护理SCI晨读：心脏手术患者手术恢复延迟的预后指标
及时识别选定的临床指标证明了延迟手术恢复的良好预后能力。
心脏手术患者手术恢复延迟的预后指标
分享智慧
共同成长
摘要
目的
分析心脏手术患者整个住院期间的延迟手术恢复护理诊断临床指标的预后能力。
设计
前瞻性队列设计。在术前即刻和住院期间对接受择期心脏手术的住院患者进行了随访。这项研究是在巴西东南部的一家国家机构进行，该机构治疗高度复杂的疾病并进行心脏外科手术。数据收集自2017年7月至2018年7月。
方法
在数据收集的1年末，该研究随访了181例患者。使用Kaplan-Meier方法计算与延迟手术恢复相关的生存时间。此外，还使用调整了时变协变量的扩展Cox模型，以识别影响护理诊断状态变化的临床体征。
结果
所研究的样本中有23.2％存在延迟的手术恢复护理诊断。预期的住院时间为8至10天，大多数新的延迟手术恢复病例是在术后第10天观察到的，此后的存活率一直降低到术后第29天，此时不再出现护理诊断。手术区域的中断愈合，食欲不振和房扑是与延迟手术恢复风险增加相关的指标。
结论
及时识别选定的临床指标证明了延迟手术恢复的良好预后能力。
临床相关性
准确识别预后因素可以使护士识别术后并发症的早期征兆。因此，专业人员可以制定个性化的护理计划，以期使患者更好地康复。
Abstract
Purpose
The purpose of this study was to analyze the prognostic capacity of the clinical indicators of a delayed surgical recovery nursing diagnosis throughout the hospital stay of patients having cardiac surgery.
Design
A prospective cohort design was adopted. A sample of inpatients undergoing elective cardiac surgery was followed during the immediate preoperative period and hospitalization. This research was conducted in the southeast region of Brazil at a national reference institution that treats highly complex diseases and performs cardiac surgeries. Data were collected from July 2017 to July 2018.
Methods
At the end of 1 year of data collection, 181 patients were followed in this study. The Kaplan‐Meier method was used to calculate the survival time related to delayed surgical recovery. In addition, an extended Cox model of time‐dependent covariates was adjusted to identify the clinical signs that influenced the change in the nursing diagnosis status.
Results
A delayed surgical recovery nursing diagnosis was present in 23.2% of the sample studied. With an expected length of stay of 8 to 10 days, most new cases of delayed surgical recovery were observed on the 10th postoperative day, and the survival rate after this day was decreased until the 29th postoperative day, when the nursing diagnosis no longer appeared. Interrupted healing of the surgical area, loss of appetite, and atrial flutter were indicators related to an increased risk for delayed surgical recovery.
Conclusions
Timely recognition of selected clinical indicators demonstrates a promising prognostic capacity for delayed surgical recovery.
Clinical Relevance
Accurate identification of prognostic factors allows nurses to identify early signs of postoperative complications. Consequently, the professional can develop an individualized plan of care, aiming at the satisfactory clinical recovery of the patient.
原文链接：
https://sigmapubs.onlinelibrary.wiley.com/doi/full/10.1111/jnu.12662
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