序贯护理模式在超声引导下PTCD后口服胆汁患者的应用

Application of sequential nursing model based on timing theoryin patients with oral bile after PTCD

目的探讨序贯护理模式在超声引导下经皮肝穿胆道引流术(percuteneous transhepatic cholangio drainage,PTCD)后口服胆汁患者护理中的应用效果。方法将2020年1月—2022年7月在我院接受超声引导下PTCD术的157例患者纳入研究,根据入院时间随机分成观察组(80例)和对照组(77例);所有患者术后均口服胆汁,对照组实施常规护理干预,观察组在常规护理基础上开展序贯护理干预,对比两组患者术后住院时间,并测定护理前后肝肾功能恢复情况,应用出院准备度量表(RHDS)评估患者出院准备情况,通过WHO生活质量测定量表(WHOQOL-100)评估患者生活质量,观察术后并发症发生情况。结果观察组术后住院时间为(12.50±2.13)d,短于对照组(15.14±2.09)d,差异有统计学意义(t=12.730,P<0.05)。干预后观察组血清ALT、AST、ALP、UA分别为(90.41±6.94)U/L、(88.32±6.53)U/L、(122.05±10.24)umol/L、(154.84±19.30)umol/L,分别低于对照组的(113.16±10.85)U/L、(107.22±10.10)U/L、(171.40±11.54)umol/L、(181.24±20.44)umol/L,差异均有统计学差异(P<0.05)。干预后观察组WHOQOL-100评分均高于对照组(P<0.05)。观察组术后并发症发生率为8.75%,低于对照组的18.18%,差异有统计学意义(P<0.05)。观察组出院准备RHDS量表个人状态为(23.38±2.14)分,适应能力为(44.23±7.95)分、预期性支持(38.12±3.62)分、总分为(106.01±3.25)分,分别高于对照组的(20.92±2.26)分、(9.16±7.985)分、(34.62±2.02)分及(93.84±2.04),差异均有统计学差异(P<0.05)。结论超声引导下PTCD术后口服胆汁患者实施序贯护理干预,有助于促进术后机体及肝肾功能恢复,改善患者生活质量,减少并发症发生,有着重要临床意义。

Objective To explore the application effect of sequential nursing model based on timing theory in the nursing of patients with oral bile after percuteneous transhepatic cholangio drainage(PTCD).Methods 157 patients who underwent ultrasound-guided PTCD in our hospital from January 2020 to July 2022 were included in the study,and were divided into observation group(80 cases)and control group(77 cases)according to the time of admission;All patients were treated with bile after surgery.The control group was treated with routine nursing intervention.The observation group was treated with sequential nursing intervention on the basis of routine nursing.The time of hospitalization after surgery was compared between the two groups,and the recovery of liver and kidney function was measured before and after nursing.The patients′discharge preparation was evaluated with the discharge preparation scale(RHDS),and the quality of life was evaluated with the WHO Quality of Life Scale(WHOQOL-100),Postoperative complications were observed.Results The postoperative hospitalization time of the observation group was(12.50±2.13)d,which was shorter than that of the control group(15.14±2.09)d,and the difference was statistically significant(t=12.730,P<0.05).After the intervention,the serum ALT,AST,ALP and UA in the observation group were(90.41±6.94)U/L,(88.32±6.53)U/L,(122.05±10.24)umol/L,(154.84±19.30)umol/L,respectively,lower than those in the control group(113.16±10.85)U/L,(107.22±10.10)U/L,(171.40±11.54)umol/L,(181.24±20.44)umol/L,with statistical differences(P<0.05).After intervention,the WHOQOL-100 score in the observation group was higher than that in the control group(P<0.05).The incidence of postoperative complications in the observation group was 8.75%,which was lower than 18.18%in the control group(P<0.05).The individual status of the RHDS scale for discharge preparation in the observation group was(23.38±2.14)points,the adaptive ability was(44.23±7.95)points,the expected support was(38.12±3.62)points,and the total score was(106.01±3.25)points,which were higher than those in the control group(20.92±2.26)points,(9.16±7.985)points,(34.62±2.02)points,and(93.84±2.04)points,respectively(P<0.05).Conclusion Sequential nursing intervention for patients with oral bile after PTCD guided by ultrasound is helpful to promote the recovery of postoperative body and liver and kidney function,improve the quality of life of patients and reduce the occurrence of complications,which has important clinical significance.