眼科日间手术患者全程管理方案的建立与评价

Establishment and Evaluation of a Comprehensive Management Program for Ophthalmic Day Surgery Patients

目的建立并评价以专科护士为主导的眼科日间手术院前-院内-院外全程管理方案的临床效果。方法纳入2022年8月—2023年8月广州市番禺区中心医院接受眼科日间手术治疗的患者100例,随机分为观察组与对照组,各50例。对照组实施常规日间手术干预方案,观察组建立并实施以专科护士为主导的院前-院内-院外全程管理方案。对比2组患者手术失约率、状态特质焦虑(STAI)量表评分、急性应激反应量表(ASRS)评分、围手术期指标、术后并发症情况及患者满意度。结果(1)手术失约率及STAI量表评分:观察组手术失约率低于对照组(χ^(2)=4.891,P=0.027),STAI量表评分低于对照组(t=9.107,P=0.000),差异均有统计学意义。(2)心理应激状况:与本组入院即刻比较,2组患者术前30 min的心理应激各项得分均下降,差异均有统计学意义(对照组:t分离症状=8.884、t_(回避症状)=7.308、t_(高警觉症状)=3.945、t_(再体验症状)=7.505,均P=0.000;观察组:t分离症状=15.329、t_(回避症状)=13.381、t_(高警觉症状)=9.346、t_(再体验症状)=17.556,均P=0.000)。观察组患者术前30 min的心理应激各项得分均低于对照组,差异均有统计学意义(t分离症状=11.718、t_(回避症状)=10.336、t_(高警觉症状)=6.585、t_(再体验症状)=18.085,均P=0.000)。(3)围手术期指标:观察组患者术后24 h疼痛评分均低于对照组,差异均有统计学意义(t_(疼痛评分)=9.671,P=0.000)。(4)并发症情况:2组术后并发症主要包括眼痛、流泪、异物感、眼睑肿胀,观察组术后并发症总发生率低于对照组,差异有统计学意义(χ^(2)=4.332,P=0.037)。(5)护理满意度:观察组患者护理满意度各项评分高于对照组,差异均有统计学意义(t_(术前准备)=11.019、t_(心理干预)=16.936、t_(术后管理)=18.974,均P=0.000)。结论以专科护士为主导的院前-院内-院外全程管理方案能够降低眼科日间手术失约率,改善术前焦虑,促进患者术后恢复,患者满意度高。

OBJECTIVE To establish and evaluate the clinical efficacy of a comprehensive preoperative-intraoperative-postoperative management program for ophthalmic day surgery led by specialist nurses.METHODS A total of 100 patients who underwent ophthalmic day surgery at Guangzhou Panyu District Central Hospital from August 2022 to August 2023 were randomly divided into an observation group and a control group,with 50 patients in each group.The control group received routine day surgery intervention,while the observation group implemented a comprehensive management program led by specialist nurses.The two groups were compared in terms of surgery no-show rate,State-Trait Anxiety Inventory(STAI)scores,Acute Stress Response Scale(ASRS)scores,perioperative indicators,postoperative complications,and patient satisfaction.RESULTS(1)Surgery no-show rate and STAI scores:The observation group had a lower surgery no-show rate(χ^(2)=4.891,P=0.027)and lower STAI scores(t=9.107,P=0.000)compared to the control group,with statistically significant differences.(2)Psychological stress status:Compared to the time of admission,the dissociative symptoms(DS),avoidance symptoms(AS),hypervigilance symptoms(HS),reexperiencing symptoms(RS)of psychological stress scores 30 minutes before surgery in both groups decreased significantly(Control group:t_(DS)=8.884,t_(AS)=7.308,t_(HS)=3.945,t_(RS)=7.505,all P=0.000;Observation group:t_(DS)=15.329,t_(AS)=13.381,t_(HS)=9.346,t_(RS)=17.556,all P=0.000).The observation group had significantly lower psychological stress scores 30 minutes before surgery compared to the control group(t_(DS)=11.718,t_(AS)=10.336,t_(HS)=6.585,t_(RS)=18.085,all P=0.000).(3)Perioperative indicators:The observation group had shorter awakening times(AS),lower pain scores(PS)24 hours after surgery compared to the control group,with statistically significant differences(t=9.671,P=0.000).(4)Complications:Postoperative complications in both groups mainly included eye pain,tearing,foreign body sensation,and eyelid swelling.The total incidence of postoperative complications in the observation group was lower than that in the control group,with a statistically significant difference(χ^(2)=4.332,P=0.037).(5)Nursing satisfaction:The observation group had higher preoperative preparation(PP),psychological intervention(PI),postoperative management(PM)of nursing satisfaction scores in all aspects compared to the control group,with statistically significant differences(t_(PP)=11.019,t_(PI)=16.936,tPM=18.974,all P=0.000).CONCLUSIONS The comprehensive management program led by specialist nurses for preoperative-intraoperative-postoperative care can reduce the no-show rate for ophthalmic day surgery,alleviate preoperative anxiety,promote postoperative recovery,and achieve high patient satisfaction.