院外延续管理在长期携带胆道外引流管患者中的应用价值

Application value of continuous management out-of-hospital patients with long-term biliary extra-drainage tube

目的探讨院外延续管理在高位恶性胆道梗阻(malignant high biliary obstruction,MHBO)胆道外引流管(biliary extra-drainage tube,BEDT)植入术后患者中的临床应用价值,为减少院外期间BEDT并发症的发生提供合理建议。方法选择MHBO-BEDT植入术后患者120例,采用完全随机化分为对照组和实验组各60例,对照组实施常规管理,出院后采用定期来医院复诊,实验组在常规管理基础上,针对院外期间BEDT常见并发症实施院外延续管理,比较2组院外期间BEDT并发症的发生情况及管理情况。结果院外期间对照组BEDT移位、脱出、堵塞及胆道感染发生率明显高于实验组,对照组BEDT并发症总发生率高于实验组,差异均有统计学意义(P<0.05)。院外期间对照组未定期冲洗胆道、未定期更换敷料、未定期更换引流袋、未记录引流液颜色和引流量、未来医院复诊患者明显多于实验组,差异均有统计学意义(P<0.05)。院外期间对照组因BEDT并发症再次住院32例(53.3%),明显多于实验组的7例(11.7%),差异有统计学意义(P<0.05)。结论要从根本上解决院外期间BEDT并发症带来的困扰重在预防,院外延续管理有效减少了院外期间BEDT并发症的发生,提高了BEDT的使用时间及使用率,降低了患者的卫生服务成本,值得临床推广应用。

Objective To study the clinical value of continued out-of-hospital management in patients with malignant high biliary obstruction(MHBO)after implantation of biliary extradrainage tube(BEDT),providing reasonable suggestions to reduce the incidence of out-of-hospital complications during BEDT.Methods 120 patients with MHBO after implantating BEDT,were randomly divided into control group and experimental group.60 cases in the control group received routine management,visiting the hospital regularly.On the basis of conventional management,another 60 cases in the experimental group received continued out-of-hospital management to prevent the relative complications of BEDT.The incidence and management of complications of BEDT implatation in the two groups outside the hospital were compared.Results Outside hospital,the overall complication rate of BEDT in the control group was significantly higher than that in the experimental group with statistically significance(P<0.05),including displacement、prolapsus、obstruction of BEDT and biliary tract infection.The hospital referral of patients in the control group was higher than those in the experimental group(P<0.05).Because the patients in the control group did not regularly sluice biliary tract,nor regularly change surgical dressing and drainage pack,and they did not record the color and capacity of drainage.32 cases(53.3%)of the control group were rehospitalized due to complications of BEDT outside hospital,which included 7 cases in the experimental group(11.7%).The difference was statistically significant(P<0.05).Conclusion In order to fundamentally solve the brought outside the hospital during BEDT complications,prevention was the most important.Continued out-of-hospital management could reduce incidence of BEDT complications,improve the use of BEDT time and usage rate,reduce the patient's health service cost,which was worthy of clinical application.The prevention and continued out-of-hospital management are the keys to fundamentally resolve and reduce the beset produced by complications of BEDT.Also,continued out-of-hospital management improves the usage of BEDT and reduces the health service cost of patients,worthy of generalized clinical application.