Orem自护理论对恶性梗阻性黄疸行经皮肝穿刺胆道引流术患者的影响分析

李灵艳; 王红雨; 刘双池; 许文青; 张艳芳; 谈燚

doi:10.16766/j.cnki.issn.1674-4152.002390

Orem自护理论对恶性梗阻性黄疸行经皮肝穿刺胆道引流术患者的影响分析

doi: 10.16766/j.cnki.issn.1674-4152.002390

1.
蚌埠医学院第一附属医院肝胆外科，安徽蚌埠 233004
2.
蚌埠医学院体适能研究中心，安徽蚌埠 233030

基金项目:

安徽省高校人文社科重大研究项目 SK2020ZD32

安徽省高校自然科学重大研究项目 BYTM2019023

蚌埠医学院“512计划”骨干教师项目 by51201208

蚌埠医学院自然重点项目 2020byzd100

详细信息

通讯作者:
王红雨，E-mail: wanghongyu81920@163.com

中图分类号: R473.6 R575
计量
- 文章访问数: 169
- HTML全文浏览量: 72
- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-08
- 网络出版日期: 2022-08-13

Analysis of the influence of Orem's self-nursing theory on patients with malignant obstructive jaundice undergoing percutaneous transhepatic cholangial drainage

1.
Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨Orem自护理论的护理方法对经皮肝穿刺胆道引流术(percutaneoustransh epatic cholangial drainage, PTCD)患者自护能力、护理满意率、疾病相关知识掌握程度的影响。方法选取2020年5月—2021年3月在某市三甲医院因恶性梗阻性黄疸行PTCD治疗的93例患者，按随机数字表法分为实验组(47例)和对照组(46例)。对照组实施常规护理，实验组实施基于自护理论的护理干预，干预周期为1个月，比较2组患者自我护理能力、护理满意率及疾病知识的掌握程度。结果干预1个月后实验组自我护理能力4个维度评分依次为(25.71±2.38)分、(16.29±2.87)分、(35.79±3.84)分、(47.45±4.76)分，均高于对照组的(23.06±3.42)分、(13.75±3.11)分、(32.68±4.12)分、(38.26±3.49)分，差异有统计学意义(均P＜0.05)；实验组护理满意率为95.7%，对照组为77.3%，差异有统计学意义(χ²=6.574，P=0.010)；2组对伤口观察、PTCD管护理、并发症的观察及护理、饮食知识、活动知识的评分比较差异有统计学意义(均P＜0.05)。结论将自护理论应用到PTCD术患者中可以提高患者自我护理能力及护理满意率，促进患者更好地掌握疾病知识。
- 自护理论 /
- 恶性梗阻性黄疸 /
- 经皮肝穿刺胆道引流术
Abstract: Objective To explore the effect of the nursing method of Orem's self-care theory on the self-care ability, nursing satisfaction rate and disease-related knowledge of patients with percutaneous transhepatic cholangial drainage (PTCD). Methods Ninety-three patients who underwent PTCD treatment for malignant obstructive jaundice in a third-class hospital in a city from May 2020 to March 2021 were divided into the experimental group (47 cases) and control group (46 cases) according to the random number table. The observation group was given routine nursing care, and the experimental group was given nursing intervention based on self-care theory. The intervention period was one month. The two groups of patients were compared for their self-care ability, nursing satisfaction rate and disease knowledge mastery. Results After one month of intervention, the four dimensions of self-care ability in the experimental group were (25.71±2.38) points, (16.29±2.87) points, (35.79±3.84) points and (47.45±4.76) points, and those in the control group were (23.06±3.42) points, (13.75±3.11) points, (32.68±4.12) points and (38.26±3.49) points. The difference was statistically significant (all P < 0.05). The nursing satisfaction rate of the experimental group was 95.7%, and that of the control group was 77.3%. The difference was statistically significant (χ²=6.574, P=0.010). There were statistically significant differences in the scores of wound observation, PTCD tube nursing, complication observation and nursing, diet knowledge and activity knowledge between the two groups (all P > 0.05). Conclusion The application of self-care theory to patients undergoing PTCD can improve patients' self-care ability and nursing satisfaction rate, and promote patients to better grasp disease knowledge.
- Self-care theory /
- Malignant obstructive jaundice /
- Percutaneous transhepatic cholangial drainage

