目的: 探究多学科联合质量改进护理在降低肝内胆管结石经皮肝穿刺胆道镜取石术（percutaneous transhepatic choledochoscopic stone removal,PTCSL）术后经皮肝穿刺胆道引流术（percutaneous transhepatic biliary drainage,PTCD）导管阻塞或脱出中的应用效果。方法: 纳入2022年3月至2024年3月期间本院收治的80例肝内胆管结石PTCSL术后患者进行研究,以随机数字表法分为对照组（n=40）与观察组（n=40）。对照组行常规护理,观察组基于对照组采用多学科联合质量改进护理。比较两组的敷贴更换频次、住院时间以及导管相关不良事件（导管滑脱、堵塞等）发生情况;比较两组干预前后的视觉模拟评分表（visual analogue scale,VAS）评分、自护能力（exercise of self-care ability scale,ESCA）评分及抑郁自评量表（self-rating depression scale,SDS）和焦虑自评量表（self-rating anxiety scale,SAS）评分。结果: 观察组敷贴更换频次以及住院时间均显著少于对照组;两组干预后的VAS、ESCA、SDS以及SAS评分较干预前均显著改善,且观察组改善优于对照组;观察组的导管滑脱、阻塞事件的发生率均显著低于对照组。结论: 多学科联合质量改进护理对肝内胆管结石PTCSL术后患者的护理效果显著,可明显降低PTCD导管阻塞或脱出等不良事件发生率,促进患者康复。
Abstract
Objective To explore the effects of multidisciplinary joint quality improvement nursing in reducing catheter obstruction or prolapse after percutaneous transhepatic choledochoscopic stone removal (PTCSL) and percutaneous transhepatic biliary drainage (PTCD) for intrahepatic bile duct stones. Methods A total of 80 patients with intrahepatic bile duct stones after PTCSL admitted to our hospital from March 2022 to March 2024 were included in the study and divided into the control group (n=40) and the observation group (n=40) by the random number table method. The control group received routine care, while the observation group adopted multidisciplinary joint quality improvement care based on the control group. Compare the frequency of patch replacement, hospital stay and the occurrence of catheter-related adverse events (such as catheter slippage and blockage) between the two groups; The visual analogue scale (VAS) scores, exercise of self-care ability scale (ESCA) scores, self-rating depression scale (SDS) and self-rating anxiety scale (SAS) scores before and after the intervention were compared between the two groups. Results The frequency of patch replacement and hospital stay in the observation group were both less than those in the control group and the differences were statistically significant. The VAS, ESCA, SDS and SAS scores of the two groups after intervention significantly improved compared with those before the intervention, and the improvement of the observation group was better than that of the control group. The incidences of catheter slippage and obstruction events in the observation group were significantly lower than in the control group. Conclusion Multidisciplinary joint quality improvement nursing has a significant effect on the nursing of patients after PTCSL for intrahepatic bile duct stones. It can significantly reduce the incidence of adverse events such as PTCD catheter obstruction or protrusion and promote the recovery of patients.
关键词
质量改进 /
经皮肝穿刺胆道引流术 /
肝内胆管结石 /
经皮肝穿刺胆道镜取石术 /
不良事件 /
导管管理
Key words
quality improvement /
percutaneous hepatic puncture biliary drainage /
intrahepatic bile duct calculus /
percutaneous hepatocentesis choledochoscopy /
adverse events /
catheter management
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基金
国家自然科学基金资助项目“循环非编码RNA调控肿瘤免疫微环境中TRAF6/NF-κB网络在肝癌进展中的作用机制研究”（81972675）
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