"5W1H"夹管清单在经皮肝穿刺胆道引流+胆道支架置入术后护理中的应用

Application of"5W1H"clamp list in nursing care after PTBD+biliary stent implantation

目的探讨"5W1H"夹管清单在经皮肝穿刺胆道引流(percutaneous transhepatic biliary drainage,PTBD)+胆道支架置入术后夹管患者护理中的应用。方法收集2021年3月至2022年11月湖南省人民医院收治的PTBD+胆道支架置入术后带管出院患者的临床资料,采用随机数字表分为对照组和观察组。对照组患者于手术和出院日均由责任护士行留置PTBD管路及夹管护理健康教育,观察组在对照组的基础上手术当天发放"5W1H"夹管清单,采用自制问卷评估2组患者/家属术后1、2、3、4周直至拔出管道为止对夹管时机、夹管原则、具体步骤、暂停标准、拔管时机、紧急应对护理措施等自护能力,并比较2组患者并发症发生率及总带管时长。结果本研究实际纳入患者150例,每组患者75例。观察组患者/家属疾病自护能力明显高于对照组(P<0.05),术后并发症发生率(感染、管道脱出、管道堵塞)、带管时长明显低于对照组(P<0.05)。结论应用"5W1H"夹管清单能提高PTBD+胆道支架置入术后患者/家属的自护能力,减少并发症的发生,促使患者尽早完成夹管,早日康复。

Objective To explore the application of"5W1H"clamp list in the nursing of patients with clamping after percutaneous transhepatic biliary drainage(PTBD)and biliary stent implantation.Methods From March 2021 to November 2022,150 patients discharged with tubes after PTBD+biliary stent implantation were randomly divided into control group(75 cases)and observation group(75 cases)using a random number table.The patients in the control group were given nursing health education of indwelling PTBD tubes and tube clamping by the responsible nurse on both the operation and discharge days.The patients in the observation group were given a"5W1H"tube clamping list on the day of operation,based on the control group.The self-made questionnaire was used to evaluate the self-care ability of the two groups of patients/family members at 1,2,3,and 4 weeks after operation until the tube was removed,including tube clamping timing,tube clamping principles,specific steps,suspension standards,tube removal timing,and emergency response nursing measures.The incidence of complications and the duration of total catheterization between the two groups of patients were compared.Results The self-care ability of patients/family members in the observation group was significantly higher than that in the control group(P<0.05).The incidence of postoperative complications(infection,tube prolapse,tube blockage)and the duration of tube insertion were significantly lower than those in the control group(P<0.05).Conclusion The application of"5W1H"clamp list can improve the self-care ability of patients/family members after percutaneous transhepatic biliary drainage(PTBD)+biliary stent implantation,reduce the occurrence of complications,and promote patients to complete clamping of tube as soon as possible and recover as soon as possible.