| Research background:Diabetes exists as an independent cardiovascular risk factor[1],the risk of diabeticpatients with cardiovascular disease is two to four times as with those do not havediabetes[2].Compare the symptoms and treatments of coronary heart disease with bothconditions, even if the degree of the disease is similar or even less severe, diabeticpatients are more prone to have complications like heart failure or cardiogenicshock[3].If the efficacy of comprehensive interventions for patients including drugtherapies are not ideal, health care workers should consider percutaneous coronaryintervention, its purpose is to enable the recanalization occluded vessels in shortperiod of time, and to improve cardiac ischemic symptoms in maximum extent, thistechnique becomes an important means of treating CHD because it is minimallyinvasive, relatively safe, it has significant treatment effect and the patients couldrecover from surgery in a shorter time. No matter treated with what kind ofrevascularization ways, the prognosis will not be ideal for coronary heart diseasepatients complicated with type Ⅱ diabetes compared with whose who do notcomplicated with type Ⅱdiabetes, and the re-stenosis rate are also high[4](level-Arecommended).Even though through the active treatment the clinical efficacy can beimproved, the potential atherosclerosis risk factors cannot be eliminated byPCI[5](level-A recommended),the patient could suffer angina or even myocardialinfarction again, these will all turn into an unsatisfactory prognosis, especially CHDpatients associated with type Ⅱ diabetes,its long-term prognosis is worse than thosepatients who do not have DM[6](level-A recommended), its pathological changes aremore complicated, it involves a wide range of severe, rapid progress, targeted caremust be implemented in clinical nursing. Therefore close observation and proper care after intervention can be effective in reducing the incidence of complications.Evidence-based medicine has changed the traditional care that based on the behaviorand habits of personal experience and intuition, proposes a new perspective and playsa more important role in the development of cardiology care.This paper aims to study evaluation and application of evidence-based nursing inpatients with coronary heart disease complicated with type Ⅱdiabetes mellitustreated with percutaneous transluminal coronary angioplasty and intracoronarystenting during peri-operative care.Research objective:(1)Enhance nursing expertise of peri-operative care, improve clinical care procedureand rules on patients have CHD and type Ⅱ diabetes treated with coronaryintervention.(2)Seeking for the best clinical evidence, providing reliable scientific clinical nursingpractice decision basis, and providing ideas and guidance for clinical nursing path(CNP).(3)Perfect clinical care plan and apply into clinical nursing, improve the quality ofnurses and nursing work.(4)Apply and evaluate the effect of nursing, summarize and improve the methods ofnursing, enable the patients to get the best quality of care.Research method:The study has selected108patients who have CHD and type Ⅱ diabetes treatedwith percutaneous coronary intervention in a hospital in Changchun from April toAugust in the year2013as research subjects. Apply digital random sampling methodand divide them into evidence-based group (experimental group) and conventionalgroup (control group),54patients in each group. All patients are undergoingpercutaneous coronary intervention, and the intervention approaches are radial arteryor (and) the femoral artery puncture. According to the research methods ofevidence-based nursing, select material by searching through books, knowledgenetworks and authority opinions of experienced clinical doctors and nurses, thensummarize the obtained documents into evidence-based and standardized nursingmethods by classifying, evaluating, analyzing and summarizing, developing nursing interventions that combined with the wishes of the patients, and use them into clinicalpractice, then analyze and evaluate the effect of nursing measures. Evidence-basedgroup uses the newly developed plans for nursing care, and conventional group usesconventional care plans. Using statistical methods to analyze research findings, all thedata entered by EpiData3.1software, use SPSS17.0software for data analysis, use Utest for measurement data and X2test for count data.Research results:There are no significant differences between the two groups in gender, age,educational level and the composition of disease (P>0.05); there are no significantdifferences in vascular lesions, the number of lesions, the degree of stenosis andthrombosis site (P>0.05); there are no significant differences in the cradle type,number of stents, the amount of contrast agent and heparin(P>0.05),which means thetwo groups of patients are comparable.The evidence-based group has a lower degree of the incidence of arrhythmia,hypoglycemia, complications of punctured vascular injury than that of conventionalgroup, the differences are significant(P<0.05),which shows the care measures ofevidence-based group are more effective in controlling blood sugar, heart rate, andwound healing; the incidence of cardiogenic shock and heart failure are reduced,which shows the care measures of evidence-based group are more effective, but thedata is not statistically significant(P>0.05)The incidence of hemorrhage, urinary retention, vagal reflex, back pain,hypotension, insomnia, the contrast agent reactions, back pain, physical activity painand constipation are lower than conventional group, differences are statisticallysignificant(P<0.01); the incidence of wound healing problems, contrast agentresponse