Study Of Bundles Of Care In The Continuous Blood Purification Of Patients With Severe Acute Pancreatitis

Objective:1.To construct the bundles of care plan for patients with severe acute pancreatitis(SAP)in continuous blood purification though.2.To explore the impact of this plan on the average filter life length,the incidence of filter coagulation,the filter clearance performance,the incidence of unplanned instrument-removal,complications of continuous blood purification of SAP patients towards the care in order to provide reference for clinically promoting the treatment and care performance of continuous blood purification for SAP patients.Method:Part 1: To develop the bundles of care plan.At first,propose questions based on evidence,then screen literatures through literature retrieval,evaluate and summarize the retrieved evidence.Form the initial bundles of care plan for SAP patients in continuous blood purification,and finally establish the bundles of care for SAP patients in continuous blood purification based on Delphi method and clinical practice.Part 2: To implement the bundles of care plan.Select a total of 120 cases of SAP patients under continuous blood purification treatment in a Class III Grade I hospital in Qingdao City from March 2016 to August 2018.Divide the patients into intervention group and control group including 60 patients separately by random number table method.SAP patients in the control group are given routine care during continuous blood purification treatment while SAP patients in the intervention group are given the bundles of care plan during continuous blood purification treatment.The average filter life length during continuous blood purification treatment,the incidence of filter coagulation within12 hours in the first continuous blood purification treatment,the change of average transmembrane pressure during the continuous blood purification treatment,the filter clearance performance in continuous blood purification treatment,the incidence of unplanned instrument-removal,complications of continuous blood purification,treatment effect,pain anxiety of patients and satisfaction towards nursing are compared between the two groups of SAP patients.The collected data is analyzed using IBM SPSS Statistics23.0.The statistical methods included independent sample t test,chi square test,and repeated ANOVA.Results:1.The bundles of care plan was constructed with 6 first-level indicators,13second-level indicators,29 third-level indicators.After 2 rounds of expert consultation,the recovery rates were 90% and 100% respectively;The expert authority coefficient(CR)of the two rounds of correspondence consultation were 0.87 and 0.89 respectively;The coordination coefficient(Kendall’s W)of the two rounds of correspondence consultation was 0.213 and 0.458 respectively.2.The results of clinical controlled trials showed that the average filter life of continuous blood purification was significantly longer than that in the control group,statistical significance of the difference(P<0.05);The incidence of unexpected interruption of continuous blood purification treatment,the incidence filter blood coagulation in the first continuous blood purification treatment within 12 hours,the average transmembrane pressure at the 6th、12th、24th hour during continuous blood purification treatment,the incidence of complications in continuous blood purification treatment,the score of pain and anxiety in the intervention group were significantly lower than those in the control group,statistical significance of the difference(P<0.05).The filter clearance effect,the therapeutic effect and the satisfaction towards nursing in the intervention group were also significantly better than those in the control group,statistical significance of the difference(P<0.05).Conclusion:The bundles of care plan of continuous blood purification for SAP patients is reliable,scientific and feasible.The plan can effectively prolong the life length of filters,and delay filter blood coagulation,and reduce the incidence of unexpected interruption and complications of continuous blood purification,and enhance the effect of filter clearance on inflammatory media,and reduce the patient’s pain and anxiety,and significantly improve the quality of continuous blood purification care for SAP patients.