临床护理路径在成人肾穿刺活检术中的应用

Application of clinical nursing pathway in adult renal biopsy

目的探讨临床护理路径在成人肾穿刺活检术中的应用价值。方法将2009年7—11月需做肾穿刺活检术的120例成人患者设为观察组，2009年2—6月108例行肾穿刺活检术的成人患者设为对照组，观察组采用临床护理路径模式，对照组采用传统护理模式。对两组患者术后舒适度、并发症发生率、住院天数、住院费用的情况进行比较。结果观察组患者出现腰背痛（17例）、肢体麻木（20例）、烦躁（12例）、失眠（15例）的例数均少于对照组（39，41，35，47例），两组比较差异有统计学意义（χ2值分别为14．77，13．16；17．44，27．62；P〈0．05）；观察组急性尿潴留的发生率、住院天数和住院费用明显低于对照组[18％比29％，（7．12±0．76）d比（9．56±0．53）d，（5478．35±413．62）元比（7544．45±481．50）]元，两组比较，差异有统计学意义（Xz=4．87，t分别为-31．12，-30．64；P〈0．05）。两组患者在肉眼血尿、。肾周血肿、穿刺伤口痛、感染、动静脉瘘等并发症方面比较，差异无统计学意义（x。值分别为0．92，0．45，2．98，0．26，0．39；P〉0．05）。结论在肾穿刺活检术中实施临床护理路径可增加患者的舒适度，减少术后并发症的发生，缩短住院时间，降低住院费用。

Objective To explore the application of clinical nursing pathway in adult renal biopsy. Methods 120 adult patients who received renal biopsy from July to November in 2009 were chosen as the observational group, while 108 adult patients from February to June in 2009 were chosen as the control group. The patients in observational group adopted the clinical nursing pathway while the patients in control group received the conventional nursing pattern. Patients＇ comfort degree after the surgery, the incidence rate of complications, hospitalization length and cost were compared between two groups. Results In the observational group, 17 patients had pain in lower back, 20 had numbness in the limb, 12 had irritability and 15 had insomnia, fewer than those in the control group （39,41,35,47, respectively）, and the differences were statistically significant （ χ2 = 14.77,13.16 ; 17.44,27.62, respectively;P 〈 0.005 ）. The rate of acute urinary retention, hospitalization length and cost for patients in the experiment group [ 18, （7.12 ± 0.76）d, （5478.35 ± 413.62） yuan] were all lower than those in the control group [ 29, （9.56 ± 0.53 ）d, （5478.35 ± 413.62 ） yuan ], and the differences were statistically significant （ χ2 = 4.87, t = - 31.12, - 30.64, respectively ; P 〈 0.05 ）. But there was no significant difference between two groups in complications such as gross hematuria, perinephric hematoma, puncture wound pain, infenction and fistula. Conclusions The application of clinical nursing pathway in renal biopsy is able to increase patients＇ comfort degree, and reduce complications, hospitalization length and cost.