HTML全文

表 1 2组恶性梗阻性黄疸患者一般资料比较

Table 1. Comparison of general data between two groups of malignant obstructive jaundice patients

组别	例数	年龄(x±s，岁)	性别(例，男/女)	文化程度(小学及以下/ 初中及以上, 例)	住院天数(x±s，d)	高血压(无/有, 例)	糖尿病(无/有, 例)	参保类型(城乡居民医保/职工医保, 例)	疾病类型(胰腺癌/肝癌/ 胆管或胆囊癌, 例)
实验组	46	67.7±10.8	27/19	33/13	13.9±6.1	24/22	37/9	23/23	10/8/28
对照组	44	69.7±8.8	28/16	30/14	14.7±5.4	29/15	35/9	19/25	7/6/31
统计量		-0.923^a	0.231^b	0.136^b	-0.578^a	1.752^b	0.011^b	0.420^b	0.924^b
P值		0.358	0.631	0.713	0.565	0.186	0.916	0.517	0.630
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 2组患者自我护理能力评分比较(x±s，分)

Table 2. Comparison of self-care ability between two groups (x±s, points)

组别	例数	自我概念		自我责任感		自我护理技能		健康知识水平
组别	例数	干预前	干预1个月	干预前	干预1个月	干预前	干预1个月	干预前	干预1个月
实验组	46	20.86±3.53	25.71±2.38	13.43±2.05	16.29±2.87	26.57±3.15	35.79±3.84	36.82±10.76	47.45±4.76
对照组	44	20.25±2.25	23.06±3.42	12.97±2.56	13.75±3.11	27.25±2.68	32.68±4.12	34.97±9.54	38.26±3.49
t值		0.982	4.249	0.938	4.307	-1.105	2.511	0.864	10.47
P值		0.329	＜0.001	0.351	＜0.001	0.272	＜0.001	0.390	＜0.001

下载: 导出CSV

表 3 2组患者护理满意度比较

Table 3. Comparison of nursing satisfaction between two groups

组别	例数	非常满意(例)	基本满意(例)	不满意(例)	满意度(%)
实验组	46	36	8	2	95.7 (44/46)
对照组	44	27	7	10	77.3 (34/44)
注：2组满意度比较，χ²=6.574，P=0.010。

下载: 导出CSV

表 4 2组患者对术后疾病知识的掌握程度(x±s，分)

Table 4. The degree of knowledge of postoperative disease in two groups (x±s, ponits)

组别	例数	伤口观察	PTCD管护理	并发症的观察及护理	饮食知识	活动知识
实验组	46	14.28±2.37	16.36±1.88	22.57±3.56	15.47±2.08	8.13±1.62
对照组	44	11.67±3.28	14.87±2.49	20.85±3.73	12.15±2.76	7.06±1.83
t值		4.311	3.193	2.236	6.423	2.932
P值		0.001	0.002	0.028	＜0.001	0.004

下载: 导出CSV

参考文献(20)

