肝胆管结石胆道镜手术专业化护理的疗效分析

The clinical effect of specialized perioperative choledochoscope nursing for hepatolithiasis

目的探讨肝胆管结石胆道镜手术器械护士专业化对手术情况、结石残留率、术中污染、胆道镜操作相关并发症及术者满意度的影响。方法回顾性分析比较肝胆管结石胆道镜手术非专业化(2006年5月至2010年8月)与专业化(2010年9月至2012年12月)护理,比较两组间手术情况、结石残留率、术中污染、器械损毁、胆道镜操作相关并发症及术者满意度。结果专业组的结石取净率86.4%,与非专业组的79.2%相近(P>0.05)。专业组术中器械污染特别是在取石篮器械护士操作污染以及取石篮损毁方面,明显优于非专业组(P<0.05)。非专业组及专业组的操作相关并发症发生率分别为33.9%及15.9%,差异有统计学意义(χ2=4.158,P=0.041)。经专业的胆道镜培训后,主刀医师满意度明显提高达93.2%,显著高于非专业组的77.4%(P<0.05)。结论经专业的胆道镜培训,规范台前胆道镜消毒规程,加强对术中胆道镜及配件的无菌管理,器械护士与主刀医师熟练配合,注意避免术中胆道镜及配件污染,可减少院内感染发生并提高医护间的满意程度。

Objective To investigate the effects of specialized perioperative choledochoscope nursing on operation, residual stone, postoperative procedure-related complications and surgeon's satisfaction. Methods From May 2006 to August 2010, non-specialized nurses, and from September 2010to December 2012, specialized nurses cooperated with surgeons in intraoperative choledochoscope in our hospital. The residual stone rate, intraoperative appliance contamination and damage, procedure-related complications, and surgeon's satisfaction were compared between the non-specialized and specialized groups.Results The postoperative clearance rate of intrahepatic duct calculus was 86.4% in the specialized group,similar to 79.2% in the non-specialized group. The proportions of stone basket contamination and damage were significantly lower in the specialized group than those in the non-specialized group. The overall procedure-related complication rate in the specialized group was 33.9% in the non-specilized group,significantly higher than 15.9% in the specialized group(P <0.05). After professional training of choledochofiberscope nursing, the degree of surgeon's satisfaction increased to 93.2% in the specialized group, significantly higher than 77.4% in the non-specialized group(P <0.05). Conclusions After professional training of choledochofiberscope nursing, formulating the standard preoperative sterilized rules of cholangioscopy, strengthening the asepsis management of cholangioscopy and accessories, improving the cooperation proficiency of nurses and surgeons, it is helpful to prevent the contamination of cholangioscopy and accessories, reduce the hospital infection rate and improve the degree of surgeon's satisfaction.