理的最佳证据总结

目的 检索并总结结直肠癌术后女性患者盆底康复管理的最佳证据,为医护人员进行科学有效的盆底康复管理提供循证依据。方法 计算机检索2010年1月至2023年2月国内外有关指南网站和数据库中结直肠癌术后女性患者盆底康复管理的文献,对所纳入文献进行方法学质量评价后,对证据进行汇总、分级并归纳主题。结果 最终纳入22篇文献,其中指南4篇、临床决策5篇、专家共识2篇、系统评价8篇、随机对照试验3篇,提炼出11个方面、共55条最佳证据主题。结论 总结的结直肠癌术后女性患者盆底康复管理的最佳证据切实可行,医护人员可在多学科合作和循证基础上为结直肠癌术后女性患者提供标准化的结直肠癌术后盆底康复的管理与护理。     

肝癌加速康复外科术中保温技术的循证实践

目的提炼加速康复外科术中保温技术的最佳证据并应用于肝癌手术患者,以预防低体温的发生,促进患者康复。方法遵循JBI临床证据应用模式,系统检索后纳入指南、系统评价、专家共识共12篇文献,总结最佳证据,制定8项审查指标。对47例肝癌手术患者及7名手术室护士开展基线审查,分析障碍因素,进行系统改进,并将证据应用于47例肝癌手术患者。比较证据应用前后护士对审查指标的执行率及患者术中体温维持情况与低体温、寒战发生率。结果证据应用后护士对7项审查指标的执行率显著高于证据应用前(均P0.01);证据应用后患者术中体温显著高于证据应用前,低体温发生率由85.1%下降至27.7%(P0.05,P0.01)。结论基于最佳证据的保温技术用于肝癌患者加速康复外科手术,能维持患者术中体温,降低低体温发生率,加速患者术后康复。     

脊柱外科术后患者深静脉血栓预防及管理的最佳证据应用

目的将脊柱外科术后深静脉血栓预防及管理的最佳证据应用于临床实践,降低患者深静脉血栓发生率。方法遵循澳大利亚JBI证据临床应用模式,检索并总结脊柱外科术后患者深静脉血栓预防及管理的最佳证据,制定审查指标,通过证据应用前的基线审查、实践变革和证据应用后再审查,判断实施效果。结果最佳证据应用后,患者深静脉血栓发生率由2.90%降至0;医护人员深静脉血栓预防及管理知识得分,出血风险评估、机械及药物预防、健康宣教执行率显著提高(均P0.01)。结论深静脉血栓预防及管理最佳证据的应用,可提高医护人员深静脉血栓预防及管理水平,规范预防管理行为,降低患者深静脉血栓发生率。     

疼痛护理学组的组建和实践

目的成立疼痛护理学组,以提高全院疼痛管理质量和患者满意度。方法择优选取与疼痛管理相关科室的护理骨干为疼痛护理学组成员,并明确学组成员职责;设立学组质控控制体系;制定疼痛质控标准;规范镇痛流程;加强护士疼痛知识培训和教育等。结果成立疼痛护理学组后,患者的疼痛护理满意率由成立前的82.0%提升至97.1%(P0.01);患者24h内中重度疼痛发生率由60.0%下降至20.0%(P0.01);护士疼痛管理知识合格率由45.0%提升至70.0%(P0.01);疼痛评估合格率由85.0%提升到95.1%(P0.01)。结论疼痛护理学组的建立不仅可以提高医院疼痛管理质量、提高患者的满意度和舒适度,而且可以提升护士的疼痛管理水平和学术水平,推进疼痛护理学科向专业化发展。     

基于循证的维持性血液透析患者液体摄入依从性管理

目的将与维持性血液透析患者液体摄入依从性管理有关的最佳证据应用于临床护理实践,提高血液透析患者液体摄入控制依从性。方法将JBI临床证据实践应用系统和临床转化系统作为审查工具,基于现有的血液透析患者液体摄入依从性管理的最佳证据,制定5条审查标准。对20名护士、30例患者实施基线审查和证据应用后第2轮审查。结果基线审查时4条标准执行率较差(0~55.0%),第2轮审查时,第3条审查标准(患者自我监测液体摄入)执行率73.3%,其余4条审查标准执行率均100%。护士液体摄入管理知识和技能得分从12.70提高到14.60(P0.01);血液透析患者液体摄入知识和技能得分从11.13分提高到13.47分(P0.01),其液体摄入控制不依从率从53.33%降低至23.33%(P0.05)。结论基于循证的质量审查改善维持性血液透析患者液体摄入依从性管理的临床护理实践,可提高患者液体摄入控制依从性。     

