膽道疾病病人的護理特點及護理探討

論文編號:HL155  論文字數:11947.頁數:25

論文題目：膽道疾病病人的護理特點及護理探討

摘 要

研究背景

  膽道疾病的護理是我們臨床護理工作中常見的內容之一, 隨著人均壽命的增長以及生活水平的不斷提高，人們的飲食習慣有所改變，膽道疾病也逐年增多，僅2007年我院就收治了2072例膽道疾病的患者。但是目前對膽道疾病的護理還存在著弊端，尤其是基層的中小醫院，發生膽道術后出血、膽瘺、感染等并發癥的機率仍然不低，給患者帶來了痛苦，而且患者滿意度較差，因此，規范,科學的護理是醫院醫療質量考核的重要標準，也是減低醫療安全風險的主要環節，以達到保障住院患者安全的目的.特別針對目前醫患關系緊張，醫療糾紛層出不窮，以及患者安全目標的實施要求,總結我科120例膽囊切除術（包括腹腔鏡下膽囊切除術）和膽總管探查術的資料，著重介紹圍手術期護理方法以及健康教育。結果全組術后并發癥發生率低，無死亡病例。

研究目的
 
 描述膽道疾病術前、術后護理，預防及降低膽道疾病術后并發癥、復發及死亡率，尋找更加合理的護理方法。
 
研究方法

 選擇120位膽道手術患者，分為實驗組（60例）采用圍手術期護理方法及健康教育進行護理。對照組（60例）采用一般外科手術護理常規進行護理。觀察兩組患者術后出血、膽瘺及感染的情況，并對醫療費用、住院時間、患者滿意度等進行對比分析，同時觀察并記錄兩組患者的術后感受。

研究結果

患者中，對照組60例患者中16例出現出血大于等于30毫升，實驗組5例患者出現出血大于等于30毫升，實驗組明顯少于對照組。(X2=8.64,P<0.01)
發生膽瘺：60例患者中，實驗組2例明顯低于對照組13例。(X2=7.62,P<0.01)
發生感染：60例患者中，對照組16例發生感染，實驗組5例發生感染。實驗組明顯少于對照組。(X2=8.64,P<0.01)
醫療費用：術后醫療費用實驗組為1.14+0.24（萬元），對照組1.57+0.31（萬元），實驗組明顯少于對照組。(P<0.01)
住院時間：實驗組7.07+0.71（天），對照組8.73+2.51(天)，兩者相比有顯著性差異。(P<0.01)
患者滿意度：實驗組93.65+1.93%與對照組88.30+1.60%差異有顯著性意義。(P<0.01)
患者術后的感受：實驗組47例感覺舒適，對照組12例感覺舒適。試驗組明顯好于對照組。(X2=40.85,P<0.01)

結論

     采用圍手術期護理方法及健康教育進行護理對膽道術后并發癥地預防與治療起了積極有效的作用。有效的護理了膽道術后患者，保證了患者順利康復。其有效的減少并發癥，縮短了患者的住院時間，減少了抗生素及其他藥物的使用，降低了患者在院期間的醫療費用，同時使患者術后感覺舒適，提高了患者滿意度，既提高了護理人員的工作效率，又提高了護理人員的服務質量。

關 鍵 詞：膽道疾病；圍手術期護理；健康教育
 
論文類型: 研究報告

  
 
 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 錄
 
1前言 1
 1.1研究背景及意義 1
 1.2研究目的及目標 1
 1.2.1研究目的 1
 1.2.2研究目標 2
 1.3關鍵詞及意義 2
     1.3.1膽道疾病 2
     1.3.2圍手術期護理 2
     1.3.3健康教育 2
 1.4文獻回顧 2
 1.4.1膽道術后發生并發癥的主要機制 2
         1.4.1.1出血 2
         1.4.1.2膽瘺 3
         1.4.1.3感染 3
 1.4.2圍手術期護理 3
         1.4.2.1重視心理護理 3
         1.4.2.2病情觀察與護理 3
     1.4.3健康教育 4
     1.4.4一般外科手術護理常規 4
          1.4.4.1住院常規檢查 4
          1.4.4.2級別護理 4
          1.4.4.3按手術要求進行皮膚準備 4
          1.4.4.4采集標本進行交叉配血 4
          1.4.4.5按要求留置管道 4
2研究設計 7
 2.1設計類型 7
 2.2 研究對象 7
     2.2.1研究對象 7
 2.2.2納入標準 7
     2.2.3排除標準 7
 2.3研究步驟 7
     2.3.1兩組護理方法如下 7
             2.3.1.1對照組 7
             2.3.1.2試驗組 7
         2.3.2觀察指標 8
 2.4資料分析 9
3研究結果 11
 3.1一般資料統計分析 11
 3.2兩組患者發生出血、膽瘺、感染的情況 11
    3.3患者住院時間、醫療費用、患者滿意度 11
    3.4兩組患者舒適度比較 12
4討論 13
 4.1采用圍手術期護理方法及健康教育進行護理可有效地預防術后出血的發生 13
 4.2采用圍手術期護理方法及健康教育進行護理可有效地預防術后膽瘺的發生 14
 4.3采用圍手術期護理方法及健康教育進行護理可有效地預防術后感染的發生 14
 4.4采用圍手術期護理方法及健康教育進行護理后可減少住院時間、降低次均住院費用 15
 4.5采用圍手術期護理方法及健康教育進行護理后患者滿意度的提高 15
 4.6采用圍手術期護理方法及健康教育進行護理后患者舒適度的提高 16
5推論及建議 19
 5.1研究結論 19
 5.2建議 19
致謝 21
參考文獻 23
附件 25