腹部手术大出血患者紧急开腹护理预案的构建

Establishment of a nursing preplan for emergency laparotomy caused by massive hemorrhage in robot abdominal surgery

目的构建腹部手术大出血患者紧急开腹护理预案。方法通过查阅文献、视频分析结合临床经验构建腹部手术大出血患者紧急开腹护理预案初稿。2022年4月—6月采用德尔菲法进行专家咨询,确定预案最终内容。结果共开展3轮专家咨询,3轮咨询问卷有效回收率分别为94.12%、100%、100%,专家权威系数分别为0.816、0.851、0.878;3轮咨询各阶段、步骤、操作的重要性肯德尔和谐系数分别是0.149~0.204、0.163~0.236、0.407~0.436,差异具有统计学意义(均P<0.05),操作可行性的肯德尔和谐系数分别为0.302、0.243、0.409,差异具有统计学意义(均P<0.001);第3轮咨询各阶段、步骤、操作重要性变异系数为0~0.21,满分率为25.00%~100%,可行性变异系数为0~0.17,满分率为31.25%~100%。最终版的腹部手术大出血患者紧急开腹护理预案包含3个阶段、10个步骤、47项操作。结论该研究构建的腹部手术大出血患者紧急开腹护理预案具有科学性、可行性、实用性、针对性,可为机器人手术护理提供指导。

Objective The aim of the study is to establish the nursing preplan for emergency change of operation mode caused by hemorrhage in robotic abdominal surgery.Methods We constructed the first draft of the nursing preplan through literature review,video analysis and clinical experience.3 rounds of expert consultations were performed by Delphi method from April to June 2022 to establish the final nursing preplan for emergency change of operation mode caused by hemorrhage in robotic surgery.Results A total of 16 experts were included in the study;the response rates of 3 rounds were 94.12%,100%and 100%,respectively;the authority coefficients of the experts were 0.816,0.851 and 0.878,respectively.The Kendall’s concordance coefficients of the importance of each stage,step,and operation in the 3 rounds were 0.149~0.204,0.163~0.236,0.407~0.436,which were statistically significant(all P<0.05);the Kendall’s coefficients for operational feasibility were 0.302,0.243 and 0.409,which were statistically significant(all P<0.001);the coefficient of variation of the importance of each stage,step,and operation in the third round is 0~0.21,and the full mark rate is 25.00%~100%;the coefficient of variation of the feasibility of each item in the third round is 0~0.17,and the full mark rate is 31.25%~100%.The final nursing scheme for emergency change of operation mode caused by hemorrhage in robotic surgery includes 3 stages,10 steps,and 47 operations.Conclusion The constructed nursing preplan for emergency change of operation mode caused by hemorrhage in robot abdominal surgery in this study is scientific,feasible,practical and specific,which provides guidance for robotic surgical care.