[1]	MA J, LUO J, GU J, et al. Malignant obstructive jaundice treated with intraluminal placement of Iodine-125 seed strands and metal stents: An analysis of long-term outcomes and prognostic features[J]. Brachytherapy, 2018, 17(4): 689-695. doi: 10.1016/j.brachy.2018.04.001
[2]	REES J, MYTTON J, EVISON F, et al. The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: A retrospective cohort study[J]. BMJ Open, 2020, 10(1): 1-11.
[3]	MOOLE H, BECHTOLD M, PULI S R. Efficacy of preoperative biliary drainage in malignant obstructive jaundice: A meta-analysis and systematic review[J]. World J Surg Oncol, 2016, 14(1): 182-193. doi: 10.1186/s12957-016-0933-2
[4]	黄忠华, 石炳林, 何传果, 等. 恶性梗阻性黄疸治疗进展[J]. 中国医学创新, 2019, 16(14): 169-172. doi: 10.3969/j.issn.1674-4985.2019.14.043 HUANG Z H, SHI B L, HE C G, et al. Progress in the treatment of malignant obstructive jaundice[J]. Medical Innovation in China, 2019(14): 169-172. doi: 10.3969/j.issn.1674-4985.2019.14.043
[5]	周云, 李萍, 陈松旺, 等. 超声结合数字减影血管造影双引导行左肝管经皮肝穿刺胆道引流术的疗效[J]. 中国临床研究, 2019, 32(12): 1652-1655. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201912010.htm ZHONG Y, LI P, CHEN S W, et al. Application of ultrasound combined with DSA-guided left hepatic duct PTCD[J]. Chinese Journal of Clinical Research, 2019, 32(12): 1652-1655. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK201912010.htm
[6]	王嵘, 吉琳, 赵超. 恶性梗阻性黄疸病人PTCD术后延续性护理需求调查[J]. 循证护理, 2020, 6(12): 1329-1333. doi: 10.12102/j.issn.2095-8668.2020.12.010 WANG Z, JI L, ZHAO C. Investigation on continuous nursing needs of patients with malignant obstructive jaundice after PTCD[J]. Chinese Vidence-based Nursing, 2020, 6(12): 1329-1333. doi: 10.12102/j.issn.2095-8668.2020.12.010
[7]	陈聪英. 恶性梗阻性黄疸PTCD治疗后患者带管出院的导管维护状况及影响因素分析[J]. 国际医药卫生导报, 2021, 27(2): 269-272. doi: 10.3760/cma.j.issn.1007-1245.2021.02.030 CHEN C Y. Catheter maintenance status and influencing factors of patients with malignant obstructive jaundice after percutaneous transhepatic cholangial drainage (PTCD) treatment[J]. International Medical and Health Guide. 2021, 27(2): 269-272. doi: 10.3760/cma.j.issn.1007-1245.2021.02.030
[8]	徐苗, 闻利红, 闫保君, 等. 全国130家医院恶性胆道梗阻PTCD引流管护理问题现况调查[J]. 全科护理, 2020, 18(4): 489-491. https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202004036.htm XU M, WEN L H, YAN B J, et al. Status of PTCD drainage tube nursing for malignant biliary obstruction in 130 hospitals in China[J]. Chinese General Practice Nursing, 2020, 18(4): 489-491. https://www.cnki.com.cn/Article/CJFDTOTAL-JTHS202004036.htm
[9]	范本芳, 杨海霞, 何伯圣, 等. PBL结合微视频健康教育方案在PTCD带管患者中的应用[J]. 介入放射学杂志, 2020, 29(6): 621-625. doi: 10.3969/j.issn.1008-794X.2020.06.021 FAN B F, YANG H X, HE B S, et al. Application of PBL combined with micro - video health education program in educating patients carrying an indwelling PTCD tube[J]. Intervent Radiol, 2020, 29(6): 621-625. doi: 10.3969/j.issn.1008-794X.2020.06.021
[10]	张学敏, 毕胜, 张嗣敏, 等. 扩展Barthel指数量表评定脑卒中ADL能力的效度研究[J]. 中国康复, 2019, 34(3): 134-137. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF201903009.htm ZHANG X M, BI S, ZHANG S M, et al. Validity of extended barthel index for assessing stroke ability[J]. Chinese Journal of Rehabilitation, 2019, 34(3): 133-137. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF201903009.htm
