目的:探讨急诊护理心理干预对肝硬化并发上消化道出血患者治疗的影响。方法:选择40例肝硬化并发上消化道出血患者作为研究对象,采用抓阄随机化分组法将其分为观察组(20例,急诊护理干预组)和对照组(20例,常规护理组)。比较两组的护理效果。结果:护理后,观察组止血时间、输血量、住院时间、肝性脑病发病率均低于对照组(P < 0.05),自我护理能力测定量表(ESCA)评分高于对照组(P < 0.05)。结论:急诊护理心理干预对肝硬化并发上消化道出血患者的护理效果显著,可提高患者的自我护理能力。 Objective: To explore the treatment effects of emergency nursing mentality intervenes on patients with liver cirrhosis complicated with upper gastrointestinal bleeding. Methods: A total of 40 patients with liver cirrhosis complicated with upper gastrointestinal bleeding were selected as the research objects, and the patients were divided into observation group (20 cases, emergency nursing group) and control group (20 cases, conventional nursing) using lottery randomization grouping method. The nursing effect of the two groups was compared. Results: After nursing, the bleeding time, blood transfusion volume, hospital stays and the incidence of hepatic encephalopathy of the observation group were lower than those of the control group (P < 0.05), and evaluation of self-care ability scale (ESCA) score in the observation group was higher than that in the control group (P < 0.05). Conclusion: The emergency nursing mentality intervenes on patients with liver cirrhosis complicated with upper gastrointestinal bleeding has a significant care effect, which can improve the self-care ability and medical compliance of patients.
目的:探讨急诊护理心理干预对肝硬化并发上消化道出血患者治疗的影响。方法:选择40例肝硬化并发上消化道出血患者作为研究对象,采用抓阄随机化分组法将其分为观察组(20例,急诊护理干预组)和对照组(20例,常规护理组)。比较两组的护理效果。结果:护理后,观察组止血时间、输血量、住院时间、肝性脑病发病率均低于对照组(P < 0.05),自我护理能力测定量表(ESCA)评分高于对照组(P < 0.05)。结论:急诊护理心理干预对肝硬化并发上消化道出血患者的护理效果显著,可提高患者的自我护理能力。
急诊护理心理干预,肝硬化,上消化道出血,心理压力,疗效
Minfeng Huang
Emergency Department, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong
Received: Jun. 21st, 2021; accepted: Jul. 28th, 2021; published: Aug. 2nd, 2021
Objective: To explore the treatment effects of emergency nursing mentality intervenes on patients with liver cirrhosis complicated with upper gastrointestinal bleeding. Methods: A total of 40 patients with liver cirrhosis complicated with upper gastrointestinal bleeding were selected as the research objects, and the patients were divided into observation group (20 cases, emergency nursing group) and control group (20 cases, conventional nursing) using lottery randomization grouping method. The nursing effect of the two groups was compared. Results: After nursing, the bleeding time, blood transfusion volume, hospital stays and the incidence of hepatic encephalopathy of the observation group were lower than those of the control group (P < 0.05), and evaluation of self-care ability scale (ESCA) score in the observation group was higher than that in the control group (P < 0.05). Conclusion: The emergency nursing mentality intervenes on patients with liver cirrhosis complicated with upper gastrointestinal bleeding has a significant care effect, which can improve the self-care ability and medical compliance of patients.
Keywords:Emergency Nursing Mentality Intervene, Liver Cirrhosis, Upper Gastrointestinal Bleeding, Psychological Pressure, Treatment Effect
Copyright © 2021 by author(s) and Hans Publishers Inc.
