收稿日期: 2020-06-30
网络出版日期: 2021-06-24
The perioperative safety management practice of patients with advanced age undergoing endoscopic retrograde cholangiopancreatography
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
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 . DOI: 10.3761/j.issn.1672-9234.2021.06.014
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.
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