消化内镜下黏膜剥离术（ESD）患者围术期标准化护理路径的构建与实证研究
|
孔雪蒙
|
云南省曲靖中心医院，云南曲靖，655000
|
摘要：目的 构建针对消化内镜下黏膜剥离术（ESD）患者的围术期标准化护理路径，并验证其在临床实践中的应用效果。方法 采用类实验研究方法，本研究纳入2023年1月至2024年6月在我院内镜中心接受ESD 治疗的120 例患者，按照随机数字表法将其随机分为观察组和对照组，每组各60 例。对照组实施常规围术期护理，观察组则应用基于循证医学构建的标准化护理路径进行管理。比较两组患者的围术期指标（术前准备时间、术中配合度、术后下床活动时间）、并发症发生率（包括术中穿孔、术后出血、术后感染）、焦虑评分（采用SAS 量表）、疼痛评分（采用VAS 量表）、健康知识掌握度及患者满意度。结果 干预后，观察组患者的术前准备时间（45.32±8.15 vs 68.75±10.24 分钟）显著短于对照组（P<0.05），术中配合度优良率（95.00% vs 81.67%）高于对照组（P<0.05）。观察组的术后下床活动时间（18.56±4.82 vs 25.41±5.73 小时）早于对照组（P<0.05）。观察组并发症总发生率仅5.00%，明显低于对照组18.33%（P<0.05）。此外，观察组患者的SAS 评分（42.15±5.38 vs 50.62±6.17）和术后24h VAS 评分（2.85±0.94 vs 4.12±1.15）均低于对照组，健康知识掌握度评分（92.45±4.37vs 80.33±6.52）和护理满意度观察组达98.33%，较对照组提升10 个百分点，差异有统计学意义（P＜0.05）。结论 对ESD患者实施围术期标准化护理路径，能够有效优化诊疗流程，提高护理效率与质量，显著降低并发症风险，缓解患者负性情绪，促进术后康复，并提升患者就医体验与满意度，具有显著的临床推广应用价值。
关健词：消化内镜黏膜剥离术；围术期护理；标准化护理路径；并发症；患者满意度
|
Development and Empirical Study of a Standardized Nursing Pathway for Perioperative Patients Undergoing Endoscopic Submucosal Dissection (ESD)
|
Xuemeng Kong
Qujing Central Hospital, Yunnan Province, Qujing Yunnan 655000，China
|
Abstract： Objective To develop a standardized nursing pathway for perioperative patients undergoing Endoscopic SubmucosalDissection (ESD) and verify its application effect in clinical practice.Methods Using a quasi-experimental study design, 120patients who underwent ESD in our endoscopy center between January 2023 and June 2024 were enrolled and randomly dividedinto an observation group and a control group using a random number table, with 60 patients in each group. The control groupreceived routine perioperative care, while the observation group was managed using a standardized nursing pathway developedbased on evidence-based medicine. The perioperative indicators (preoperative preparation time, intraoperative cooperation, time to first ambulation postoperatively), complication rates (including intraoperative perforation, postoperative bleeding, postoperativeinfection), anxiety scores (using the SAS scale), pain scores (using the VAS scale), health knowledge mastery, and patientsatisfaction were compared between the two groups. Results After the intervention, the preoperative preparation time in theobservation group (45.32 ± 8.15 vs. 68.75 ± 10.24 minutes) was significantly shorter than that in the control group (P < 0.05),and the excellent-good rate of intraoperative cooperation (95.00% vs. 81.67%) was higher than that in the control group (P <0.05). The time to first ambulation postoperatively in the observation group (18.56 ± 4.82 vs. 25.41 ± 5.73 hours) was earlierthan that in the control group (P < 0.05). The total incidence of complications in the observation group was only 5.00%, significantlylower than the 18.33% in the control group (P < 0.05). Furthermore, the SAS scores (42.15 ± 5.38 vs. 50.62 ± 6.17) andthe VAS scores at 24 hours postoperatively (2.85 ± 0.94 vs. 4.12 ± 1.15) in the observation group were lower than those in thecontrol group. The health knowledge mastery score (92.45 ± 4.37 vs. 80.33 ± 6.52) and nursing satisfaction rate in the observationgroup reached 98.33%, which was 10 percentage points higher than that in the control group, with statistically significantdifferences (P < 0.05). Conclusion The implementation of a standardized perioperative nursing pathway for ESD patients caneffectively optimize the diagnosis and treatment process, improve nursing efficiency and quality, significantly reduce the risk ofcomplications, alleviate patients’ negative emotions, promote postoperative recovery, and enhance the patient experience andsatisfaction, demonstrating significant clinical value for promotion and application.
Keywords : Endoscopic Submucosal Dissection; Perioperative Nursing; Standardized Nursing Pathway; Complications; Patient
Satisfaction
参考文献
[1]莫春荣,贺学强,唐乔,等.基于自制悬挂式支架的标准化流程管理在内镜黏膜剥离术中的应用[J].上海护理,2025,25(1):69-73.
[2]肖石,刘丽,张文凤,等.标准化流程管理在手术室医院感染质量控制中的应用[J].齐鲁护理杂志,2022,28(4)：83-86.
[3]王银芳,沈祝苹,朱秋燕,等.结直肠癌腹腔镜手术区块化器械摆放与清点探讨[J].医院管理论坛,2021,38(9)：46-48.
[4]马慧芬,王少华,李曼林,等.标准化器械传递在腹腔镜结直肠癌手术中的护理配合研究[J].河北医药,2021(10)：1595-1597.
[5]曹晶.内镜黏膜下剥离术（ESD）治疗早期胃癌术前术后护理配合及体会[J].健康必读,2021(11)：93.
|
|
|
论文收录证明 / 文献检索报告
Document Retrieval Certificate / Proof of Publication Indexing
作者贡献声明 / 贡献确认书
Author Contribution Statement / Certificate of Authorship Contribution
同行评审报告 / 评审意见
Peer Review Report / Peer Review Comments
利益冲突
Conflict of Interest
作者声明不存在任何利益冲突。
The author declares no conflict of interest.
|
|
