Construction And Application Of Fluid Management Scheme In Elderly Patients After Heart Valve Replacement

Objective: To summarize the best evidence of fluid management for the elderly patients after heart valve replacement,and provide evidence support for the construction of fluid management scheme for the elderly patients after heart valve replacement;To build an integrated fluid management scheme for the elderly patients after heart valve replacement,and provide ideas and references for the current clinical fluid management of the elderly patients after heart valve replacement;The fluid management scheme for elderly patients after heart valve replacement was applied to clinical practice and its application effect was discussed.Methods: Phase I: Through systematic search and scientific evaluation of the guidelines,clinical decisions,expert consensus,system evaluation and meta-analysis related to fluid management of the elderly patients after heart valve replacement,which were published in February 2022 after the establishment of the database at home and abroad,the literature was screened according to the inclusion and exclusion criteria of the literature and the results of the literature quality evaluation,and the evidence was extracted and integrated,Finally,the best evidence of fluid management for elderly patients after heart valve replacement was formed.Phase II: Based on the summary of evidence and group discussion,the fluid management scheme for elderly patients after heart valve replacement was initially formulated,and the plan was reviewed and revised through two rounds of Delphi expert consultation,and finally the fluid management scheme for elderly patients after heart valve replacement was established.Phase III: 100 elderly patients who underwent heart valve replacement in a Class III Class A hospital in Guangxi from March to December 2022 were selected as the study subjects,and were divided into the experimental group and the control group with 50 cases each.The experimental group implemented the evidence-based fluid management scheme,while the control group adopted the conventional fluid management method.The incidence of fluid overload and related complications,reaching the target of fluid management,3-day cumulative fluid intake and output,fluid balance,duration of mechanical ventilation and length of stay in ICU were compared between the two groups,to evaluate the effectiveness of fluid management scheme for elderly patients after heart valve replacement.Results: Phase I: 16 articles were included,including 4 guidelines,3 clinical decisions,4 expert consensus,3 systematic evaluation,1 best practice,and 1meta-analysis.Finally,the best evidence for fluid management of patients after heart valve replacement in the elderly in 6 categories was formed,including teamwork,dynamic evaluation and monitoring of fluid status,early fluid resuscitation,early and correct use of positive inotropic drugs and vasoactive drugs,rational use of diuretics,and the use of goal directed fluid therapy strategies to guide individualized fluid management.Phase II: Based on the results of evidence integration,the fluid management scheme for elderly patients after heart valve replacement was initially formulated.After two rounds of expert consultation,the number of experts participating was 19,and the recovery rate of the questionnaire was 95% and 100% respectively;The authority coefficients are 0.866 and 0.863 respectively;The Kendall’s W levels is 0.128～0.212,which finally forms the integrated fluid management scheme for elderly patients after heart valve replacement,including 5first-level indicators,11 second-level indicators and 39 third-level indicators.Phase III: After the intervention program was implemented,the incidence of fluid overload and related complications was lower,the rate of reaching the target of fluid management in the experimental group was higher than that in the control group,the two groups Left ventricular ejection fraction(LVEF),cardiac index(CI),cardiac troponin I(c Tn I),creatine kinase isoenzyme(CK-MB),and N-terminal B-type natriuretic peptide precursor(NT-pro BNP),indicators change with time,and there is interaction between groups and time(P<0.05).By simple effect analysis,two groups LVEF、CI、c Tn I、CK-MB and NT-pro BNP no difference before intervention,6h,24 h,72h after intervention two groups LVEF、CI、c Tn I、CK-MB and NT-pro BNP are different(P<0.05).LVEF、CI、c Tn I、CK-MB and NT-pro BNP the difference between the groups was statistically significant(P<0.05);There was statistically significant difference in the cumulative fluid inflow and fluid balance at 3 days after operation(P<0.05);The duration of mechanical ventilation,the length of stay in ICU all lower than those in the control group(P<0.05).Conclusion(s): This study adopts evidence-based nursing research methods to construct a fluid management program for elderly patients after HVR surgery.Through clinical verification,this study confirmed that the fluid management scheme for elderly patients after heart valve replacement can effectively reduce the incidence of fluid overload and related complications,improve the target rate of fluid management,reduce the use of venous fluid,shorten the time of mechanical ventilation and ICU hospitalization,and is worthy of further promotion and application in clinical practice.