延续护理对心脏瓣膜置换术后患者服药与凝血功能状况的影响

目的 探讨以电话随访为主的延续护理对心脏换瓣患者服药依从性和凝血功能状况的影响。方法 选取2013年9月-2014年9月在我院胸心外科行心脏瓣膜手术的患者106例，按患者出院先后顺序分为对照组和观察组各53例，对照组在住院期间和出院后给予常规的治疗、护理、健康教育及出院指导，观察组在此基础上出院后给予系统的延续护理1年，比较两组患者抗凝相关知识掌握程度、抗凝治疗依从性、按时复诊情况、患者INR监测和抗凝不当引起的并发症发生的情况。结果 观察组对抗凝相关知识掌握与对照组比较，差异有统计学意义（P<0.05）；观察组按时服药依从性与对照组比较，差异有统计学意义（P<0.05）；观察组按时复诊率与对照组比较，差异有统计学意义（P<0.05）；观察组患者发生出血、血栓或栓塞等症状与对照组比较明显减少，差异有统计学意义（P<0.05）。结论 对心脏瓣膜置换术后患者加强出院后的延续护理指导，尤其是按时服药的监督与管理，可以提高患者的服药依从性，提高INR达标率，降低抗凝治疗相关并发症，对提高患者的生活质量有重要意义。

The application of monitoring bispectral index combined with RASS in sedation patients with unplanned extubation of mechanical ventilation

To discuss the application of monitoring bispectral index combined with RASS in sedation patients with unplanned extubation of mechanical ventilation. Method Take into 88 patients who have received mechanical ventilationfor more than 24h and randomly divide them into control group and treatment group, each of 44 cases. The control group aremonitored with RASS and the treatment group with both bispectral index and RASS, according to the degree of sedation for corresponding nursing treatment, and centralized operation as far as possible. Compare the incidence of unplanned extubation of mechanical ventilation between the two groups. Results The incidence of unplanned extubation of mechanical ventilation from the treatment group is obviously lower than from the control group. Conclusion the application of monitoring bispectral index combined with RASS can reduce the incidence of unplanned extubation obviously compared with application of RASS alone, which makes nursing the postoperative patients safer and more effective.