胆道疾病病人的护理特点及护理探讨

论文编号:HL155  论文字数:11947.页数:25

论文题目：胆道疾病病人的护理特点及护理探讨

摘 要

研究背景

  胆道疾病的护理是我们临床护理工作中常见的内容之一, 随着人均寿命的增长以及生活水平的不断提高，人们的饮食习惯有所改变，胆道疾病也逐年增多，仅2007年我院就收治了2072例胆道疾病的患者。但是目前对胆道疾病的护理还存在着弊端，尤其是基层的中小医院，发生胆道术后出血、胆瘘、感染等并发症的机率仍然不低，给患者带来了痛苦，而且患者满意度较差，因此，规范,科学的护理是医院医疗质量考核的重要标准，也是减低医疗安全风险的主要环节，以达到保障住院患者安全的目的.特别针对目前医患关系紧张，医疗纠纷层出不穷，以及患者安全目标的实施要求,总结我科120例胆囊切除术（包括腹腔镜下胆囊切除术）和胆总管探查术的资料，着重介绍围手术期护理方法以及健康教育。结果全组术后并发症发生率低，无死亡病例。

研究目的
 
 描述胆道疾病术前、术后护理，预防及降低胆道疾病术后并发症、复发及死亡率，寻找更加合理的护理方法。
 
研究方法

 选择120位胆道手术患者，分为实验组（60例）采用围手术期护理方法及健康教育进行护理。对照组（60例）采用一般外科手术护理常规进行护理。观察两组患者术后出血、胆瘘及感染的情况，并对医疗费用、住院时间、患者满意度等进行对比分析，同时观察并记录两组患者的术后感受。

研究结果

患者中，对照组60例患者中16例出现出血大于等于30毫升，实验组5例患者出现出血大于等于30毫升，实验组明显少于对照组。(X2=8.64,P<0.01)
发生胆瘘：60例患者中，实验组2例明显低于对照组13例。(X2=7.62,P<0.01)
发生感染：60例患者中，对照组16例发生感染，实验组5例发生感染。实验组明显少于对照组。(X2=8.64,P<0.01)
医疗费用：术后医疗费用实验组为1.14+0.24（万元），对照组1.57+0.31（万元），实验组明显少于对照组。(P<0.01)
住院时间：实验组7.07+0.71（天），对照组8.73+2.51(天)，两者相比有显著性差异。(P<0.01)
患者满意度：实验组93.65+1.93%与对照组88.30+1.60%差异有显著性意义。(P<0.01)
患者术后的感受：实验组47例感觉舒适，对照组12例感觉舒适。试验组明显好于对照组。(X2=40.85,P<0.01)

结论

     采用围手术期护理方法及健康教育进行护理对胆道术后并发症地预防与治疗起了积极有效的作用。有效的护理了胆道术后患者，保证了患者顺利康复。其有效的减少并发症，缩短了患者的住院时间，减少了抗生素及其他药物的使用，降低了患者在院期间的医疗费用，同时使患者术后感觉舒适，提高了患者满意度，既提高了护理人员的工作效率，又提高了护理人员的服务质量。

关 键 词：胆道疾病；围手术期护理；健康教育
 
论文类型: 研究报告

  
 
 Title: Characteristics of patients with biliary tract diseases and nursing care of
ABSTRACT
 
 
Background

 Biliary tract disease, clinical nursing care is one of the elements common with the average life expectancy of the growth and rising living standards, people's eating habits change, biliary tract disease is also increasing year by year, only in 2007 admitted to our hospital on the of the 2072 cases of biliary tract disease patients. But at present the care of biliary tract disease, there are still drawbacks, especially the grass-roots small hospital, occurred after biliary tract bleeding, biliary fistula, infection and other complications of the probability is still not low, has been a painful for patients, and patient satisfaction than the poor, therefore, standardized and scientific quality of hospital medical care is an important criterion for assessment.To reduce the security risks are also key areas of health care in order to achieve the purpose to protect the safety of hospitalized patients. Specifically for physician-patient relationship is currently strained, medical disputes, as well as the patient safety goal of the implementation of the requirements of Section 120 cases concluded I cholecystectomy (including laparoscopic cholecystectomy) and the common bile duct exploration data, highlighting the perioperative nursing methods and health education. Results The postoperative complication rate is low, no death cases.

Objectives:

 Description biliary tract disease before surgery, care, prevention and to reduce postoperative complications of biliary tract disease, relapse and mortality, to find a more reasonable method of care.
 
