产科临床实践中产后出血预防和护理的最佳证据总结

Summary of the Best Evidence for Postpartum Hemorrhage Prevention and Care in Obstetric Clinical Practice

摘要: 目的：检索、评价和整合预防产后出血的最佳证据。总结循证护理在产科临床中产后出血预防与护理中的应用效果，指导其临床应用。方法：采用PIPOST方法，从人群、干预措施、对照措施、结局指标、实施场所、时间六个维度，全面细致界定循证问题，保障循证实践的科学性与针对性。从上到下系统检索国内外权威资源，依据“6S”金字塔证据模型。范围涵盖电脑决策系统、预览网站、专业学会网站、知名资料库。检索证据类型多样，覆盖临床决策、指南、系统综述等，全面涵盖预防产后出血领域成果。对符合标准文献严格质量评价，用AGREE II量表评指南质量，确保文献可靠有效。提取预防产后出血相关关键信息，最后依据证据质量和可靠性分级，为循证实践提供清晰依据，协助医护人员合理选择措施。结果：最终纳入文献13篇，其中指南2篇、专家共识2篇、证据总结1篇、护理与调查研究3篇、系统评价1篇、综述3篇。从风险评估、贫血管理、健康教育、分娩方式选择、缩宫素应用、第三产程处理、产程控制、生命体征监测、阴道流血量监测、子宫收缩监测及心理护理11个方面，系统总结出23条产后出血预防与护理的最佳证据。结论：临床管理者肩负着重要职责，需着重强化对产后大出血急诊处理流程的精细化管理。大力推进对医护人员的规范化、系统化培训工作，通过丰富多样的培训形式与专业课程，切实提升临床医护人员在预防和治疗产后大出血方面的专业素养与实操能力。在实际临床工作中，能够更有效地应对产后大出血情况，尽可能地减少产后大出血的发生几率，显著降低其死亡率，为产妇的生命健康提供更为坚实可靠的保障。意义：通过系统检索和整合国内外权威资源，总结了23条产后出血预防与护理的最佳证据，帮助护理人员更好地进行护理评估、护理诊断和护理规划，制定科学有效的护理措施，改进工作方法，解决患者存在的和潜在的问题，从而促进临床护理实践的科学性和有效性。适用范围：适用于有出血倾向的产妇，预防产妇产后出血，帮助医务工作者制定科学有效的医疗护理措施。

Abstract: Objective: To search, evaluate and integrate the best evidence for the prevention of postpartum hemorrhage. To summarize the application effect of evidence-based nursing in the prevention and nursing of postpartum hemorrhage in obstetrics and guide its clinical application. Methods: The PIPOST method was used to define evidence-based problems comprehensively and carefully from six dimensions of population, intervention measures, control measures, outcome indicators, implementation places and time, so as to ensure the scientific and pertinence of evidence-based practice. Authoritative resources at home and abroad were searched systematically from top to bottom, according to the “6S” pyramid evidence model. The scope covers computer decision systems, tour websites, professional association websites, and well-known databases. The search evidence types are diverse, covering clinical decision-making, guidelines, systematic reviews, etc., and comprehensively covering the prevention of postpartum hemorrhage. The paper conducted a rigorous quality assessment of eligible literature using the AGREE II instrument to ensure the reliability and validity of the guidelines. Key information related to the prevention of postpartum hemorrhage was extracted, and finally graded according to the quality and reliability of evidence to provide a clear basis for evidence-based practice and assist medical staff to choose reasonable measures. Results: 13 pieces of literature were included, including 2 guidelines, 2 expert consensus, 1 evidence summary, 3 nursing and investigation studies, 1 systematic review, and 3 reviews. From 11 aspects, such as risk assessment, anemia management, health education, delivery mode selection, uterine hormone application, the third stage of labor management, labor control, vital signs monitoring, vaginal bleeding monitoring, uterine contraction monitoring and psychological care, 23 best pieces of evidence for postpartum bleeding prevention and care were systematically summarized. Conclusion: Clinical managers shoulder important responsibilities and need to strengthen the fine management of the emergency treatment process of postpartum massive hemorrhage. Standardized and systematic training for medical staff should be vigorously promoted. Through a variety of training formats and specialized courses, the professional competence and practical skills of clinical medical staff in the prevention and treatment of postpartum hemorrhage should be effectively enhanced. In actual clinical work, it can more effectively deal with postpartum massive bleeding, reduce the incidence of postpartum massive bleeding as much as possible, significantly reduce its mortality, and provide a more solid and reliable guarantee for the life and health of pregnant women. Significance: Through systematic retrieval and integration of domestic and foreign authoritative resources, 23 best pieces of evidence of postpartum hemorrhage prevention and nursing were summarized to help nurses better conduct the nursing assessment, nursing diagnosis and nursing planning, formulate scientific and effective nursing measures, improve working methods, and solve existing and potential problems of patients, so as to promote the scientific and effective clinical nursing practice. The scope of application: It is applicable to women with bleeding tendencies, to prevent postpartum bleeding, and to help medical workers develop scientific and effective medical care measures.