肝动脉化疗栓塞术患者的多模式疼痛管理

目的评价多模式疼痛管理方案应用于肝动脉化疗栓塞术患者的效果。方法将166例肝动脉化疗栓塞术患者随机分为对照组80例和干预组86例,对照组采用传统疼痛管理策略,干预组采用多模式疼痛管理策略,包括建立医生、护士、药师及疼痛治疗师多学科团队,实施多模式镇痛知识宣教、超前非甾体抗炎药镇痛、局部浸润渗透、静脉自控镇痛泵、疼痛分级护理等措施。结果干预组术后24h内疼痛严重程度、不良反应(恶心呕吐、便秘腹胀)发生率及睡眠质量显著优于对照组(P0.05,P0.01)。结论多模式疼痛管理方案可有效控制肝动脉化疗栓塞术患者术后疼痛,有利于促进术后恢复。     

全麻气管插管患者术后咽喉疼痛预防最佳证据总结

目的 总结全麻气管插管患者术后咽喉疼痛预防的最佳证据,为预防术后咽喉疼痛提供循证依据.方法 运用循证护理的方法,检索相关数据库建库至2020年8月针对围手术期咽喉疼痛预防的临床决策、推荐实践、最佳实践信息册、指南、证据总结、系统评价、专家共识.结果 共纳入18篇文献,从咽喉疼痛评估、插管策略、预防药物、套囊管理、拔管管理方面总结20条最佳证据.结论 临床医护人员可通过最佳证据的临床转化及应用来减少全麻气管插管患者术后咽喉疼痛发生率和严重程度,促进患者康复.     

老年患者医用粘胶剂相关性皮肤损伤预防及管理的循证实践

目的 将老年患者医用粘胶剂相关性皮肤损伤预防及管理的最佳证据应用于临床实践,通过质量审查促进护理质量改进。方法 采取前瞻性对照设计,总结老年患者医用粘胶剂皮肤损伤的最佳证据,基于证据制定10条审查指标。于2018年7~11月在试点病房实施循证护理实践,通过基线审查(基线审查组119例),分析临床情景障碍因素,构建循证变革方案,并将方案应用于132例老年患者（证据应用组）。结果 最佳证据应用后进行第2轮审查,老年患者医用粘胶剂相关性皮肤损伤发生率由10.08%降至0.76%,患者皮肤瘙痒发生率、揭除敷贴后疼痛发生率由19.33%、39.50%降至2.27%、3.79%,差异有统计学意义（均P<0.01）。护士对最佳证据的执行率及相关知识知晓率均大幅提高。结论 老年患者医用粘胶剂相关性皮肤损伤预防及管理的最佳证据应用于临床,可规范护士应用医用粘胶剂的操作手法,降低患者皮肤损伤发生率,促进患者舒适。     

经阴道聚丙烯网片盆底重建术治疗重度盆腔器官脱垂的主观疗效观察

目的：调查经阴道聚丙烯网片盆底重建术治疗重度盆腔器官脱垂（POP）的主观疗效。方法：对2004年5月-2011年3月因重度POP在解放军总医院第一附属医院行经阴道聚丙烯网片盆底重建术治疗的114例患者,分别于术前及术后2个月、6个月、1年时进行盆底功能障碍症状及其对生活质量影响的问卷调查,调查采用盆底功能障碍（PFD）症状问卷——盆底困扰量表简表（PFDI-20）以及生活质量问卷——盆底影响问卷简表（PFIQ-7）。结果：术后2个月、6个月、1年时随访率分别为84％（96／114例）、75％（85／114例）和68％（77／114例）。术后1年时随访患者的POP-Q分期均≤I期,手术客观成功率100％。术后2个月发生网片暴露19例（19．8％,19／96例）,术后1年时网片暴露仍有6例（7．8％,6／77例）。术后2个月患者阴道或盆腔困扰症状、排尿困扰症状及排便梗阻症状明显缓解并维持至术后1年,PFDI-20与PFIQ-7评分均较术前明显下降（P〈O．01）。结论：经阴道聚丙烯网片盆底重建术可有效缓解重度POP患者的盆底功能障碍症状,显著改善患者生活质量。     

改良全盆底重建手术并发症的预防及术后处理措施

盆腔脏器脱垂(POP)是由于盆底肌肉、筋膜等支持组织结构损伤、缺陷等导致盆腔器官位置异常和功能障碍的一类疾病,常发于中老年女性,严重影响患者的生命质量。对于中重度的POP患者,手术仍是最重要且有效的治疗方式。改良全盆底重建术能显著改善患者症状及生活质量,近年来对POP患者的治疗取得了较好的临床效果,但其近、远期并发症也引起大家的广泛重视。本文针对改良全盆底重建术的术中并发症包括出血或血肿形成,膀胱或直肠损伤,阴道侧壁穿孔和术后并发症包括排尿困难、网片暴露与侵蚀、盆底疼痛、POP复发、新发尿失禁、性交困难或疼痛不适等的产生原因、治疗方法以及预防措施进行综述。     

Pelvic floor electromyography in men with chronic pelvic pain syndrome: a case-control study

