国际联合委员会理念指导下症状性颈内动脉闭塞介入开通术围手术期的护理模式优化研究

Study on the optimization of nursing mode for interventional open operation of symptomatic internal carotid artery occlusion guided by Joint Commission International concept

目的探讨基于国际联合委员会（JCI）理念指导下的围手术期护理对行介入开通术的症状性颈内动脉闭塞患者的影响。方法回顾性分析2016年1月至2018年2月天津市第一中心医院收治的行介入开通术的症状性颈内动脉闭塞90例患者的临床病例资料，将2016年1月至2017年1月接受常规护理的40例患者设为对照组，2017年2月至2018年2月接受基于JCI理念指导下护理的50例患者设为观察组。采用汉密尔顿抑郁量表（HAMD）对患者术前1h及术后48h的焦虑情绪进行评价，对比术后拔管时间及住院时间，并比较并发症发生情况及患者配合度。结果观察组术前1h及术后48h的HAMD评分分别为（26．58±5．79）、（17．41±4．18）分，对照组分别为（29．75±5．21）、（22．26±4．64）分，2组组内术后48h与术前1h比较差异均有统计学意义（t=9．080、6．790，均P〈0．01），2组比较差异有统计学意义（t=2．697、5．208，均P〈0．01）；观察组术后拔管时间及住院时间分别为（3．81±0．62）、（12．97±3．65）d，对照组分别为（4．39±0．71）、（16．18±3．54）d，2组比较差异有统计学意义（t=4．134、4．201，均P〈0．01）；观察组总并发症发生率为18．00％（9／50），对照组总并发症发生率为40．00％（16／40），2组比较差异有统计学意义（χ^2=5．361，P〈0．05）；观察组配合良好率为76．00％（38／50），对照组配合良好率为55．00％（22／40），2组比较差异有统计学意义（χ^2=4．410，P〈0．05）。结论基于JCI理念指导下的围手术期护理可缓解症状性颈内动脉闭塞介入开通术患者焦虑情绪，缩短术后恢复时间，并可减少并发症发生及提高患者配合度。

Objective To explore the influence of perioperative nursing for interventional open operation of patients with symptomatic internal carotid artery occlusion under the guidance of the Joint Commission International（JCI） concept. Methods The clinical data of 90 patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation from January 2016 to February 2018 were retrospectively analyzed, of which 40 patients receiving routine nursing from January 2016 to January 2017 were set as control group, of which 50 patients receiving nursing guided by JCI concept from February 2017 to February 2018 were set as observation group. The Hamilton Depression Scale （HAMD） was used to evaluate the anxiety of patients at preoperative 1 h and postoperative 48 h, and the extubation time and hospitalization time were compared, as well as the incidence of complications and the patient＇s coordination degree. Results The HAMD scores of preoperative 1 h and postoperative 48 h of the observation group respectively was （26.58 ± 5.79） and （17.41 ± 4.18） points, of which the control group respeetively was （29.75 ±5.21） points and （22.26 ± 4.64） points, and the HAMD scores between the postoperative 48 h and preoperative 1 h in the 2 groups were statistically significant differences （t=9.080, 6.790, all P 〈 0.01）, of which between the 2 groups were statistically significant differences （t=2.697, 5.208, all P 〈 0.01）. The extubation time and hospitalization time of the observation group respectively was （3.81 ± 0.62） and （12.97±3.65） d, of which the control group respectively was （4.39 ± 0.71） and （16.18±3.54） d, with statistically significant differences （t=4.134, 4.201, all P 〈 0.01）. The total incidence rate of complications of the observation group was 18.00%（9/50）, of which the control group was 40.00% （16/40）, with statistically significant differences （χ^2=5.361, P 〈 0.05）. The good rate of coordination of the observation group was 76.00%（38/50）, of which the control group was 55.00%（22/40）, with statistically significant differenees （χ^2=4.410, P 〈 0.05）. Conclusions The perioperative nursing based on the JCI concept guidance ean relieve the anxiety of patients with symptomatic internal carotid artery occlusion treated by elective interventional open operation, shorten the postoperative recovery time, reduce the incidence of complications and improve the nursing coordination.