医院-社区-家庭合作型延续护理在慢性结核性脓胸术后带胸管出院患者中的应用效果

Application effect of hospital-community-family cooperative extended care in chronic tuberculous empyema patients with thoracic duct after surgery

目的探讨医院-社区-家庭合作型延续护理在慢性结核性脓胸术后带胸管出院患者中的应用效果。方法采用随机抽样法选取2014年6月—2016年12月在杭州市红十字会医院结核病诊疗中心结核外科慢性结核性脓胸术后需带胸管出院的患者50例，按随机数字表法分为对照组和试验组，每组各25例。对照组采用常规护理方法，试验组在对照组基础上实施医院-社区-家庭合作型延续护理模式，1个月后评价并比较两组患者导管相关并发症发生率、患者自我护理能力、满意度及平均拔管时间。结果试验组发生导管相关并发症1例，对照组8例，试验组导管相关并发症发生率明显低于对照组，差异有统计学意义（χ2=4.878，P〈0.05）。自我护理能力得分的比较，试验组在健康知识水平、自我概念、自护责任感、自我护理技能的各项评分均高于对照组，两组比较差异有统计学意义（t值分别为3.056 7、2.463 7、3.150 3、3.745 6；P〈0.05）。试验组和对照组患者的平均拔管时间分别是（10.24±4.14）d和（15.36±7.12）d，两组比较差异有统计学意义（t=3.108 3，P〈0.05）。结论医院-社区-家庭合作型延续护理可以减少慢性结核性脓胸术后带胸管出院患者导管相关并发症的发生率，同时提高患者的自我护理能力和患者满意度，缩短患者的拔管时间，促进患者康复，值得临床推广应用。

ObjectiveTo explore the application effect of hospital-community-family cooperative extended care in chronic tuberculous pyothorax patients, who were discharged from hospital with chest tube postoperatively.MethodsFrom June 2014 and December 2016, 50 patients, who were needed to discharge from department of tuberculosis surgery of tuberculosis diagnosing and treatment center of Hangzhou Red Cross Hospital with chest tube after the operation of chronic tuberculous empyema were selected as the research object. And the patients were divided into the control group and experimental group through random sampling method, 25 cases in each group. Patients in the control group received routine nursing care, patients in the experimental group received hospital-community-family cooperative extended care based on the care of the control group. One month later, the rate of catheter related complications, self-care ability, satisfaction and extubation time of the two groups were evaluated and compared.ResultsOne case of catheter-related complications in the experimental group compared with 8 cases of that in the control group. The incidence rate had a statistically significant difference （χ2=4.878, P〈0.05） . The scores of self-care ability in the experimental group were higher than those in the control group in the level of health knowledge, self-concept, self-care responsibility and self-care skills. There were significant differences between two groups （t=3.056 7, 2.463 7, 3.150 3, 3.745 6; P〈0.05） ; In the time of extubation, the extubation time of the experimental group and the control group was （10.24±4.14） days and （15.36±7.12） days, respectively, and the difference between the two groups was statistically significant （t=3.108 3; P〈0.05） .ConclusionsHospital-community-family cooperative continuing nursing care can reduce catheter related complications, and improve the patient＇s self-care ability and the satisfaction of patients, shorten the extubation time indirectly, promote early rehabilitation of the discharged patients with thoracic duct after chronic tuberculous empyema surgery.