精细化护理管理在复发性急性胰腺炎患者中的应用效果

Effect evaluation of meticulous nursing management in patients with recurrent acute pancreatitis

目的探讨精细化护理管理在复发性急性胰腺炎（RAP）患者随访中的应用效果。方法收集2016年1月至2017年1月间海军军医大学附属长海医院收治的RAP患者的临床资料。采用自身对照的方法建立前瞻性队列研究，采取精细化护理管理模式对患者随访12个月，通过调查问卷收集患者遵医行为、疾病改善情况、患者满意度等指标以评估精细化护理管理的效果，每3个月1次，满12个月汇总。结果最终纳入64例RAP患者，平均随访时间为（19.7±3.4）个月。就诊前平均患病时长为（4.21±3.95）年；有饮酒史30例（46.9%），吸烟史33例（51.6%），血脂异常25例（39.1%），高脂高蛋白饮食习惯40例（62.5%）；病因为酒精性10例（15.6%），高血脂性7例（10.9%），胆源性1例（1.6%），特发性46例（71.9%）；体重指数（BMI）异常49例（76.6%）。精细化护理管理干预后RAP患者发作频率、发作疼痛评分及饮酒者均显著少于干预前[（0.50±0.85）次/年比（2.77±2.52）次/年、（1.84±2.54）分比（6.47±2.15）分、2例比30例]；按时服药例数、BMI均较干预前显著升高[（52例比13例、（23.26±3.85）kg/m2比（21.92±4.27）kg/m2]，差异均有统计学意义（P值均〈0.01）。患者对此干预模式满意度为（4.90±0.56）分。结论实施精细化护理管理能有效改善RAP患者病情，提高遵医行为及生活质量。

Objective To evaluate the application effect of nursing management in the follow-up of patients with recurrent acute pancreatitis （RAP）.Methods During January 2016 and January 2017, the clinical data of RAP patients admitted in Changhai Hospital of Navy Medical University was collected. Self-control method was used to establish a prospective cohort study. Meticulous nursing management mode was applied to follow up the patients for 12 months. Patients′ compliance, symptom improvement, patients′ satisfaction and other markers are evaluated using questionnaires to assess the effect of meticulous nursing management once every 3 months. The data over 12 months were collected.Results Sixty-four RAP patients were finally included. The average follow-up period was 19.7±3.4 months. Before admission, the average disease course was（4.21±3.95） years. 30 patients （46.9%）had a history of drinking; 33 patients （51.6%）had a history of smoking. 25 patients （39.1%）had abnormal blood lipid and 40 patients （62.5%）had the dietary habit of high lipid and high protein. The etiology included alcohol （n=10, 15.6%）, high lipid （n=7, 10.9%）, biliary diseases （n=1, 1.6%）, idiopathic causes （n=46, 71.9%） and abnormal BMI （n=49, 76.6%）. After the meticulous nursing management, the frequency of pancreatitis, VAS score of pain and alcohol intake situation was obviously lower than before intervention [（0.50±0.85）times/year vs（2.77±2.52） times/year; （1.84±2.54）vs（6.47±2.15）; 2 cases vs 30 cases]. The number of patients who took medicine on time and BMI were obviously decreased[（52 cases vs 13 cases; （23.26±3.85）kg/m2vs（21.92±4.27）kg/m2）], and the differences were statistically significant （P〈0.01）. Patients′ satisfaction with this nursing model was 4.90±0.56.Conclusions The implementation of the new meticulous nursing management model can effectively alleviate patient′s symptom condition and improve the compliance behavior and life quality of the patients.