重症急性胰腺炎上腹联合侧腹壁切口术后的综合护理探讨

Severe Acute Pancreatitis:Nursing Care Approach after Lateral Incision plus Laparotomy Necrosis Debridement

目的:观察上腹联合侧腹壁切口治疗重症急性胰腺炎(severe acute pancreatitis,SAP)术后综合护理的疗效。方法:对我院2006年1月至2010年6月在我科接受上腹和侧腹联合切口手术的46例SAP患者进行回顾性分析。其中26例患者接受综合护理,包括采用造瘘袋辅助护理、使用可调节式伤口保护罩、早期持续冲洗及负压吸引等;20例患者接受常规护理。比较两种护理策略对SAP开放性伤口的预后影响。结果:接受综合护理的患者再次手术率(5/26 vs 10/20,P=0.027),住院周期(26.08±8.48 vs.31.95±8.82,P=0.03)及护士工作满意度(93.15±4.05 vs.87.45±5.90,P<0.01)等方面均优于接受常规护理的患者。综合护理组患者住院期间死亡率(0/26 vs 3/20,P=0.075)及术后肠瘘发生率(1/26 vs 4/20,P=0.08)有降低的趋势。结论:采用综合护理可降低再次手术率,促进伤口愈合,缩短住院周期,可能降低肠瘘发生率及死亡率,提高护理疗效。

Objective：To observe the effect of the comprehensive nursing for the patients with a diagnosis of severe acute pancre-atitis receiving upper and flank abdomen incision surgery.Methods：Between January 2006 and June 2010,a total of 46 patients with severe acute pancreatitis receiving upper and flank abdomen incision surgery were analyzed in the present study.Among them,26 patients were administered by using comprehensive nursing strategies,which included auxiliary nursing with the aid of ostomy bags,use of the adjustable protective cover for the wound,continuous washing during the early postoperative period and negative pressure suction.Another 20 patients were administered by using conventional nursing strategies.Results：Compared with those receiving conventional nursing strategies,the patients receiving comprehensive nursing strategies had a lower rate of re-operation（5/26 versus 10/20,p=0.027） a shorter length of hos-pital stay（26.08±8.48 vs.31.95±8.82,P=0.03） and a high proportion of satisfaction for nursing services（98.5% versus 90%）.The inci-dence of postoperative fistula（1/26 versus 4/20,p=0.081）,in-hospitalization mortality（0/26 versus 3/20,p=0.041） had a tendency of de-crease in patients receiving comprehensive nursing strategies.Conclusions：Comprehensive nursing can reduce the in-hospitalization time and improve the effect of nursing.In addition,it may also reduce the incidence of postoperative fistula and in-hospital mortality.