网络合作型延续护理在胃肠肿瘤手术患者快速康复中的应用

Application of network cooperation model transitional care in rapid rehabilitation among patients with gastrointestinal tumors surgery

目的 探讨基于网络合作的延续护理在经快速康复外科理念（FTS）护理的胃肠肿瘤手术患者出院后中的应用价值.方法 2012年1月—2015年3月,招募120例胃肠肿瘤手术患者作为研究对象,患者住院期间均使用FTS护理,利用随机数字表按1：1分成试验组和对照组.试验组康复出院后接受网络合作型延续护理,对照组接受综合医院的传统电话延续护理＋社区医院的传统社区随访.至术后第30天,评价两组患者的就诊次数、再入院率、症状、焦虑、抑郁及满意度.结果 术后第30天,试验组的就诊次数较对照组少,差异有统计学意义（Z=-2.730,P=0.006）;两组再入院率比较差异无统计学意义（χ2=0.158,P=0.691）;两组的疼痛、恶心呕吐发生率及腹胀程度差异均无统计学意义（Z值分别为-0.655、-0.356、-0.785;P值分别为0.513、0.722、0.433）;试验组患者的焦虑和抑郁得分均较对照组低,差异均有统计学意义（t值分别为-2.580、-2.380;P值分别为0.011、0.019）;试验组对社区医院和综合医院的满意程度均较对照组高,差异均有统计学意义（Z值分别为-2.133、-2.331,P值分别为0.033、0.020）.结论 网络合作型延续护理在胃肠道手术快速康复后的应用可以使患者避免不必要的门急诊复诊,能更好地满足患者的社会心理支持需求,从而使综合医院和社区医院获得患者更好的认可.

Objective To explore the effects of transitional care based on network cooperation in patients with gastrointestinal tumors surgery treated with nursing care according to fast track surgery （FTS）. Methods A total of 120 patients with gastrointestinal tumors surgery were recruited as the study subjects from January 2012 to March 2015. They all received nursing care according to FTS in duration of hospital stay. They were divided into experimental group （transitional care based on network cooperation） and control group （traditionally transitional care by telephone of the general hospital ＋ traditional community follow-up of the community hospital） in accordance with the random number table according to 1：1 proportions. The visit times,readmission rates,symptoms,anxiety,depression and satisfaction at the thirtieth day after surgery were compared between two groups.Results At the thirtieth day after surgery,the visit times of experimental group was less than that of control group with a significant difference （Z=-2.730,P=0.006）. There was no significant difference in readmission rates between two groups （χ2=0.158,P=0.691）. There was no significant differences in the incidence rates of pain,nausea and vomiting,the degree of abdominal distension between two groups （Z=-0.655,-0.356,-0.785;P=0.513,0.722,0.433）. The scores of anxiety and depression of patients in experimental group were significantly lower than those in control group （t=-2.580,-2.380;P=0.011,0.019）. The satisfaction with the general hospital and community hospital of experimental group was higher than those of control group with significant differences （Z=-2.133,-2.331;P=0.033,0.020）.Conclusions The application of transitional care based on network cooperation after FTS on the stomach and intestine can nicely make patients to avoid unnecessary return visit in outpatient and emergency department,can meet the requirements of patients for social and mental support so as to make the general hospital and community hospital be recognised by patients.