多学科协作临床护理路径对腹腔镜胆道手术治疗复杂性肝内胆管结石应用价值探讨

Application value of multidisciplinary collaborative clinical nursing pathway for patients with complex intrahepatic bile duct stones undergoing laparoscopic biliary surgery

目的探讨腹腔镜胆道手术治疗复杂性肝内胆管结石(CIBDS)患者中,应用多学科协作临床护理路径(CNP)的价值。方法选择河南省人民医院2021-2022年收治的拟行腹腔镜胆道手术治疗的CIBDS患者作为研究对象。以2021-01-01-12-31收治的52例CIBDS患者作为常规组,按照1∶1匹配的原则,选择2022-01-01-12-31收治的52例CIBDS患者纳入CNP组。常规组采用常规的护理干预策略,CNP组在常规护理基础上采用多学科协作的CNP干预策略。比较2组患者术后恢复情况(首次下床活动时间、首次排尿时间、首次排气时间、总住院天数)、围手术期舒适度、术后遵医行为、自护能力[自我护理能力量表(ESCA)]、心理状态[抑郁自评量表(SDS)和焦虑自评量表(SAS)评分]和并发症发生率。结果CNP组首次排气时间为(16.11±1.67)h,短于常规组的(20.96±2.23)h,t=12.553,P<0.001;首次下床活动时间为(2.62±0.51)d,短于常规组的(3.46±1.01)d,t=5.354,P<0.001;总住院天数为(6.21±1.03)d,短于常规组的(8.53±2.11)d,t=7.125,P<0.001。CNP组围手术期生理评分为(33.12±3.20)分,高于常规组的(25.04±2.75)分,t=13.809,P<0.001;心理评分为(30.24±3.16)分,高于常规组的(24.61±2.59)分,t=9.937,P<0.001;环境评分为(28.91±2.12)分,高于常规组的(22.76±2.81)分,t=12.599,P<0.001;文化评分为(17.69±2.45)分,高于常规组的(12.13±1.62)分,t=13.651,P<0.001。CNP组术后遵医用药行为评分为(7.92±1.24)分,高于常规组的(6.62±2.01)分,t=3.969,P<0.001;适当运动行为评分为(7.56±1.62)分,高于常规组的(5.98±1.20)分,t=5.652,P<0.001;规律作息行为评分为(8.19±1.07)分,高于常规组的(6.41±1.86)分,t=5.982,P<0.001。干预后,CNP组ESCA评分为(130.38±10.21)分,高于常规组的(119.73±8.91)分,F=15.940,P<0.001;SDS评分为(35.25±5.25)分,低于常规组的(43.92±6.29)分,F=29.380,P<0.001;SAS评分为(30.25±4.61)分,低于常规组的(41.15±5.20)分,F=63.978,P<0.001。CNP组并发症发生率为5.77%,低于常规组的19.23%,χ^(2)=4.308,P=0.038。结论多学科协作的CNP可改善行腹腔镜胆道手术CIBDS患者围手术期舒适度和负性情绪,促进其遵医行为与自护能力提升,减少术后并发症,促进术后快速康复。

Objective To investigate the value of multidisciplinary collaborative clinical nursing pathway(CNP)in laparoscopic biliary surgery for patients with complex intrahepatic bile duct stones(CIBDS).Methods CIBDS patients undergone with laparoscopic biliary tract surgery were selected in Henan Provincial People's Hospital from 2021 to 2022 as the research subjects.Fifty-two patients with CIBDS admitted from January 1,2021 to December 31,2021 were included as the routine group,and 52 patients with CIBDS admitted from January 1,2022 to December 31,2022 were included as the CNP group in a ratio of 1∶1 matching.The routine group adopted the routine nursing intervention strategy,and the CNP group adopted the multi-disciplinary collaborative CNP intervention strategy based on the routine nursing.The postoperative recovery(first time out of bed activity,first urination time,first exhaust time,total hospitalization days),perioperative comfort,postoperative compliance behavior,self-care ability[self-care ability scale(ESCA)],psychological state[self-rating depression scale(SDS)and self-rating anxiety scale(SAS)],and incidence of complications were compared between the two groups.Results In CNP group,the first exhaust time was(16.11±1.67)h,which was shorter than that in routine group(20.96±2.23)h,t=12.553,P<0.001;the first time out of bed activity was(2.62±0.51)d,which was shorter than that in routine group(3.46±1.01)d,t=5.354,P<0.001;the total hospitalization days was(6.21±1.03)d,which was shorter than that in routine group(8.53±2.11)d,t=7.125,P<0.001.In CNP group,the perioperative physiological score was(33.12±3.20)points,which was higher than that in routine group(25.04±2.75)point,t=13.809,P<0.001;psychological score was(30.24±3.16)points,which was higher than that in routine group(24.61±2.59)points,t=9.937,P<0.001;environmental score was(28.91±2.12)points,which was higher than that in routine group(22.76±2.81)points,t=12.599,P<0.001;cultural score was(17.69±2.45)points,which was higher than that in the routine group(12.13±1.62)points,t=13.651,P<0.001.In CNP group,the compliance with medical behavior score was(7.92±1.24)points,which was higher than that in routine group(6.62±2.01)points,t=3.969,P<0.001;appropriate exercise score was(7.56±1.62)points,which was higher than that in routine group(5.98±1.20)points,t=5.652,P<0.001;regular rest behavior score was(8.19±1.07)points,which was higher than that in routine group(6.41±1.86)points,t=5.982,P<0.001.After intervention,in CNP group,the ESCA score was(130.38±10.21)points,which was higher than that in routine group(119.73±8.91)points,F=15.940,P<0.001;SDS score was(35.25±5.25)points,which was lower than that in the routine group(43.92±6.29)points,F=29.380,P<0.001;SAS score was(30.25±4.61)points,which was lower than that in the routine group(41.15±5.20)points,F=63.978,P<0.001.The complication rate of CNP group was 5.77%,which was significantly lower than that of routine group 19.23%(χ^(2)=4.308,P=0.038).Conclusion Multidisciplinary CNP can improve the perioperative comfort and negative emotion of CIBDS patients undergoing laparoscopic biliary tract surgery,promote their compliance behavior and self-care ability,reduce postoperative complications,and promote rapid postoperative recovery.