临床护理路径在食管静脉曲张套扎术中的应用

发布时间：2019-05-28 08:27

【摘要】：目的:(1)参考美国东南外科护理协会制定的临床护理路径表,结合肝硬化食管静脉曲张套扎术患者的病情及治疗护理特点,制定肝硬化食管静脉曲张套扎术的临床护理路径表,并分析临床护理路径在肝硬化食管静脉曲张套扎术患者中的可行性。(2)将制定的临床护理路径表应用于肝硬化食管静脉曲张套扎术患者中,按照路径表的内容进行有针对性、有步骤地治疗及护理,观察临床护理路径在肝硬化食管静脉曲张套扎术患者中的应用效果。方法:(1)引进美国东南外科护理协会制定的临床护理路径表,比对路径表里的内容,从治疗、饮食、护理等方面综合分析,根据肝硬化食管静脉曲张套扎术患者自身的特点制定相应的临床护理路径表,征求护理专家的意见进行修改,并选取一定数量的患者进行预试验,分析临床护理路径在肝硬化食管静脉曲张套扎术患者中的可行性。(2)将符合纳入排除标准的-胃镜下行食管静脉曲张套扎术的肝硬化患者90例随机分为两组。对照组采用常规护理,包括入院指导、病情观察、健康教育、饮食护理、用药护理等;观察组将护理路径小组制定的护理路径表应用于肝硬化食管静脉曲张套扎术的患者中,对实施临床护理路径的护士进行培训,由经过培训的责任护士按照路径表的内容进行有针对性、有步骤地治疗及护理。比较两组患者的再出血发生率、患者满意度、住院时间、住院费用和健康教育知识掌握情况等,将两组的比较结果进行分析、总结,从而得到护理路径的使用效果。结果:(1)食管静脉曲张套扎术的临床护理路径表能够体现此病种的疾病护理特点、比较合理,路径表中的治疗和护理措施均能对患者起到比较显著的效果,值得进一步推广使用。(2)本研究观察组患者的再出血发生率为4.4%,低于对照组的17.8%,差异有统计学意义(P0.05);观察组的住院时间为8.2±2.7,住院费用为14922.5±4424.8,也均低于对照组,差异有统计学意义(P0.05);观察组患者的满意度为97.8%,明显要高于对照组的82.2%,差异有统计学意义(P0.05);观察组患者的健康知识得分为25.2±2.0,高于对照组的22.4±2.1,差异有统计学意义(P0.05)。结论:(1)本研究制定的肝硬化食管静脉曲张套扎术的护理路径表合理,肝硬化食管静脉曲张套扎术患者中应用护理路径的方法可行。(2)临床护理路径在食管静脉曲张套扎术患者中的应用可以显著降低患者的再出血发生率,缩短患者住院时间及降低患者住院费用,减少医疗护理支出;加强患者对治疗护理工作的依从性,主动配合治疗护理工作,提高患者满意度,对患者的治疗护理有积极作用。
[Abstract]:Objective: (1) to refer to the clinical nursing pathway list developed by Southeast Surgical Nursing Association of the United States, combined with the condition and characteristics of treatment and nursing of patients with cirrhotic esophageal varices. To establish the clinical nursing pathway table of esophageal variceal ligature in cirrhotic patients. The feasibility of clinical nursing pathway in patients with cirrhotic esophageal varices was analyzed. (2) the clinical nursing pathway table was applied to patients with cirrhotic esophageal varices. According to the contents of the path table, the treatment and nursing were carried out step by step, and the application effect of clinical nursing pathway in patients with cirrhotic esophageal varices was observed. Methods: (1) the clinical nursing pathway table made by Southeast Surgical Nursing Association of the United States was introduced, and the contents of the path table were compared, and the comprehensive analysis was made from the aspects of treatment, diet, nursing and so on. According to the characteristics of patients with cirrhotic esophageal varices, the corresponding clinical nursing pathway table was made, the opinions of nursing experts were consulted and modified, and a certain number of patients were selected for pre-trial. To analyze the feasibility of clinical nursing pathway in cirrhotic patients with esophageal variceal ligature. (2) 90 patients with liver cirrhosis undergoing esophageal variceal ligature under gastroscopy were randomly divided into two groups. The control group was treated with routine nursing, including admission guidance, condition observation, health education, diet nursing, medication nursing and so on. In the observation group, the nursing path table developed by the nursing pathway group was applied to the patients with cirrhotic esophageal variceal ligature, and the nurses who implemented the clinical nursing pathway were trained. Trained responsible nurses according to the contents of the path table targeted, systematic treatment and nursing. The incidence of rebleeding, patient satisfaction, hospitalization time, hospitalization expenses and knowledge of health education were compared between the two groups. The comparative results of the two groups were analyzed and summarized, so as to obtain the effect of nursing path. Results: (1) the clinical nursing pathway table of esophageal variceal ligature can reflect the nursing characteristics of this disease, and it is more reasonable. The treatment and nursing measures in the path table can play a more significant effect on the patients. It is worth further popularizing and using. (2) the incidence of rebleeding in the observation group was 4.4%, which was lower than that in the control group (17.8%), the difference was statistically significant (P 0.05). The hospitalization time and cost of the observation group were 8.2 卤2.7 and 14922.5 卤4424.8, respectively, which were also lower than those of the control group (P 0.05). The satisfaction rate of the patients in the observation group was 97.8%, which was significantly higher than that in the control group (82.2%), the difference was statistically significant (P 0.05). The score of health knowledge in the observation group was 25.2 卤2.0, which was significantly higher than that in the control group (22.4 卤2.1) (P 0.05). Conclusion: (1) the nursing path table of esophageal variceal ligature in cirrhotic patients is reasonable. It is feasible to apply nursing pathway in patients with cirrhotic esophageal varices. (2) the application of clinical nursing pathway in patients with esophageal varices can significantly reduce the incidence of rebleeding. Shorten the hospitalization time of patients and reduce the hospitalization expenses of patients, reduce the expenditure of medical and nursing care; Strengthening patients' compliance to treatment and nursing work, actively cooperating with treatment and nursing work, improving patient satisfaction, and playing a positive role in patients' treatment and nursing.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.6

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