漆艷華 李淑萍
摘 要 目的:探討急性胰腺炎圍術(shù)期護(hù)理要點(diǎn)。方法:將2012年11月至2016年1月收治的急性胰腺炎行手術(shù)治療患者78例,均分為觀察組和對(duì)照組各39例,對(duì)照組接受常規(guī)圍術(shù)期護(hù)理,觀察組接受圍術(shù)期優(yōu)質(zhì)護(hù)理。比較兩組患者住院時(shí)間、自我護(hù)理能力測(cè)定量表(ESCA)評(píng)分、焦慮自評(píng)量表(SAS)評(píng)分、術(shù)后并發(fā)癥情況以及護(hù)理滿意度。結(jié)果:觀察組住院時(shí)間和SAS評(píng)分分別為(24.07±4.75)d和(37.26±5.17)分,對(duì)照組分別為(30.66±5.08)d和(44.18±5.66)分,觀察組低于對(duì)照組(P<0.05)。觀察組ESCA評(píng)分為(124.66±8.73)分,高于對(duì)照組的(108.15±8.26)分(P=0.03)。觀察組術(shù)后并發(fā)癥總發(fā)生率為17.95%(7/39),低于對(duì)照組的38.46%(15/39,P<0.05)。觀察組總滿意度為94.87%(37/39),高于對(duì)照組的79.49%(31/39,P<0.05)。結(jié)論:急性胰腺炎圍術(shù)期優(yōu)質(zhì)護(hù)理有利于促進(jìn)患者康復(fù),降低術(shù)后并發(fā)癥風(fēng)險(xiǎn),提高自我護(hù)理能力,減輕心理壓力,提高護(hù)理滿意度。
關(guān)鍵詞 急性胰腺炎;圍術(shù)期優(yōu)質(zhì)護(hù)理;并發(fā)癥
中圖分類號(hào):R657.5+1 文獻(xiàn)標(biāo)志碼:A 文章編號(hào):1006-1533(2018)18-0030-02
Analysis of key points of clinical nursing in surgical treatment of acute pancreatitis
QI Yanhua, LI Shuping
(Department of Genaral Surgery Peoples Hospital of Yifeng County, Jiangxi 336300, China)
ABSTRACT Objective: To explore the key points of perioperative nursing for acute pancreatitis. Methods: Seventyeight patients with acute pancreatitis admitted from November 2012 to January 2016 were divided into an observation group and a control group with 39 cases each. The control group received routine perioperative nursing and the observation group received perioperative quality nursing. The hospitalization time, exercise of self-care agency(ESCA) score, self rating anxiety scale(SAS) score, postoperative complications and nursing satisfaction were compared between the two groups. Results: The hospitalization time and SAS score of the observation group were (24.07±4.75) d and (37.26±5.17) points, respectively, and those of the control group were (30.66±5.08) d and (44.18±5.66) points, respectively and the observation group was lower than the control group(P<0.05). The ESCA score of the observation group was (124.66±8.73), which was higher than that of the control group (108.15±8.26)(P=0.03). The total incidence of postoperative complications of the observation group was 17.95%(7/39), which was lower than that of the control group(38.46%(15/39, P<0.05)). The total satisfaction of the observation group was 94.87%(37/39), which was higher than that of the control group(79.49%(31/39, P<0.05)). Conclusion: High quality nursing in the perioperative period of acute pancreatitis is conducive to promoting rehabilitation of patients, reducing the risk of postoperative complications, improving self-care ability, reducing psychological stress and improving nursing satisfaction.
KEY WORDS acute pancreatitis; perioperative quality nursing; complication
