行内镜下逆行胰胆管造影术超高龄患者围术期安全管理

doi:10.3761/j.issn.1672-9234.2021.06.014

摘要/Abstract

摘要：

目的评价基于项目管理的行内镜下逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography,ERCP）超高龄患者围术期安全管理的实践效果。方法选择在医院接受治疗的150例ERCP超高龄患者为研究对象,将2015年10月—2017年3月的72例ERCP超高龄患者设为对照组,2017年5月—2019年1月的78例ERCP超高龄患者设为试验组。对照组采用的主要是科室医护小组常规的入院宣教、评估、手术方案、组织实施,根据科室制订的护理常规进行护理。试验组以项目管理理论为基础组建项目管理团队,针对行ERCP的超高龄患者围手术期存在的安全问题制订相应的管理方案并组织实施。比较两组行ERCP的超高龄患者围术期并发症发生率、不良事件发生率及护理质量的改善情况。结果试验组并发症的发生率为5.1%（4/78）,对照组并发症的发生率为12.5%（9/72）,两组比较差异没有统计学意义（χ²=2.417,P=0.120）。试验组发生5例（6%）不良事件;对照组发生19例（26%）,两组比较差异有统计学意义（χ²=11.119,P=0.001）。实施项目管理后,护士护理质量较实施前有改善,差异有统计学意义（P<0.05）。结论基于项目管理下的行ERCP超高龄患者围术期安全管理有效,有助于提高护理质量。

关键词: 胰胆管造影术,内窥镜逆行, 围手术期护理, 老年人,80以上, 项目管理

Abstract:

Objective To evaluate the effects of multi-disciplinary nursing project on perioperative safety management for patients aged 80 or above with endoscopic retrograde cholangiopancreatography（ERCP）. Methods Totally 150 patients with ERCP were selected with 72 patients admitted from October 2015 to March 2017 in the control group,and 78 patients admitted from May 2017 to January 2019 in the experimental group. Patients in the control group mainly received the routine care including health education,assessment,making operation plan,and perioperative care. A project management team was established for patients in the experimental group. The team made the plans to manage the perioperative safety problems of patients in the experimental group. The effects were evaluated by comparing the complication rates,adverse event rates and nursing quality improvement in the two groups. Results The perioperative complication rate of patients in the experimental group was 5.1%（4/78）,and the complication rate in the control group was 12.5%（9/72）. There was no statistically significant between the two groups（χ²=2.417,P=0.120）. There were 5 cases（6%）of adverse events in the experimental group and 19 cases（26%） in the control group（χ²=11.119,P=0.001）. After the intervention,the care quality was improved compared with that before the intervention（P<0.05）. Conclusion Safety management based on project managment is effective for ERCP patients with advanced age. It can improve the quality of nursing.

Key words: Cholangiopancreatography,Endoscopic Retrograde, Perioperative Nursing, Aged,80 and over, Project management

张煜,刘梅红. 行内镜下逆行胰胆管造影术超高龄患者围术期安全管理[J]. 中华护理教育, 2021, 18(6): 547-550.

ZHANG Yu,LIU Mei-hong. The perioperative safety management practice of patients with advanced age undergoing endoscopic retrograde cholangiopancreatography[J]. Chinese Journal of Nursing Education, 2021, 18(6): 547-550.