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肝硬化(hepatic sclerosis)是一种存在广泛性的肝细胞坏死、结缔组织增生,导致肝小叶结构破坏和假小叶形成的慢性进行性肝病 [
选取中山一院急诊2019年2月~2020年2月期间收治的40例肝硬化并发上消化道出血患者作为研究对象,其中男性患者27例,女性患者13例,患者年龄均在41~79岁之间,平均年龄为(56.3 ± 1.8)岁。上述肝硬化患者均符合中华医学会肝病学分会建立肝硬化的诊断标准 [
对照组采用常规护理干预,主要包括常规对症治疗、健康教育等。观察组采用急诊护理干预:1) 开通绿色通道:分诊护士明确患者为肝硬化并发消化道出血,启动绿色通道,转移至监护室,予以生命体征检测,开通多条静脉通道,B超引导下深静脉穿刺;2) 生活干预:除了禁食、禁饮外,止血2~3天后予以流质食物,由营养师及责任护士饮食指导,建议多吃水果泥、蔬菜泥,促进排便,减少肝性脑病的发生,并密切观察患者大便次数、形状等,定期检验大便潜血情况;3) 用药护理:输液、PPI抑酸、酶抑制剂,并输入垂体后叶素,观察有无药物反应,观察患者有无胸闷、腹痛、头晕等不适;4) 健康教育:建立良好的医患关系,主动介绍责任护士和主治医生的职责、处理能力及医院的探视制度,教育家属注意事项及医院的规章制度,并对家属进行护理指导,饮食、休息等注意事项,让家属和患者快速了解周围环境,消除患者紧张情绪,提高家属及患者的配合性,鼓励患者积极面对疾病,共同克服病患的决心;5) 心理护理:肝硬化并发上消化道出血是消化内科和急诊科常见多发病,往往肝硬化失代偿期易并发出血,治疗时间长,病情反复,且预后不佳,易对患者造成极大的心理负担,甚至有轻生念头。在住院期间,尤其是急诊科住院期间,有针对性的对患者进行心理疏导,根据患者心理变化,制定合适的心理护理方案,讲解肝硬化并发消化道出血治疗方案及治疗效果,配合治疗的重要性,及时清除患者口腔及身上的血迹,消除患者的恐惧感;在各项治疗前,讲解治疗的目的、方法、注意事项等。6) 胃镜止血护理:在内镜止血前,严密检测生命体征,需要药物止血处理,嘱托避免腹部压力增高的活动,预防再次出血或加大出血,再次检测胃镜适应症,排除禁忌症,讲解胃镜必要性,具有安全性,缓解内里不安、恐惧感;胃镜后安返病房,再次评估患者及家属对肝硬化并发消化道出血相关知识掌握情况,并反复宣教疾病相关内容,检测患者神志变化,评估患者感性脑病情况。
比较两组止血时间,输血量、住院时间,观察两组患者护理前、后的自我护理能力。采用自我护理能力测定量表(ESCA)进行评价,得分越高,说明患者自我护理能力越强。
临床数据均由SPSS20.0软件进行统计学分析处理,计数资料采用x2检验,使用[n(%)]表示,计量资料采用t检验,使用( x ¯ ± s )表示,当p < 0.05时,差异具有统计学意义。
1) 两组护理后止血时间、输血量、住院时间及肝性脑病发作率比较见表1。
组别 | 止血之间 | 输血量 | 住院时间 | 肝性脑病率 |
---|---|---|---|---|
对照组 | 37.95 ± 14.27 | 2.3 ± 2.27 | 8.05 ± 2.16 | 8 (40%) |
观察区 | 20.3 ± 9.23 | 0.6 ± 0.88 | 5.25 ± 1.55 | 2 (10%) |
X2/t | 4.616 | 3.117 | 4.703 | 4.8 |
P | 0.000 | 0.005 | 0.000 | 0.028 |
表1. 两组护理后止血时间、输血量、住院时间及肝性脑病发作率比较
2) 两组患者护理前、后的 ESCA 评分比较见表2。
组别 | 护理前 | 护理后 | t/P |
---|---|---|---|
对照组 | 82.8 ± 8.56 | 132.25 ± 17.47 | −11.336/0.000 |
观察组 | 81.25 ± 6.18 | 155.65 ± 18.8 | −18.59/0.000 |
t/P | 0.656/0.516 | −4.318/0.000 |
表2. 各组自我护理能力测定量表(ESCA)评价比较
肝硬化并发上消化道出血是急诊科最常见的急症之一,食管胃底静脉曲张破裂出血是该病最主要的原因,其发病机制复杂,出血急剧,出血量大,极易出现休克,而且还具有反复发作性,给患者带来巨大的痛苦和经济负担,治疗过程各种危险,让患者苦不堪言,极易对患者心理造成巨大的负面影响,患者的自我护理能力也随之下降,这严重影响了患者疾病的愈合 [
本研究指出,经过急诊护理的心理干预后,患者止血时间、输血量、住院时间、肝性脑病发作率均得到不同程度的减少或者下降,而且患者的自我护理能力也大大提升,这说明心理干预在治疗肝硬化并发上消化道出血上具有很强的必要性。
最近指南指出,急性上消化道出血推荐急诊胃镜下止血 [
急诊护理心理干预肝硬化并发上消化道出血不仅在疗效上取得良好的效果,也改善了患者饮食和生活习惯,还提高了自我护理能力。本研究发现经过急诊护理干预后,不管是观察组,还是对照组,患者经过个性化的急诊护理后,患者自我保护意识增强,提高了对该病的认知度,强化了对医生和护士嘱托的遵从性,减少很多负面影响,自我护理能力也随之得以提升。
综上,急诊护理心理干预对肝硬化并发上消化道出血患者治疗效果显著,而且提高了患者的自我护理能力。
黄敏枫. 急诊护理心理干预对肝硬化并发上消化道出血患者治疗的影响 Treatment Effects of Emergency Nursing Mentality Intervenes on Patients with Liver Cirrhosis Complicated with UpperGastrointestinal Bleeding[J]. 亚洲急诊医学病例研究, 2021, 09(03): 25-29. https://doi.org/10.12677/ACREM.2021.93005