AIMS: The objectives of this study were (1) to identify differences between men with chronic pelvic pain syndrome (CPPS), compared with pain-free men, in surface electromyography/biofeedback (sEMG/BFB) readings of pelvic floor muscles and (2) to determine which pelvic floor muscle sEMG readings may have differential diagnostic and treatment selection value by accurately predicting group membership, CPPS versus normal. METHODS: Twenty-one men with CPPS and 21 healthy men without pelvic pain underwent a standardized sEMG examination by a licensed physical therapist. RESULTS: On group difference measures men with CPPS showed significantly greater sEMG instability in preliminary resting baseline. Three sEMG measures reliably categorized CPPS versus normals with CPPS showing greater preliminary resting baseline hypertonicity and instability with lowered voluntary endurance contraction amplitude. CONCLUSIONS: CPPS patients manifest pelvic floor muscle instability compared to normals. Prebaseline resting hypertonicity and instability along with endurance contraction weakness reliably predicts subject membership in the CPPS vs. normal group. Pelvic floor muscle sEMG may be a valuable screening tool to identify patients with CPPS who may benefit from therapies aimed at correcting pelvic floor muscle dysfunction.     

Symptom profile variability of interstitial cystitis/painful bladder syndrome by age

Study Type – Diagnostic (symptom prevalence) Level of Evidence 2b What's known on the subject? and What does the study add? Symptom variability is profound in the population of patients diagnosed with interstitial cystitis and painful bladder syndrome because these diagnoses represent a very heterogeneous patient population. Recently, younger patients are being diagnosed with these pain syndromes, without any specific investigation into the symptoms they experience. We identified that patients diagnosed with interstitial cystitis and painful bladder syndrome have variable clinical symptom profiles depending on the age at the time of their diagnosis. Dyspareunia, external genitalia pain, urgency, frequency and dysuria were more common in younger patients whereas nocturia, urinary incontinence and the presence of Hunner's ulcers were more common in older patients. Better defining symptom profiles for patients at the time of evaluation may potentially aid in more accurate and expedited diagnosis of these conditions, particularly in the youngest patient population which is being recognized more commonly in recent times.

OBJECTIVE

• ? To investigate the clinical profile differences among patients with interstitial cystitis/painful bladder syndrome (IC/PBS) based upon age at the time of diagnosis from childhood into the geriatric age group.

METHODS

• ? An analysis of 268 patients with IC/PBS seen between 1990 and 2008 was performed.
• ? Three age cohorts were analysed: <30 years, ≥30 years but <60 years, and ≥60 years of age at time of diagnosis.
• ? Patient demographics, disease characteristics and IC/PBS‐associated symptoms were compared across the three groups.

RESULTS

• ? Of the 268 patients, 60 were <30 years of age at the time of IC diagnosis (median 22, range 11–29), 105 were ≥30 but <60 years (median 48, range 30–59) and 103 patients were ≥60 years of age (median 69, range 60–88).
• ? Of the patients in the youngest, middle and oldest age cohorts: 12.0, 42.0 and 39.8% had Hunner's ulcers, respectively (P < 0.001).
• ? Dyspareunia and external genitalia pain were more common in the youngest age cohort, P < 0.001 and P = 0.001, respectively.
• ? Urinary urgency (P = 0.033), frequency (P = 0.006) and dysuria (P < 0.001) were also more common in patients diagnosed before 30 years of age.
• ? The reported rate of nocturia and urinary incontinence increased with age, P = 0.002 and P < 0.001, respectively.

CONCLUSIONS

• ? Patients with IC/PBS analysed across a wide spectrum of ages at time of diagnosis portrayed a unique symptom profile pattern.
• ? Patients diagnosed at the youngest ages experienced significantly more urinary urgency, frequency, dysuria, dyspareunia and pain in their external genitalia.
• ? Older patients had higher rates of nocturia, urinary incontinence and Hunner's ulcer disease.

     

Barium proctography vs magnetic resonance proctography for pelvic floor disorders: a comparative study

Aim Accurate and reliable imaging of pelvic floor dynamics is important for tailoring treatment in pelvic floor disorders; however, two imaging modalities are available. Barium proctography (BaP) is widely used, but involves a significant radiation dose. Magnetic resonance (MR) proctography allows visualization of all pelvic midline structures but patients are supine. This project investigates whether there are measurable differences between BaP and MR proctography. Patient preference for the tests was also investigated. Methods Consecutive patients referred for BaP were invited to participate (National Research Ethics Service approved). Participants underwent BaP in Poole and MR proctography in Dorchester. Proctograms were reported by a consultant radiologist with pelvic floor subspecialization. Results A total of 71 patients were recruited. Both tests were carried out on 42 patients. Complete rectal emptying was observed in 29% (12/42) on BaP and in 2% (1/42) on MR proctography. Anismus was reported in 29% (12/42) on BaP and 43% (18/42) on MR proctography. MR proctography missed 31% (11/35) of rectal intussusception detected on BaP. In 10 of these cases no rectal evacuation was achieved during MR proctography. The measure of agreement between grade of rectal intussusception was fair (κ = 0.260) although MR proctography tended to underestimate the grade. Rectoceles were extremely common but clinically relevant differences in size were evident. Patients reported that they found MR proctography less embarrassing but harder to empty their bowel. Conclusions The results demonstrate that MR proctography under‐reports pelvic floor abnormalities especially where there has been poor rectal evacuation.