心肌梗死急性期患者容量管理质量改进的循证实践

doi:10.3761/j.issn.2096-7446.2025.07.017

摘要/Abstract

摘要：

目的将心肌梗死急性期患者容量管理的最佳证据应用于临床实践并评价其效果。方法总结心肌梗死急性期患者容量管理的最佳证据，基于最佳证据确定评价指标、分析证据转化的影响因素、结合临床情境制订实施计划。2023年9月—12月在重庆市某三级甲等医院两院区的心血管内科病房实施基于证据的临床实践，比较实践前后医护人员对心肌梗死急性期患者容量管理的知识水平与对审查指标的执行率，以及患者相关结局指标的改善情况。结果证据应用前后，医护人员的容量管理知识得分从（80.13±11.97）分提升到（89.37±14.91）分（P<0.001），11个审查指标的执行率从15.38%~57.69%提升到66.67%~100%（P<0.05）。患者的NYHA心功能分级、肺部B线积分、左心室射血分数、NT-proBNP、下腔静脉最大直径、住院时间、3个月内非计划再入院率均有所改善（P<0.05），6分钟步行距离无改善（P>0.05）。结论将心肌梗死急性期患者容量管理循证方案应用于临床，可改善患者预后，提高医护人员对最佳证据执行的依从性。

关键词: 心肌梗死, 容量管理, 肺部超声, 循证实践, 护理质量

Abstract:

Objective To apply the best evidence on volume management of myocardial infarction patients during the acute phase to clinical practice and evaluate its effect. Methods The team summarized the best evidence for volume management in patients with acute myocardial infarction，developed evaluation indicators based on the best evidence，analyzed the influencing factors of evidence translation，and developed implementation plans in combination with clinical scenarios. Evidence based clinical practice was implemented from September 2023 to December 2023 in cardiovascular wards of two campuses of a tertiary class A hospital in Chongqing. The knowledge level of medical staff on volume management of acute myocardial infarction patients and the implementation rate of review indicators were compared before and after the practice，as well as the improvement of patient related outcome indicators. Results Before and after the application of evidence，the nurses’ volume management knowledge score improved from （80.13±11.97） to （89.37±14.91）（P<0.001），and the implementation rate of the 11 review indicators improved from 15.38%-57.69% to 66.67%-100%（P<0.05）. Patients’ NYHA cardiac function grade，number of pulmonary B-lines，left ventricular ejection fraction，NT-proBNP，maximum diameter of inferior vena cava，length of hospital stay，and unplanned readmission rate within 3 months improved（P<0.05），while six-minute walking distance did not improve（P>0.05）. Conclusion Applying an evidence-based program for volume management in the acute phase of myocardial infarction patients improves patient prognosis and increases nurses’ adherence to best evidence implementation.

Key words: Myocardial Infarction, Volume Management, Lung Ultrasound, Evidence-Based Practice, Quality of Care

薛秋华, 李淼, 奚海霞, 韩睿, 吴婵, 瞿广素. 心肌梗死急性期患者容量管理质量改进的循证实践[J]. 中华急危重症护理杂志, 2025, 6(7): 859-865.

XUE Qiuhua, LI Miao, XI Haixia, HAN Rui, WU Chan, QU Guangsu. Best evidence practice of quality improvement in volume management in myocardial infarction patients during the acute phase[J]. Chinese Journal of Emergency and Critical Care Nursing, 2025, 6(7): 859-865.

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