医护一体化护理模式在肾结石微创经皮肾镜钬激光碎石术围术期中的应用效果

夏涛

[摘要] 目的 探討医护一体化护理模式在肾结石患者行微创经皮肾镜钬激光碎石术（MPCNL）围术期中的应用效果。 方法 将笔者所在医院2018年5月至2019年5月收治的行MPCNL术的120例肾结石患者纳入研究，以随机数字表法分为两组（各60例），干预组给予围术期医护一体化护理，对照组给予围术期常规护理，比较两组护理效果。 结果 经不同干预后，干预组术后各项指标恢复时间均早于对照组（P<0.05）;干预组血尿、感染发生率（8.33%）显著低于对照组（26.67%）（P<0.05），干预组不良事件发生率（6.67%）显著低于对照组（20.00%）（P<0.05）;两组干预前SAS、SDS及护理质量评分比较差异无统计学意义（P>0.05）;两组干预后SAS、SDS评分均显著下降，干预组SAS、SDS评分显著低于对照组，两组护理质量各项评分明显提高，干预组护理质量评分显著高于对照组（P<0.05）;干预组护理满意率（95.00%）显著高于对照组（76.67%）（P<0.05）。 结论 在肾结石患者行MPCNL术围术期实施医护一体化护理模式，对患者术后机体恢复有积极促进作用，改善患者消极心态，并能减少术后并发症和不良事件的发生，从而有效提高了护理质量和护理满意度。

[关键词] 肾结石;微创经皮肾镜钬激光碎石术;围术期;医护一体化护理模式

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2021）12-0175-05

Application effect of integrated medical care model in the perioperative period of minimally invasive percutaneous nephroscopic holmium laser lithotripsy for kidney stones

XIA Tao

Department of Surgery， Beijing Aerospace General Hospital， Beijing   100076， China

[Abstract] Objective To explore the application effect of the integrated medical care model in the perioperative period of minimally invasive percutaneous nephroscopic holmium laser lithotripsy（MPCNL） in the patients with kidney stones. Methods A total of 120 patients with kidney stone undergoing MPCNL surgery who were admitted to the author′s hospital from May 2018 to May 2019 were included in the study. They were divided into two groups（60 cases in each） by random number table method. The intervention group was given perioperative integrated medical care， and the control group was given perioperative routine care. The quality of nursing was compared between the two groups. Results After different interventions， the recovery time of all postoperative indicators in the intervention group was earlier than that in the control group（P<0.05）; the incidence rate of hematuria and infection was 8.33% in the intervention group， which was significantly lower than that of 26.67% in the control group（P<0.05）. The incidence rate of adverse events in the intervention group was 6.67%， which was significantly lower than that of 20.00% in the control group（P<0.05）; there was no significant difference in SAS， SDS， and nursing quality scores between the two groups before intervention（P>0.05）; the SAS and SDS scores in both groups were decreased significantly after intervention. The SAS and SDS scores in the intervention group were significantly lower than those in the control group. The scores of the quality of care in both groups were improved significantly， and the scores of the quality of care in the intervention group were significantly higher than those in the control group（P<0.05）; the satisfaction rate of 95.00% in the intervention group was significantly higher than that of 76.67% in the control group（P<0.05）. Conclusion The perioperative implementation of an integrated medical care model for patients with kidney stones undergoing MPCNL surgery can positively promote the recovery after surgery. It can improve the negative attitude of patients and reduce the occurrence of postoperative complications and adverse events， thereby effectively improving the quality of care and nursing satisfaction.

[Key words] Kidney stones; Minimally invasive percutaneous nephroscopic holmium laser lithotripsy（MPCNL）; Perioperative period; Integrated medical care model

肾结石为一种常见的泌尿外科疾病，以青壮年为高发人群，发病与饮食、环境及遗传因素等密切相关[1]。临床以腰腹部剧烈绞痛、血尿、恶心呕吐等为主要表现，甚至可引起尿路感染、泌尿系梗阻及肾功能不可逆性损伤，对患者造成较大的痛苦[2]。近年来，随着微创技术的进步，微创经皮肾镜钬激光碎石（Minimally invasive percutaneous nephrolithotomy，MPCNL）术已得到广泛应用，该术式具有痛苦小、术后恢复较快等优点，因而被患者广泛接受。但因肾结石术后难免存在并发症，不利于术后康复。对此，MPCNL术围术期加强护理干预尤为必要。而在临床治疗中良好的医护配合是降低并发症、促进病情康复的关键[3]。故我院对2018年5月至2019年5月收治的行MPCNL术治疗的肾结石患者实施围术期医护一体化护理模式，取得了满意效果，现报道如下。……