胚胎移植术后卧床的最佳证据应用

目的:收集有关胚胎移植后卧床的最佳证据并应用于临床实践,以优化胚胎移植后的护理规范,改善病人临床结局。方法:采用PIPOST格式构建循证问题,并进行证据检索,最终纳入指南1篇、系统评价5篇,在对证据进行质量评价后,依据最佳证据,制定5条审查指标,遵循分析障碍、构建策略、采取行动3个步骤实施变革,在变革前后进行基线审查和证据应用后的再审查,并比较两次审查数据。结果:基线审查时病人离院前休息时间为(36.93±20.09)min,首次排尿时间为(18.54±10.00)min,回家后平均增加卧床时间为(3.75±3.01)h,证据应用后再审查阶段,病人离院前休息时间为(26.25±24.33)min,首次排尿时间为(12.18±10.48)min,回家后平均增加卧床时间为(2.26±2.89)h,证据应用前后比较,差异均有统计学意义(P<0.05)。证据应用前后胚胎着床率分别为45.57%、57.50%,临床妊娠率分别为58.70%、75.00%,证据应用前后比较差异有统计学意义(P<0.05)。结论:胚胎移植术后任何时长的卧床均无益于病人结局,延长卧床时间反而不利于提高妊娠成功率。表明循证护理实践可促进证据向临床实践转化,优化护理规范,提高护理质量,改善病人结局。

Application of best evidence about bed rest after embryo transfer

Objective:To collect the best evidence about bed rest after embryo transfer and apply it to clinical practice to optimize the nursing specifications after embryo transfer and improve the clinical outcome of patients.Methods:The evidence was searched by using a PIPOST format to construct the evidence-based question.Finally,1 guideline and 5 systematic reviews were included.After evaluating the quality of evidence,five review indicators were formulated based on the best evidence.And the transform was implemented in three steps:analyzing obstacles,constructing strategies and taking actions.Baseline review and re-review after evidence application were conducted before and after the transform.Then,data from two reviews were compared.Results:During the baseline review,the patient′s rest time before leaving hospital was(36.93±20.09)min,the first urination time was(18.54±10.00)min,and the average increased bedtime after returning home was(3.75±3.010)h.After the evidence was applied,the patient′s rest time before leaving hospital was(26.25±24.33)min,the first urination time was(12.18±10.48)min and the average increased bedtime after returning home was(2.26±2.89)h.The differencs were statistically significant(P<0.05).The implantation rate before and after the application was 45.57%and 57.5%,the clinical pregnancy rate was 58.7%and 75%,respectively.There were statistically significant differencs between the two groups(P<0.05).Conclusion:The bed rest for any time after embryo transfer is not beneficial to the patient′s outcome.And prolonging the bed time is harmful to improving the pregnancy success.Evidence-based nursing practice can facilitate the transformation of evidence into clinical practice,optimize care norms,improve nursing quality,and improve patient outcomes.