链式管理预防小儿神经外科手术压力性损伤的效果

王煜; 韩丁; 边寒雪; 吴新雁; 陈梅丽; 潘守东

doi:10.16766/j.cnki.issn.1674-4152.002212

链式管理预防小儿神经外科手术压力性损伤的效果

doi: 10.16766/j.cnki.issn.1674-4152.002212

1.
首都儿科研究所附属儿童医院麻醉科，北京 100020
2.
首都儿科研究所附属儿童医院护理部，北京 100020

基金项目:

首都临床特色应用研究项目 Z181100001718096

首都儿科研究所青年课题基金 QN-2019-22

详细信息

通讯作者:
潘守东, E-mail: panshoudong@shouer.com.cn

中图分类号: R473.6 R651
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- 被引次数: 0
出版历程
- 收稿日期: 2020-08-12
- 网络出版日期: 2022-02-15

Application of chain management to prevent pressure injury in paediatric neurosurgery

1.
Department of Anesthesiology, Children's Hospital Affiliated to Capital Institute of Pediatrics, Beijing 100020, China

摘要

摘要: 目的在小儿神经外科手术中应用链式管理，观察分析其预防小儿神经外科手术压力性损伤的效果。方法选取2019年3月—2020年1月在首都儿科研究所附属儿童医院符合纳入标准的神经外科手术患儿120例。按随机数字表法分为对照组和实验组，各60例。对照组接受常规护理模式预防压力性损伤。观察组采用链式管理预防压力性损伤, 建立多科合作的压力性损伤护理小组, 在病房、手术室、麻醉恢复室、重症监护室，针对皮肤情况和预防压力性损伤的措施, 采取“链条式”闭环管理。比较2组患儿手术后2 d内各观测时点压力损伤评分、医护人员满意度和患儿满意度。结果观察组和对照组围术期压力性损伤发生率分别为3.3%(2/60)和11.7%(7/60), 差异无统计学意义(P>0.05)。术后即刻至术后24 h，观察组患儿受压部位皮肤情况优于对照组(P < 0.05)。观察组患儿家长满意度和医护满意度均显著高于对照组(均P < 0.05)。结论作为一种多科室协同合作的管理模式，链式管理用于小儿神经外科手术有利于降低围术期压力性损伤发生率, 提高家长满意度和医护满意度，促进团队合作, 值得在临床推广。
- 链式管理 /
- 压力性损伤 /
- 小儿 /
- 护理管理 /
- 神经外科
Abstract: Objective To observe and analyse the effect of chain management to prevent pressure injury in paediatric neurosurgery. Methods A total of 120 neurosurgical children who met the inclusion criteria from March 2019 to January 2020 in our hospital were selected. According to the random number table generated by SPSS 22.0, the patients were divided into control group and experimental group with 60 cases in each group. The control group received routine nursing mode to prevent pressure injury. The observation group received chain management to prevent pressure injury. A multidisciplinary cooperative nursing group for pressure injury was formed in the ward, operating room, anaesthesia recovery room and intensive care unit, specific to the skin conditions to stress injury prevention measure. The closed-loop 'chain' management was applied. The score of pressure injury within 2 days after operation and satisfaction rate of medical staff and children were compared between the two groups. Results The incidences of perioperative pressure injury in the observation group and control group were 3.3% (2/60) and 11.7% (7/60), respectively, with no statistical difference (P>0.05). From immediately after surgery to 24-h post-surgery, the skin condition of the pressure site was better in the observation group than in the control group (P < 0.05). The satisfaction rates of parents and medical staff in the observation group were significantly higher than those in the control group (all P < 0.05). Conclusion As a multidisciplinary collaborative management mode, the use of chain management in paediatric neurosurgery is helpful to reduce the incidence of perioperative pressure injury, improve parents' and medical staff's satisfaction rates and promote team cooperation, which is worthy of clinical promotion.
- Chain management /
- Pressure injury /
- Children /
- Nursing management /
- Neurosurgery

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表 1 2组手术患儿基线资料比较

组别	例数	性别 (男/女，例)	年龄 [M(P₂₅, P₇₅)，岁]	体重 [M(P₂₅, P₇₅)，kg]	手术时长[M(P₂₅, P₇₅)，min]	体位(例)				头部固定(例)
组别	例数	性别 (男/女，例)	年龄 [M(P₂₅, P₇₅)，岁]	体重 [M(P₂₅, P₇₅)，kg]	手术时长[M(P₂₅, P₇₅)，min]	仰卧位	仰卧头侧位	俯卧位	侧卧位	头架	头托	头圈
对照组	60	34/26	3.4(1.7, 7.1)	17.1(11.1, 25.1)	300(262, 330)	16	19	21	4	11	3	46
观察组	60	36/24	5.5(2.5, 10.0)	20.5(12.4, 37.1)	320(270, 398)	16	30	11	3	16	4	40
统计量		0.137^a	-1.874^b	-1.677^b	-1.401^b	5.726^a
P值		0.711	0.061	0.094	0.161	0.124				0.485^c
注：^a为χ²值, ^b为Z值，^c为Fisher精确检验。

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表 2 2组手术患儿术后不同测点受压部位皮肤情况的比较(例)

组别	例数	时点	皮肤情况
组别	例数	时点	良好	压红	1期PI	2期PI
对照组	60	术后即刻	39	16	3	2
		术后0.5 h	39	16	3	2
		术后2 h	39	15	4	2
		术后4 h	39	14	5	2
		术后24 h	39	14	4	3
		术后2 d	45	8	4	3
观察组	60	术后即刻	49	10	0	1
		术后0.5 h	49	10	0	1
		术后2 h	49	10	0	1
		术后4 h	49	9	1	1
		术后24 h	50	8	1	1
		术后2 d	52	6	1	1

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表 3 2组手术患儿家长满意度和医护满意度的比较(x±s，分)

组别	例数	患儿家长满意度评分	医护满意度评分
对照组	60	82.1±3.2	84.4±2.2
观察组	60	90.6±2.3	89.6±1.7
t值		-16.846	-10.105
P值		< 0.001	< 0.001

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