CT引导下胸腔镜肺小结节切除术患者的临床护理路径管理

Clinical nursing pathway management in patients with CT-guided thoracoscopic small pulmonary nodules resection

目的观察临床护理路径管理在CT引导下胸腔镜肺小结节切除术患者中的应用效果。方法选取肺小结节患者120例作为研究对象,随机分为路径组与对照组,每组60例,均行CT引导下胸腔镜肺小结节切除术。对照组实施胸外科围术期常规护理措施,路径组在此基础上实施临床护理路径管理。比较2组患者术后首次下床时间、胸腔引流管留置时间和住院时间,比较2组患者干预前后自理能力评分(Barthel指数评定量表评分)、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分和术后不同时点数字疼痛量表(NRS)评分。结果路径组术后首次下床时间、胸腔引流管留置时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。干预前,2组患者自理能力评分、SAS评分、SDS评分比较,差异无统计学意义(P>0.05);干预后,路径组自理能力评分高于对照组,SAS评分、SDS评分低于对照组,差异有统计学意义(P<0.05)。术后12、24、48 h时,路径组NRS评分均低于对照组,差异有统计学意义(P<0.05)。结论将临床护理路径管理应用于CT引导下胸腔镜肺小结节切除术患者,能有效缩短胸腔引流管留置时间,减轻术后疼痛和减少不良情绪,并缩短住院时间。

Objective To observe the effect of clinical nursing pathway management in thoracoscopic resection of small pulmonary nodules under CT guidance.Methods A total of 120 patients with small pulmonary nodules were randomly divided into pathway group(n=60)and control group(n=60).All patients underwent thoracoscopic small pulmonary nodule resection under CT guidance.The control group was given perioperative nursing measures for thoracic surgery,while the pathway group implemented clinical nursing pathway management.The first time of getting out of bed,the indwelling time of thoracic drainage tube and the length of hospital stay were compared between the two groups.The self-care ability score(Barthel Index Rating Scale score),Self-rating Anxiety Scale(SAS),Self-rating Depression Scale(SDS)before and after intervention and Digital Pain Scale(NRS)scores at different time points were compared between the two groups.Results The first time of getting out of bed,the indwelling time of thoracic drainage tube and the length of hospital stay in the pathway group were shorter than those in the control group(P<0.05).Before intervention,there were no significant differences in self-care ability score,SAS score and SDS score between the two groups(P>0.05).After intervention,the self-care ability score of the pathway group was higher than that of the control group,and the SAS score and SDS score were lower than those of the control group(P<0.05).At 12,24 and 48 h after operation,the NRS scores of the pathway group were lower than that of the control group(P<0.05).Conclusion Nursing pathway management can effectively shorten the retention time of drainage tube,relieve postoperative pain and adverse emotions,and shorten the hospitalization time for patients undergoing thoracoscopic pulmonary nodule resection under CT guidance.