急性胰腺炎是臨床常見的急腹癥,患者起病急驟,多需進(jìn)行手術(shù)治療[1]。臨床研究表明,有效的圍術(shù)期護(hù)理是改善患者預(yù)后的重要環(huán)節(jié)[2]。隨著患者對(duì)醫(yī)療服務(wù)質(zhì)量要求的不斷提高,如何穩(wěn)步提升護(hù)理服務(wù)質(zhì)量是臨床研究的熱點(diǎn)。本文報(bào)道采用圍術(shù)期優(yōu)質(zhì)護(hù)理的效果。
1 資料與方法
1.1 一般資料
將2012年11月至2016年1月接診的行手術(shù)治療的急性胰腺炎患者78例,均分為觀察組和對(duì)照組各39例。觀察組中男23例,女16例,年齡為20~65歲,平均(40.17±5.33)歲。對(duì)照組中男性22例,女性17例,年齡為20~65歲,平均(40.13±5.38)歲。兩組患者的一般資料相比差異無統(tǒng)計(jì)學(xué)意義(P>0.05)。
1.2 方法
對(duì)照組接受常規(guī)圍術(shù)期護(hù)理,包括入院時(shí)健康宣教、術(shù)前心理疏導(dǎo)、術(shù)前準(zhǔn)備指導(dǎo)、術(shù)中護(hù)理、術(shù)后飲食指導(dǎo)、并發(fā)癥預(yù)防、出院指導(dǎo)等。
觀察組接受圍術(shù)期優(yōu)質(zhì)護(hù)理,即在對(duì)照組基礎(chǔ)上增加舒適護(hù)理、語言和行為暗示和自我護(hù)理技巧指導(dǎo)。①舒適護(hù)理。營造溫馨舒適的病房環(huán)境,保持病房溫度、濕度、光照適宜,病床配備柔軟的床墊,通過滿足患者生理舒適需求,降低其對(duì)病情的焦慮、對(duì)手術(shù)的緊張以及初入陌生環(huán)境的不安感[3]。②語言和行為暗示。建立良好的護(hù)患關(guān)系,耐心與患者溝通,用豐富的理論知識(shí)解答患者的疑惑,用堅(jiān)定和自信的語言和嫻熟的操作技能給患者以安全可靠的暗示,獲得其信任,鼓勵(lì)其增強(qiáng)治療信心[4]。③自我護(hù)理技巧指導(dǎo)。向患者講解術(shù)后注意事項(xiàng)以及相關(guān)護(hù)理技巧,包括如何調(diào)節(jié)情緒狀態(tài)、自我判斷引流液及尿液性狀是否正常、如何擺放體位能夠提高舒適度且利于術(shù)后恢復(fù)、如何防范疾病復(fù)發(fā)、如何自我照料等[5]。
比較兩組患者住院時(shí)間、自我護(hù)理能力測(cè)定量表(ESCA)[6]評(píng)分、焦慮自評(píng)量表(SAS)[7]評(píng)分、術(shù)后并發(fā)癥情況以及護(hù)理滿意度。
1.3 評(píng)估標(biāo)準(zhǔn)
ESCA評(píng)分共包含43項(xiàng)題目,每項(xiàng)均采用0~4分的5級(jí)評(píng)分法,計(jì)算總評(píng)分,評(píng)分越高表示自我護(hù)理能力越強(qiáng)。SAS包括20個(gè)題目,每個(gè)問題均采用4級(jí)計(jì)分法,以50分為分界值,評(píng)分越高表示焦慮狀態(tài)越嚴(yán)重。護(hù)理滿意度使用我院自制調(diào)查問卷,由患者根據(jù)主觀感受自主選擇滿意、一般或不滿意3個(gè)選項(xiàng),總滿意度=(滿意例數(shù)+一般例數(shù))/總例數(shù)×100%。
1.4 統(tǒng)計(jì)學(xué)分析
2 結(jié)果
2.1 兩組住院時(shí)間、ESCA評(píng)分和SAS評(píng)分
觀察組住院時(shí)間和SAS評(píng)分分別為(24.07±4.75)d和(37.26±5.17)分,對(duì)照組分別為(30.66±5.08)d和(44.18±5.66)分,觀察組低于對(duì)照組(P<0.05)。觀察組ESCA評(píng)分為(124.66±8.73)分,高于對(duì)照組的(108.15±8.26)分(t=11.81,P=0.03)。
2.2 兩組術(shù)后并發(fā)癥發(fā)生情況
觀察組患者術(shù)后并發(fā)癥總發(fā)生率為17.95%,低于對(duì)照組的38.46%(P<0.05,表1)。
2.3 兩組護(hù)理滿意度對(duì)比
觀察組總滿意度為94.87%,高于對(duì)照組的79.49%(P<0.05,表2)。
3 討論
急性胰腺炎發(fā)病機(jī)制復(fù)雜,患者保守治療無效后需立即進(jìn)行手術(shù)治療,否則容易造成嚴(yán)重后果[8]。有研究指出,急性胰腺炎患者圍手術(shù)期護(hù)理需求較多,包括心理需求、疾病知識(shí)需求、疼痛減輕需求、舒適度需求等,滿足患者上述生理或心理需求有利于提高治療依從性和手術(shù)效果[9]。國內(nèi)大量文獻(xiàn)報(bào)道也對(duì)急性胰腺炎圍術(shù)期實(shí)施有效護(hù)理干預(yù)的效果進(jìn)行了肯定,多認(rèn)為實(shí)施針對(duì)性的護(hù)理干預(yù)能防范并發(fā)癥、促進(jìn)患者康復(fù)、改善患者負(fù)性情緒及降低疾病復(fù)發(fā)率等[10-13]。江西省宜豐縣人民醫(yī)院結(jié)合國內(nèi)外先進(jìn)經(jīng)驗(yàn),在常規(guī)圍術(shù)期護(hù)理基礎(chǔ)上提出優(yōu)質(zhì)護(hù)理,增加了舒適護(hù)理、語言和行為暗示以及自我護(hù)理技巧指導(dǎo)等護(hù)理策略,通過全方位手段增加了患者的安全感和自我素質(zhì),提高了治療信心和依從情況。本研究結(jié)果顯示,觀察組住院時(shí)間及SAS評(píng)分低于對(duì)照組,ESCA評(píng)分高于對(duì)照組,術(shù)后并發(fā)癥總發(fā)生率低于對(duì)照組,也證實(shí)了圍術(shù)期優(yōu)質(zhì)護(hù)理的臨床優(yōu)勢(shì),與上述研究相符。另外,本研究中觀察組患者總滿意度高于對(duì)照組,主要與圍術(shù)期優(yōu)質(zhì)護(hù)理實(shí)施后整體護(hù)理服務(wù)水平明顯提升,患者預(yù)后改善效果也受到積極影響,從而提高了患者滿意度。
綜上所述,急性胰腺炎圍術(shù)期優(yōu)質(zhì)護(hù)理有利于改善患者康預(yù)后和心理狀態(tài),提高其自我護(hù)理能力,提升護(hù)理服務(wù)質(zhì)量,值得臨床推薦。
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