and bloating are lower than conventional group, but the data is not statisticalsignificant(P>0.05),which suggests the care methods of evidence-based nursing groupcan help reducing the incidence of negative effects of postoperative care.Monitoring the abnormal condition of patients’ glucose, ECG and bloodpressures before and after the treatment; the incidence of glucose abnormal ofevidence-based group before treatment is significantly lower than that of conventionalgroup(P<0.01),the differences are statistically significant; the incidence of bloodpressure abnormal of evidence-based group before the treatment is lower than that of conventional group, the differences are statistically significant(P<0.05);the incidenceof ECG abnormal before the treatment of evidence-based group is lower than that ofconventional group, but the data is not statistical significant(P>0.05);the incidence ofblood pressure abnormal of evidence-based group after the treatment is significantlower than that of conventional group (P<0.01),the differences are statisticallysignificant; the incidence of glucose abnormal and ECG abnormal of evidence-basedgroup after the treatment are lower than that of conventional group, the differences arestatistically significant(P<0.05);which suggests the care methods of evidence-basednursing group can help reducing the incidence of glucose abnormal, ECG abnormaland blood pressure abnormal before and after the treatment.Compare the insecurity of the two groups after the nursing intervention for thepatients, the incidence of angina, taking medicine by not following doctors’ orders,not having a strict control of diet, not having exact exercise methods, fasting plasmaglucose are higher or lower than normal of evidence-based group is lower than that ofconventional group(P<0.01),the differences are statistically significant; the incidenceof having chest tightness after defecation, hypoglycemia of evidence-based group islower than that of conventional group, the differences are statisticallysignificant(P<0.05);the incidence of falling down of evidence-base group is lowerthan that of conventional group, but the data is not statisticalsignificant(P>0.05);which suggests the care methods of evidence-based nursing groupcan help improving the safety of the patients.Compare the early activities of the two groups of patients, compare the time ofpatients’ that started the activities in bed, the time to start the activities out of bed,6minutes’ walking distance24hours after the surgery,12minutes’ walking distance1day before leaving the hospital. The time of patients’ started the activities in bed andout bed of evidence-based group is significantly shorter than that of conventionalgroup, the distance of6minutes’24hours after the surgery and12minutes’1daybefore leaving the hospital of evidence-based group is significantly longer than that ofconventional group, the differences are statistically significant(P<0.01); whichsuggests the care methods of evidence-based nursing group can help improvingpatients’ ability of early activities.Compare the satisfaction of two groups of patients, the data of satisfaction ofevidence-based group is significantly higher than that of conventional group in the informing the progression of disease, the differences are statisticallysignificant(P<0.001); the data of satisfaction of evidence-based group is significantlyhigher than that of conventional group in the postoperative evaluation of healtheducation and overall assessment of the work of nurses, the differences arestatistically significant(P<0.001);the data of satisfaction of evidence-based group issignificantly higher than that of conventional group in the evaluation of healtheducation during pre-operative and service attitude of nurses, the differences arestatistically significant (P<0.05); the data of satisfaction of evidence-based group issignificantly higher than that of conventional group in the assessment of nursing skillsof operation and communication, but the data is not statistical significant(P>0.05);which suggests the care methods of evidence-based nursing group can help improvingpatients’ satisfaction.Conclusion(1)The nursing methods of evidence-based group can help reducing the incidenceof negative reactions, and help to promote early rehabilitation and the quality ofpatients’ life with CHD and type Ⅱ diabetes treated with coronary intervention.(2)The nursing behavior have been standardized, medical care activities haveachieved to be standardized and procedural, which transforms nursing from passivework to active, planned, predictable implementation, and it helps to improve the caremethods to be more efficient.(3)The care methods implement the overall care, concept of evidence-based care,which choose the best methods of nursing care, provide continuous multidisciplinaryteam of service, and improve the quality of health care, and show significant specialistfeatures.(4)The awareness of patients’ ability of self-management, the trust andsatisfaction gained by nurses has been improved. The initiative-collaborativenurse-patient relationship has been established.(5)Continuous improvement of specialist care has been promoted,quality carehas been emphasized on.We are able to find deficiencies in clinical nursing work byevidence-based care group measures, to keep the good qualities, and to abandon thebad ones and to improve the irrational aspects, which ensure the effectiveimplementation of nursing work. (6)The update and consolidation of nursing knowledge and specialist traininghave been strengthened, which has a meaningful importance for nurses to broaden andenhance professional nursing care methods. |
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