[11]	纪翠红, 徐晓艳, 王娜, 等. "医院-社区-家庭"联动延续性护理模式在经皮肝穿刺胆道引流患者中的应用[J]. 中华现代护理杂志, 2018, 24(34): 4121-4125. JI C H, XU X Y, WANG N, et al. Application of "hospital-community-family" linked continuing care model in patients receiving percutaneous transhepatic Cholangial drainage[J]. Chin J Mod Nur, 2018, 2(34): 4121-4125.
[12]	毛美芹. Orem自护理论运用于缺血性脑卒中患者中的效果观察[J]. 基层医学论坛, 2019, 23(21): 2978-2980. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT201921010.htm MAO M J. Effect of orem self-care theory on patients with ischemic stroke[J]. The Medical Forum, 2019, 23(21): 2978-2980. https://www.cnki.com.cn/Article/CJFDTOTAL-YXLT201921010.htm
[13]	LEE E, PARK E. Self-care behavior and related factors in older patients with uncontrolled hypertension[J]. Contemp Nurse, 2017, 53(6): 607-621.
[14]	吴桂红, 马灵亚, 沈藕英, 等. Orem自护模式对女性精神分裂症患者精神症状和社会功能及复发率的影响[J]. 中华全科医学, 2020, 18(11): 1893-1896. doi: 10.16766/j.cnki.issn.1674-4152.001647 WU G H, MA L Y, SHEN O Y, et al. Effects of Orem self-care model on mental symptoms, social function and recurrence rate of female patients with schizophrenia[J]. Chinese Journal of General Practice, 2020, 18(11): 1893-1896. doi: 10.16766/j.cnki.issn.1674-4152.001647
[15]	刘晔, 曹素玉, 刘瑶, 等. Orem自理理论在经导管动脉化疗栓塞术后肝癌患者护理中的应用[J]. 中国介入影像与治疗学, 2016, 13(10): 605-608. https://www.cnki.com.cn/Article/CJFDTOTAL-JRYX201610007.htm LIU Y, CAO S Y, LIU Y, et al. Application of Orem seif-care on nursing for patients with hepatocellular carcinoma after transcatheter arterial chemoembolization[J]. Chin J Imaging THer, 2016, 13(10): 605-608. https://www.cnki.com.cn/Article/CJFDTOTAL-JRYX201610007.htm
[16]	杨菲菲, 孙晓林, 郑丽娜. Orem自理理论对胃癌患者术后癌因性疲乏及舒适的影响[J]. 癌症进展, 2020, 18(8): 857-860. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202008026.htm YANG F F, SUN X L, ZHENG L N. Effect of Orem'self-care theory on postoperative cancer-related fatigue and self-care theory on postoperative cancer-related fatigue and comfort in patients with gastric cancer comfort in patients with gastric cancer[J]. Oncolgy Pross, 2020, 18(08): 857-860. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202008026.htm
[17]	KHATIBAN M, SHIRANI F, OSHVAND K, et al, Orem's Self-Care Model With Trauma Patients: A Quasi-Experimental Study[J]. Nurs Sci Q, 2018.31(3): 272-278.
[18]	方园, 王晓玲, 徐姗姗, 等. Orem自护模式在老年糖尿病护理中的应用效果分析[J]. 中华全科医学, 2019, 17(8): 1424-1426. doi: 10.16766/j.cnki.issn.1674-4152.000960 FANG Y, WANG X L, XU S S, et al. Analysis of the application effect of Orem self-care Mode in the nursing of elderly patients with diabetes[J]. Chinese Journal of General Practice, 2019, 17(8): 1424-1426. doi: 10.16766/j.cnki.issn.1674-4152.000960
[19]	韩褀, 徐晨, 王荣华, 等. 某市出院病人护理满意度调查及影响因素分析[J]. 护理研究, 2019, 33(14): 2540-2542. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201914045.htm HAN Q, XU C, WANG R H. Survey on satisfaction of nursing care and analysis of influencing factors among discharged patients in a city[J]. Chinese Nuring Research, 2019, 33(14): 2540-2542. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201914045.htm
[20]	严莉, 李筠, 耿丽等. 以微信为媒介的延续护理在慢性心力衰竭患者中的应用效果[J]. 广西医学, 2020, 42(9): 1171-1174. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202009033.htm YAN L, LI J, GENG L, et al. The application effect of continuous care mediated by wechat in patients with chronic heart failure[J]. Guangxi medical, 2020, 42(9): 1171-1174. https://www.cnki.com.cn/Article/CJFDTOTAL-GYYX202009033.htm