全程护理优化方案干预对提高内镜下黏膜剥离术临床质量的价值

Value of optimized nursing protocol for improving the nursing quality of endoscopic submucosal dissection

目的探讨采用全程护理优化方案对上消化道早癌患者行内镜下黏膜剥离术(ESD)临床质量提升的价值。方法对该院2016年12月至2018年12月167例内镜下ESD手术患者给予全程护理优化方案干预,针对术前心理评估、术中预见性护理配合及“医生化”护理质量管理及时发现和处理ESD术后并发症,观察该方法的临床效果及价值。结果经过全程护理优化方案干预的167例ESD手术患者病变组织完全剥离,手术时间平均76.2min,1例胃窦创面发生术中穿孔,3例胃底创面术后出现迟发性出血,1例胃底创面术后发生延迟性穿孔,均经内镜积极处理,未行外科手术治疗,所有患者平均住院时间5.6d,较前缩短1.1d,且患者满意度显著提高。结论全程护理优化方案能有效减少ESD相关并发症的发生,对于已经发生的并发症做到早发现、早期内镜下处置,预后满意。

Objective To evaluate efficiency of the optimized nursing protocol on nursing quality of upper gastrointestinal tract early cancer patients suffered endoscopic submucosal dissection (ESD). Methods Optimized nursing protocol was applied to 167 ESD patients between December 2016 to December 2018.The protocol was combined with pre-surgical psychological evaluation,intra-operative predictive nursing and "doctor-like" nursing quality management to discover and treat the postoperative complications of ESD in time,the clinical effect and value of the method were observed. Results 167 cases received optimized nursing protocol during ESD surgery,the lesions were completely stripped.The averaged operation time was 76.2 min,1 case happened gastric antrum perforation,3 cases happened tardive bleeding,1 case happened tardive perforation.All complications were managed by endoscopic treatment,and no surgical operation was involved.Meanwhile,the average in-patient duration was 5.6 days,sparing 1.1 days.Moreover,patients′ satisfaction significantly improved. Conclusion The optimized nursing protocol could effectively reduce the occurrence of ESD-related complications,facilitate early detection and early endoscopic treatment of the existing complications.