ISSN 2097-6054（网络） ISSN 1672-9234（印刷） CN 11-5289/R
主管：中国科学技术协会　主办：中华护理学会
出版：中华护理杂志社
收录：中国科学引文数据库（CSCD）来源期刊
　　　中国期刊全文数据库
　　　中国核心期刊（遴选）数据库
　　　Scopus
中华护理教育

中华护理教育 ›› 2026, Vol. 23 ›› Issue (9): 1108-1114.doi: 10.3761/j.issn.1672-9234.2026.09.013

• 职业成长与发展研究 • 上一篇    下一篇

四象限定位结合力学量化法在经内镜逆行胰胆管造影术护理配合培训中的应用研究

田静蕾1(), 余爱玉2, 马文聪2, 沈绚丽2, 胡婷婷2, 楼奇峰2,*()   

  1. 1 浙江中医药大学护理学院 杭州市 310053
    2 西湖大学医学院附属杭州市第一人民医院消化内科 杭州市 310006
  • 收稿日期:2026-01-15 出版日期:2026-09-15 发布日期:2026-09-15
  • 通讯作者: *楼奇峰，E-mail：louqifeng0503@163.com
  • 作者简介:田静蕾：女，本科（硕士在读），E-mail：iamtianjinglei@163.com
    第一联系人：

    田静蕾：研究设计、数据收集与分析、论文撰写；余爱玉：教学方法实施、数据收集；马文聪：质性访谈实施与分析；沈绚丽：统计分析、论文修改；胡婷婷：文献检索、资料整理；楼奇峰：研究设计与指导、论文审校、经费支持。

  • 基金资助:
    浙江省医药卫生科技计划临床研究应用项目(2024KY190)

Application of four-quadrant localization combined with mechanical quantification method in nursing education for endoscopic retrograde cholangiopancreatography

TIAN Jinglei1(), YU Aiyu2, MA Wencong2, SHEN Xuanli2, HU Tingting2, LOU Qifeng2,*()   

  1. 1 School of Nursing， Zhejiang Chinese Medical University， Hangzhou 310053， China
    2 Department of Gastroenterology， Affiliated Hangzhou First People’s Hospital，School of Medicine，Westlake University， Hangzhou 310006， China
  • Received:2026-01-15 Online:2026-09-15 Published:2026-09-15
  • Contact: *LOU Qifeng，E-mail：louqifeng0503@163.com
  • Supported by:
    Zhejiang Provincial Medical and Health Science and Technology Plan Clinical Research Application Project(2024KY190)

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摘要：

目的 探讨四象限定位判断法与力学量化法相结合，在经内镜逆行胰胆管造影术（endoscopic retrograde cholangiopancreatography，ERCP）护理配合培训中的应用成效。 方法 选取某医院消化内镜中心的ERCP进修护士为研究对象。将2022年1月—2023年12月的57名进修护士设为对照组，2024年1月—2025年6月的59名进修护士设为试验组。对照组采用阶段性教学方法，试验组则在对照组基础上融入四象限定位判断法和力学量化法。对两组的理论考核成绩、操作考核成绩及教学效果评价进行比较，并对试验组开展半结构式访谈。 结果 试验组操作考核成绩高于对照组，差异具有统计学意义（P<0.05），该差异主要体现在胆胰管轴向判断、切开刀方向调整及导丝深插管配合等单项技能方面。两组对教学方法评价的比较结果显示，在有助于知识与理论的理解、加深动作精准度、提高评判性思维能力、提高分析问题的能力、自信心与职业价值感的提升5个方面，差异均具有统计学意义（P<0.001）。访谈提炼出5个主题，分别为四象限定位提升判断的主动性与准确性、分级量化力学有助于手感控制；医护配合从“被动等待”走向“主动协同”； 教学方法具象化、结构化，降低学习曲线与焦虑情绪；对规范化、系统化培训体系的期待。 结论 四象限定位判断法结合力学量化法能够有效提高ERCP进修护士的操作技能水平，推动其理论认知、实践能力与职业自信的协同发展。

关键词: 胰胆管造影术, 内窥镜逆行, 进修护士, 在职培训

Abstract:

Objective To explore the application effect of the combination of four-quadrant localization and mechanical quantitative method in nursing education for advanced training nurses in endoscopic retrograde cholangiopancreatography（ERCP）. Methods A historical control study design was adopted，with ERCP advanced training nurses from the digestive endoscopy center of a hospital as the research objects. Those from January 2022 to December 2023（n=57） were assigned to the control group，and those from January 2024 to June 2025（n=59） to the experimental group. The control group adopted phased teaching method，while the experimental group integrated four-quadrant localization and mechanical quantitative method in addition to the phased teaching. Theoretical assessment scores，operational assessment scores and teaching effect evaluation were compared between the two groups，and semi-structured interviews were conducted with the experimental group. Results The operational assessment scores of the experimental group was significantly higher than those of the control group，and the difference was statistically significant（P<0.05）. This difference was mainly reflected in individual skills such as biliary-pancreatic duct axial judgment，direction adjustment of incision knife and coordination of deep guidewire intubation. Comparison of teaching method evaluations between the two groups showed statistically significant differences in five aspects：facilitating the understanding of knowledge and theory，enhancing movement accuracy，improving critical thinking ability，improving problem-analysis ability，and enhancing self-confidence and sense of professional value（all P<0.001）. Five themes were extracted from qualitative interviews：four-quadrant positioning improves judgment proactivity and accuracy；graded force quantification aids in force control；nursephysician cooperation shifts from “passive waiting” to “active coordination”；the teaching method is concrete and structured，reducing the learning curve and anxiety；and expectations for a standardized and systematic training system. Conclusion The combination of four-quadrant localization and mechanical quantitative method can effectively improve the operational skill level and comprehensive teaching effect of ERCP advanced training nurses，and promote the coordinated development of theoretical cognition，practical ability and professional confidence.

Key words: Cholangiopancreatography, Endoscopic Retrograde, Advanced Training Nurses, In-service Training