临床路径在子宫切除术患者护理中的应用

目的探讨实施临床路径配合责任护理对于子宫切除术患者的临床意义。方法选择2009年7月—乏013年5月实施子宫切除术患者104例，按照随机数字表法分为对照组和干预组，每组各52例，对照组采用传统的治疗护理，干预组采用临床路径结合责任护理的手段，比较两组患者术后首次下床时间和首次排气时间、住院时间、并发症、围手术期应激反应等情况。结果干预组患者首次下床时间和首次排气时间分别为（18．02±9．12），（50．43±8．65）h，均短于对照组的（30．54±12．95），（59．22±11．75）h，差异有统计学意义（t值分别为4．03，3．15；P〈0．01）；干预组住院时间短于对照组，差异有统计学意义（P〈0．05）；术前两组胰岛素抵抗（IR）指数差异无统计学意义（P〉0．05），术后第1天和第3天干预组IR指数分别为（5．61±0．49），（4．43±0．67），低于对照组的（11．03±0．24）（7．13±0．54），差异有统计学意义（t值分别为5．49，3．24；P〈0．05）。干预组患者术后并发症发生率为17．3％，低于对照组的46．2％，差异有统计学意义（x2=5．67，P〈0．05）。结论对子宫切除术患者实施临床路径配合责任护理可以提高护理服务质量，减轻应激反应，降低术后并发症，缩短住院时间，适合进一步应用。

Application of clinical pathway in the nursing of patients with hysterectomy

Objective To explore the clinical significance of carrying out clinical pathway combined with responsibility nursing in patients with hysterectomy. Methods One hundred and four patients with hysterectomy from July 2009 to May 2013 were chosen and divided into the control group and the intervention group according to the random number table, each with 52 cases. The control group received the routine nursing, and the intervention group received the clinical pathway combined with responsibility nursing. The time of getting out of bed and exhaust for the first time, the hospitalization time, the occurrence of postoperative complication, the perioperative stress reaction and so on were compared between two groups. Results The time of getting out of bed and exhaust for the first time were respectively （ 18.02 ± 9.12） , （50.43 ± 8.65 ） h in the intervention group, and were shorter than （ 30.54 ± 12.95 ）, （59.22 ± 11.75 ） h in the control group, and the differences were statistically significant （t = 4. 03,3.15, respectively;P 〈 0. 01 ）. The hospitalization time in the intervention group was less than that of the control group （P 〈 0. 05 ）. No difference was found in the index of insulin resistance （IR） before the operation between two groups （P 〉 0. 05 ） ; the index of IR on the first and third day after the operation were respectively （5.61 ± 0.49 ）, （4.43 ± 0.67 ） in the intervention group, and were lower than （ 11.03±-. 24） , （ 7.13±0. 54） in the control group, and the differences were statistically significant （ t = 5. 49,3.24, respectively ; P 〈 0. 05 ）. The incidence rate of postoperative complication was 17.3% in the intervention group, and was lower than 46.2% in the control group, and the difference was statistically significant （ X2 = 5.67, P 〈 0. 05 ）. Conclusions The implement of clinical pathway combined with responsibility nursing in patients with hysterectomy can improve the quality of nursing, and reduce the stress reaction, and decrease the occurrence of postoperative complication, and shorten the hospitalization time, and is suitable for further application in the hospital.