短“O”改良固定法在经内镜鼻胆管引流术后的应用效果及患者舒适度的影响因素分析-现代医学

短“O”改良固定法在经内镜鼻胆管引流术后的应用效果及患者舒适度的影响因素分析

单位：南京大学医学院附属鼓楼医院消化科, 江苏南京 210008

分类号：R473

出版年·卷·期（页码）：2022·50·第十一期（1425-1430）

摘要：

目的：探讨短“O”改良固定法在经内镜鼻胆管引流术后的应用效果及患者舒适度的影响因素。方法：选取2021年1月至2022年5月在我科实施径内镜鼻胆管引流术患者93例，分为试验组(采用短“O”改良固定法)46例和对照组(采用常规固定法)47例，比较两组患者年龄、性别、文化程度、术前肝功能指标、胆汁引流量、胆汁引流速度、引流时间、鼻贴更换时间、鼻贴更换次数、视觉模拟评分(VAS)、非计划拔管情况、皮肤压力性损伤情况等。以VAS≤3分进行分组，进行单因素和多因素Logistic回归分析鼻胆管固定后患者舒适度的影响因素。结果：两组患者在性别、年龄、文化程度、术前肝功能指标、鼻贴更换时间和胆汁引流量方面比较，差异均无统计学意义(均P＞0.05)。和对照组比较，试验组胆汁引流时间短，鼻贴更换次数低，VAS评分低，胆汁引流速度快，差异均有统计学意义(均P＜0.05)。对照组非计划拔管发生率和皮肤压力性损伤率均为6.38%，试验组未发生非计划拔管和皮肤压力性损伤情况。VAS≤3分者55例，VAS＞3分者38例，单因素分析结果显示，患者年龄、体外鼻胆管长度、鼻贴更换次数、非计划拔管和皮肤压力性损伤均为影响鼻胆管固定后舒适度的相关因素(P<0.05)。多因素Logistic回归分析显示，体外鼻胆管长度为鼻胆管固定后舒适度的主要影响因素(P<0.05)。结论：短“O”改良固定法加快了胆汁引流速度、缩短了胆汁引流时间、减少了鼻贴更换次数、降低了非计划性拔管率，从而提高了护理工作效率和患者舒适度，有助于患者早日康复。

Objective: To investigate the application effect of short “O” modified fixation method and the influencing factors of patients' comfort after endoscopic external nasobiliary drainage. Methods: A total of 93 patients who underwent endoscopic nasobiliary external drainage were selected in our department from January 2021 to May 2022, among which 46 patients receiving short “O” modified fixation method were set as the experimental group and 47 patients receiving conventional fixation method were set as the control group.The data including age, gender, education level, preoperative liver function indicators, bile drainage volume,bile drainage rate, drainage time, nasal patch replacement times, unplanned extubation rate, visual analogue scale(VAS), skin pressure injury, etc., were compared between the two groups.Then patients were divided in two groups according to VAS no more than 3, then univariate and multivariate logistic regression analysis were conducted to analyze the influencing factors of patients' comfort after nasobiliary duct fixation. Results:There were no significant differences in gender, age, culture, preoperative liver function indicators, nasal patch replacement time, and bile drainage volume between the two groups(All P>0.05).Compared with control group,experimental group has shorter bile drainage time, less nasal patch replacement times,lower VAS and faster bile drainage velocity,there were statistically significant differences between the two groups(All P＜0.05). The rate of unplanned extubation and skin pressure injury were all 6.38% in control group, and there is no occurrence of unplanned extubation and skin pressure injury in experimental group. There were 55 patients with VAS no more than 3 and 38 patients with VAS more than 3 points. Univariate analysis showed that patients' age, external nasobiliary duct length, frequency of nasal patch replacement, unplanned extubation, and pressure injury were the correlated factors influencing the patients' comfort after nasobiliary duct fixation(P<0.05).Furthermore, multivariate logistic regression analysis showed that external nasobiliary duct length was a main factor for the patients' comfort(P<0.05). Conclusion: The short “O” modified fixation method can increase the drainage speed, shorten the drainage time, decrease the number of nasal patch replacement, reduce the rate of unplanned extubation, and improve the nursing efficiency and patients' comfort, thus effectively promoting the recovery of patients.

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