图/表 1

参考文献 14

[1]	Thaker AM, Mosko JD, Berzin TM. Post-endoscopic retrograde cholangiopancreatography pancreatitis[J]. Gastroenterol Rep(Oxf), 2015,3(1):32-40.
[2]	石玉琪, 许春芳. ERCP联合腹腔镜胆囊切除术治疗胆总管结石合并胆囊结石术后胆总管结石复发的危险因素分析[J]. 中华消化内镜杂志, 2016,33(10):689-692.
	Shi YQ, Xu CF. Risk factors for common bile duct stones recurrence in patients undergoing ERCP and LC[J]. Chin J Dig Endosc, 2016,33(10):689-692.
[3]	Han SJ, Lee TH, Kang BI, et al. Efficacy and safety of therapeutic endoscopic retrograde cholangiopancreatography in the elderly over 80 years[J]. Dig Dis Sci, 2016,61(7):2094-2101. doi: 10.1007/s10620-016-4064-y
[4]	王荣希. 85岁及以上患者行治疗性ERCP并发症的危险因素分析[D]. 郑州:郑州大学, 2019.
	Wang RX. Risk factors of complications in therapeutic ERCP for patients aged>85 years[D]. Zhengzhou:Zhengzhou University, 2019.
[5]	王淼, 谢娟. 项目管理在四川大学华西医院管理实践中的应用[J]. 中国循证医学杂志, 2014,14(3):369-372.
	Wang M, Xie J. Application of project management in West China Hospital of Sichuan University[J]. Chin J Evid Based Med, 2014,14(3):369-372.
[6]	美国项目管理协会. 项目管理知识体系指南[M]. 王勇,张斌,译. 北京:电子工业出版社, 2013.
	Project Management Institute. A guide of the project mangement body of knowledge[M]. Wang Y,Zhang B,Trans. Beijing:Publishing House of Electronic Industry, 2013.
[7]	白玉玲, 刘霞, 郑元, 等. 六步标准沟通流程在老年肺癌患者护理沟通中的应用[J]. 中华现代护理杂志, 2019,25(19):2475-2479.
	Bai YL, Liu X, Zheng Y, et al. Application of six-step standard communication process in nursing communication with elderly lung cancer patients[J]. Chin J Mod Nurs, 2019,25(19):2475-2479.
[8]	张煜, 姚伟, 王媛媛. CICARE沟通模式在透明帽辅助内镜下硬化术治疗痔疮医护一体化术前访视中的应用[J]. 心理医生, 2019,25(1), 316-317.
	Zhang Y, Yao W, Wang YY. The application of CICARE communication model in the treatment of hemorrhoids by sclerotherapy with transparent cap before preoperative visit[J]. Psy-chological Doctor, 2019,25(1), 316-317.
[9]	中华医学会消化内镜学分会麻醉协作组. 常见消化内镜手术麻醉管理专家共识[J]. 临床麻醉学杂志, 2019,35(2):177-185.
	Anaesthesia Cooperation Group of digestive endoscopy Branchi in Chinese Medical Association. Consensus of experts in anesthesia management for digestive endoscopy surgery[J]. J Clin Anesthesiol, 2019,35(2):177-185.
[10]	王淑萍, 李丽. 高龄患者行逆行胰胆管造影术治疗的围术期安全性护理[J]. 解放军护理杂志, 2018,35(17):61-64.
	Wang SP, Li L. Research on the safety nursing of ERCP in elderly patients[J]. Nurs J Chin PLA, 2018,35(17):61-64.
[11]	金景鹏, 李长锋, 孙晨. 针形刀乳头括约肌切开术在老年胆总管结石病例中的应用[J]. 中华消化内镜杂志, 2019,36(10):766-767.
	Jin JP, Li CF, Sun C. Application of needle knife nipple sphincterotomy in elderly patients with Choledocholithiasis[J]. Chin J Dig Endosc, 2019,36(10):766-767.
[12]	张煜, 刘梅红. 1例腹腔低分化癌并发恶性梗阻性黄疸行超声内镜引导下对接技术患者的远程多学科协作护理[J]. 中国临床护理, 2020,12(2):182-184.
	Zhang Y, Liu MH. A case of poorly differentiated abdominal carcinoma complicated with malignant obstructive jaundice. Remote multidisciplinary collaborative nursing care of a patient who underwent ultrasound-guided docking technology[J]. Chin Clin Nurs, 2020,12(2):182-184.
[13]	Chan S, Hee S, Ki B, et al. Urgent ERCP for acute cholangitis reduces mortality and hospital stay in elderly and very elderly patients[J]. Hepatobiliary Pancreat Dis Int, 2016,15(6):619-625. doi: 10.1016/S1499-3872(16)60130-3
[14]	Croxatto A, Greub G. Project management:importance for diagnostic laboratories[J]. Clin Microbiol Infect, 2017,23(7):434-440. doi: 10.1016/j.cmi.2017.04.007