经导管主动脉瓣置换术患者Ⅰ期心脏康复的最佳证据应用

目的 将经导管主动脉瓣置换术（transcatheter aortic valve replacement,TAVR）患者Ⅰ期心脏康复的最佳证据应用于临床实践中,评价其效果,以促进TAVR患者术后早期康复。 方法 运用循证护理的方法总结TAVR患者Ⅰ期心脏康复的最佳证据,制订循证实践方案,经过基线审查、分析障碍因素、构建最佳证据应用策略,并于2020年9月30日—12月31日在浙江省某三级甲等医院心内科实施,比较证据应用前后患者的各项指标以及审查指标的执行率。 结果 患者TAVR术后住院时间由基线审查时的5（1,7） d缩短至3（1,6） d（P=0.016）,术后30 d的纽约心脏病学会心功能分级Ⅰ级占比由基线审查时的31.63%上升至72.09%（P<0.001）,Katz日常生活活动量表得分也较前有所改善（P=0.032）。最佳证据应用后,各审查指标的执行率均显著提高,从0~77.55%提高至59.30%~100%,差异具有统计学意义（P<0.001）。 结论 TAVR应用患者Ⅰ期心脏康复最佳证据指导护理实践,可缩短患者住院时间,改善患者临床结局。

Best evidence application of phase Ⅰ cardiac rehabilitation in transcatheter aortic valve replacement patients

Objective To investigate the application of best evidence for phase I cardiac rehabilitation in transcatheter aortic valve replacement（TAVR） patients into clinical practice and to evaluate its effectiveness. Methods The best evidence for phase I cardiac rehabilitation in patients with TAVR was summarized using an evidence-based care approach,and an evidence-based practice protocol was developed. The best evidence application strategy was constructed after a baseline review and analysis of barriers,and it was implemented in the cardiology department of a tertiary care hospital in Zhejiang Province from September 30 to December 31,2020. The indicators of patients before and after the application of evidence and the implementation rate of the reviewed entries were compared. Results The length of stay of patients after TAVR was shortened from 5（1,7） d at the baseline review to 3（1,6） d（P=0.016）. The percentage of cardiac function of New York Heart Association（NYHA） class I at 30 days postoperatively increased from 31.63% to 72.09%（P<0.001）,and the Katz index also improved（P=0.032）. After the application of best evidence,the rates of review indicators increased from 0~77.55% to 59.30%~100%,with a statistically significant difference（P<0.001）. Conclusion Best evidence application for phase I cardiac rehabilitation in patients undergoing TAVR can shorten patient length of stay,improve patient clinical outcomes,and standardize nurse behaviors.