经皮肾镜碎石取石术围术期规范化全程护理方案的构建和应用

Construction and application of a standardized whole-process nursing program for percutaneous nephrolithotomy

目的构建《经皮肾镜碎石取石术围术期规范化全程护理方案》(以下简称《方案》),并探讨其临床应用效果。方法成立《方案》构建小组,通过半结构式访谈确定《方案》大纲,将质量为A级或B级的文献作为条目制订的指导依据,运用德尔菲法对23名专家进行2轮函询,以确定最终《方案》。选取广州医科大学附属第一医院海印院区泌尿外科80例经皮肾镜碎石取石术患者作为研究对象,将2020年11月至12月入院的患者纳入对照组,2021年1月至2月入院的患者纳入观察组。对照组实施围术期常规护理,观察组通过制订的《方案》进行干预,比较两组的住院时间,住院费用,首次下床活动时间,日常生活活动能力,并发症发生率和随访满意率。结果本研究构建的《方案》分为术前、术中和术后管理三部分,涵盖38项可供操作的具体条目。观察组在应用《方案》干预后,其首次下床活动时间较对照组提前,住院时间缩短,并发症发生率降低,随访满意度提高,差异均有统计学意义(P<0.05)。结论本研究构建的《方案》具有良好的科学性、可靠性和实用性,《方案》的实施可有效缩短PCNL患者的住院时间,改善患者的健康结局。

Objective To construct the"Percutaneous Nephrolithotomy Standardized Whole-course Nursing Program"(hereinafter referred to as the"Program")and discuss its clinical application effects.Methods A program construction team to determine the program framework through semi-structured interviews was set up.The A-level or B-level literature were used as the guidance basis for the formulation of each item.Finally,the Delphi method was used to conduct 2 rounds of correspondence inquiries with 23 experts to determine the final version of the program.A total of 80 patients underwet PCNL from our hospital were selected as the research objects.Patients admitted from November to December 2020 were included in the control group,and patients admitted from January to February 2021 were included in the observation group.The control group received routine care during the perioperative period,and the observation group intervened through the program.The hospitalization time,hospitalization expenses,activities of daily living,complication rate and follow-up satisfaction rate were compared between the two groups.Results The program constructed in this study is divided into three parts:preoperative,intraoperative and postoperative management,covering 38 specific items that can be operated.After the intervention of the application program,the observation group’s time to get out of bed for the first time was earlier than that of the control group,the length of stay was shortened,the incidence of complications was reduced,and the satisfaction of follow-up was improved.The above differences were statistically significant(P<0.05).Conclusions The program constructed in this study has good scientificity,reliability and practicability.The implementation of the program can reduce the length of stay for PCNL patients and improve their health outcomes.