| 谢杜娟,江艺,谢海英,等.持续质量改进对经T管窦道胆管镜联合激光碎石术不良反应和并发症的影响[J].安徽医药,2019,23(8):1555-1558. |
| 持续质量改进对经T管窦道胆管镜联合激光碎石术不良反应和并发症的影响 |
| Effect of continuous quality improvement on adverse reactions and complications of choledochoscopy combined with laser lithotripsy through Ttube sinus |
| 投稿时间：2017-10-19 |
| DOI： |
| 中文关键词: 胆结石 自然腔道内镜手术/副作用 碎石术,激光/副作用 围手术期医护 手术中并发症 手术后并发症 质量改进 |
| 英文关键词: Cholelithiasis Natural orifice endoscopic surgery/adverse effects Lithotripsy,laser/adverse effects Perioperative care Intraoperative complications Postoperative complications Quality improvement |
| 基金项目: |
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| 中文摘要: |
| 目的 探讨实施持续质量改进(CQI)对经T管窦道胆管镜联合激光碎石术不良反应和并发症的影响。方法 以2014年10月至2016年3月解放军联勤保障部队第九〇〇医院CQI模式实施前105例经T管窦道胆管镜联合激光碎石术病人作为对照组,通过比较不良反应、并发症、术中疼痛视觉模拟评分(VAS)和术中镇痛药使用比例情况,综合评价2016年4月至2017年9月解放军联勤保障部队第九〇〇医院CQI实施后127例病人的效果。结果 与CQI实施前相比,CQI实施后病人胃肠道不良反应(21.9%比11.8%,χ2=4.276,P=0.039)、寒战高热(15.2%比6.3%,χ2=4.952,P=0.026)、引流管脱出(9.5%比1.6%,χ2=7.405,P=0.007)、窦道并发症(11.4%比3.1%,χ2=6.136,P=0.013)发生率显著降低,术中VAS疼痛评分(3.3±2.1比2.7±1.5,χ2=2.532,P=0.012)显著减少,术中镇痛药使用比例(22.9%比8.7%,χ2=9.042,P=0.003)显著下降。结论 持续质量改进提高了经T管窦道胆管镜联合激光碎石术围手术期管理质量,病人不良反应和并发症减少,疼痛程度减轻,操作安全性提高。 |
| 英文摘要: |
| Objective To explore the effect of continuous quality improvement (CQI) on adverse reactions and complications of choledochoscopy combined with laser lithotripsy through Ttube sinus.Methods One hundred and five cases of choledochoscopy combined with laser lithotripsy through Ttube sinus in The PLA's 900th Hospital of the Joint Logistics Team from October 2014 to March 2016 before the implementation of CQI model as the control group,the implementation effect of CQI in 127 cases during the 18 months from April 2016 to September 2017 was evaluated by comparing the adverse reactions,complications,intraoperative pain visual analogue score (VAS) and intraoperative analgesic use ratio.Results After the implementation of CQI,the gastrointestinal adverse reactions (21.9% vs. 11.8%,χ2=4.276,P=0.039),fever (15.2% vs. 6.3%,χ2=4.952,P=0.026),drainage tube prolapse (9.5% vs. 1.6%,χ2=7.405,P=0.007),sinus complications (11.4% vs. 3.1%,χ2=6.136,P=0.013) were significantly lower,the intraoperative VAS pain score (3.3±2.1 vs. 2.7±1.5,χ2=2.532,P=0.012) was significantly reduced,the proportion of analgesic use during operation (22.9% vs. 8.7%,χ2=9.042,P=0.003) has decreased significantly.Conclusion The CQI has improved the quality of perioperative management for choledochoscopy combined with laser lithotripsy through Ttube sinus,reduces adverse reactions and complications,relieves the operation related pain,and improves the safety of operation. |
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