循证护理在老年患者腹腔镜下胆囊切除术中的应用

目的探讨循证护理在老年患者腹腔镜下胆囊切除术中的应用价值。方法选择2009年10月-2013年2月在温州医学院附属慈溪医院及滨州医学院附属医院行腹腔镜下胆囊切除术的68例老年患者。随机分为循证组及对照组，每组各34例。对照组实施常规护理，循证组在术前、术中及术后实施循证护理。比较两组患者在术前焦虑指数、配合程度及术后心率、血压、并发症、住院天数、患者满意率。结果循证组术前焦虑指数低于对照组（t=2．150，P〈0．05），手术配合程度高于对照组（t=2．930，P〈0．05），术后心率低于对照组（t=-3．410，P〈0．05），收缩压及舒张压也低于对照组（t分别为-4．098、-2．628，P〈0．05）。并发症对比循证组术后疼痛程度0、I、Ⅱ、Ⅲ级比例均低于对照组（x2分别为4．191、7．173、11．769、4．570，P〈0．05）；恶心、呕吐得分低于对照组（t分别为-5．416、-2．659，P〈0．05）；呼吸道感染、排尿困难等并发症发生率少于对照组（x2分别为4．610、7．503，P〈0．05）；两组胆漏、腹腔出血及皮下气肿等并发症发生率差异无统计学意义（P〈0．05）；住院天数循证组少于对照组（t=-2．106，P〈0．05），患者满意率高于对照组（x2=6．476，P〈0．05）。结论循证护理在老年患者腹腔镜下胆囊切除术中有重要价值，护理效果优于常规护理，可以降低焦虑指数和手术风险，减少常见术后并发症的发生，提高患者的手术配合程度，缩短住院日期，提高患方满意率。

Application of evidence-based nursing for elderly patients undergoing LC

Objective To explore the value of evidence-based nursing for elderly patients undergoing LC. Methods 68 elderly patients undergoing LC from Affiliated Cixi hospital of Wenzhou Medical College and Affiliated Hospital of Binzhou Medical College from October 2009 to February 2013 were selected and divided into evidence-based group and control group ran- domly with 34 patients in each group. The control group was treated with routine care while the evidence-based group was treated with evidence-based nursing on the basis of routine care. The anxiety index before operation, cooperation of operation, heart rate, blood pressure after operation, postoperative complications, date of in-patient and degree of satisfaction of patients were compared. Results The anxiety index in evidence-based group was lower than that in control group （t = 2.150, P 〈 0.05）, operational cooperation in evidence-based group was significantly better than that in control group （t = 2.930, P 〈 0.05）, and the heart rate, blood pressure after operation were lower than that in control group （t = -3.410, -4.098, -2.628 respectively, P 〈 0.05）. Incidence of common postoperative complications as 0, I , II, III grade of pain, nausea, vomit, infection of respiratory system and dysuresia after operation in evidence-based group was significantly better than that in control group （all P 〈 0.05）; but there was no significent difference in 2 group for serious postoperative complications as leak of bile, haemorrhage in abdominal cavity and subcutaneous pneumatosis （P 〉 0.05）. The date of in-patient of evidence-based group was less than that in control group （t = -2.106, P 〈 0.05）, while degree of satisfaction was significantly better than that in control group （x2= 6.476, P 〈 0.05）. Conclusion The value of evidence-based nursing for elderly patients undergoing LC is important and the nursing effect is better than control group. Evidence-based nursing can reduce the anxiety index and risk of operation, com- mon postoperative complications and improve the cooperation of operation and degree of satisfaction,.