Methods:

     Select 120 patients with biliary tract surgery were divided into experimental group (60 cases) using perioperative nursing care methods and health education. The control group (60 cases) of conventional type commonly used in surgical care in nursing. Were observed in patients with postoperative bleeding, biliary fistula, and infections, and medical costs, length of stay, patient satisfaction were analyzed at the same time observe and record the two groups of patients with postoperative experience.

Results:

    1. Patients, 60 patients in the control group, 16 cases of bleeding than or equal to 30 ml in the experimental group five cases of bleeding in patients greater than or equal 30 ml in the experimental group significantly lower than the control group. (X2 = 8.64, P &lt;0.01)
 2. Biliary fistula occurred: 60 patients, two cases of experimental group was significantly lower than the control group 13 cases. (X2 = 7.62, P &lt;0.01)
 3. Infection: 60 patients, control group, 16 cases of infection in the experimental group five cases of infection. Experimental group was significantly lower than the control group. (X2 = 8.64, P &lt;0.01)
 4. Medical expenses: medical costs after the experimental group was 1.14 +0.24 (million), the control group 1.57 +0.31 (million), the experimental group significantly lower than the control group. (P &lt;0.01)
 5. Length of stay: Experimental group 7.07 +0.71 (days), the control group 8.73 +2.51 (days), both were significantly difference. (P &lt;0.01)
 6. Patient satisfaction: the experimental group and control group, 93.65 +1.93% 88.30 +1.60% difference was statistically significant. (P &lt;0.01)
 7. Postoperative feelings: the experimental group 47 cases feel comfortable in the control group 12 patients feel comfortable. Test group was significantly better than the control group. (X2 = 40.85, P &lt;0.01)
 
Conclusion:

 Use of perioperative nursing care methods and health education for prevention of biliary complications and treatment played an active and effective role. Effective care of patients with biliary tract surgery to ensure the successful rehabilitation of patients. Their effective to reduce complications and shorten the patient's hospital stay, reduced use of antibiotics and other drugs to reduce the patient during his hospital medical costs, while postoperative comfort, improved patient satisfaction, not only improves the Nurses working efficiency, but also improves the quality of services nurses.
 
KEY WORDS: biliary tract disease， perioperative nursing，health education

TYPE OF THESIS: research report

 
目 录
 
1前言 1
 1.1研究背景及意义 1
 1.2研究目的及目标 1
 1.2.1研究目的 1
 1.2.2研究目标 2
 1.3关键词及意义 2
     1.3.1胆道疾病 2
     1.3.2围手术期护理 2
     1.3.3健康教育 2
 1.4文献回顾 2
 1.4.1胆道术后发生并发症的主要机制 2
         1.4.1.1出血 2
         1.4.1.2胆瘘 3
         1.4.1.3感染 3
 1.4.2围手术期护理 3
         1.4.2.1重视心理护理 3
         1.4.2.2病情观察与护理 3
     1.4.3健康教育 4
     1.4.4一般外科手术护理常规 4
          1.4.4.1住院常规检查 4
          1.4.4.2级别护理 4
          1.4.4.3按手术要求进行皮肤准备 4
          1.4.4.4采集标本进行交叉配血 4
          1.4.4.5按要求留置管道 4
2研究设计 7
 2.1设计类型 7
 2.2 研究对象 7
     2.2.1研究对象 7
 2.2.2纳入标准 7
     2.2.3排除标准 7
 2.3研究步骤 7
     2.3.1两组护理方法如下 7
             2.3.1.1对照组 7
             2.3.1.2试验组 7
         2.3.2观察指标 8
 2.4资料分析 9
3研究结果 11
 3.1一般资料统计分析 11
 3.2两组患者发生出血、胆瘘、感染的情况 11
    3.3患者住院时间、医疗费用、患者满意度 11
    3.4两组患者舒适度比较 12
4讨论 13
 4.1采用围手术期护理方法及健康教育进行护理可有效地预防术后出血的发生 13
 4.2采用围手术期护理方法及健康教育进行护理可有效地预防术后胆瘘的发生 14
 4.3采用围手术期护理方法及健康教育进行护理可有效地预防术后感染的发生 14
 4.4采用围手术期护理方法及健康教育进行护理后可减少住院时间、降低次均住院费用 15
 4.5采用围手术期护理方法及健康教育进行护理后患者满意度的提高 15
 4.6采用围手术期护理方法及健康教育进行护理后患者舒适度的提高 16
5推论及建议 19
 5.1研究结论 19
 5.2建议 19
致谢 21
参考文献 23
附件 25