李丽莉



持续质量改进对胆囊切除术后并发症及PCS发生的影响

李丽莉

目的探讨持续质量改进（CQI）对胆囊切除术后并发症及胆囊切除术后综合征（PCS）的影响。方法2014年1月～2015年1月在胆囊切除术护理工作中行CQI，分析护理工作存在的问题及原因，以问题作为切入点，制定CQI措施，并与2012年12月～2013年12月CQI实施前对比，对比CQI实施前后并发症发生率及PCS发生情况；自拟调查问卷评估两组患者疾病相关知识的认知度。结果实施CQI后，患者胆管损伤及胆瘘、切口感染及PCS的发生率显著低于CQI前（P＜0.05)；患者疾病知识、手术知识、术后护理、饮食知识及预防知识评分显著高于CQI前（P＜0.05)。结论CQI能够提高腹腔镜胆囊切除术患者对疾病相关知识的认知度，有利于降低术后并发症发生率。

胆囊；切除；持续质量改进；并发症；胆囊切除术后综合征

[Abstract]Objective To investigate the effects of continuous quality improvement(CQI)on postcholecystectomy comp lications and postcholecystectomy syndrome(PCS).Methods CQIwas performed in nursing services of cholecystectomy between January 2014 and January 2015.The problems and reasons existing in the nursing serviceswere analyzed.The problems were taken as a starting point to develop CQI measures,which were compared with those before the implementation of CQI during December 2012 to December 2013.The incidence of complications and the occurrence of PCSbefore and after the implementation were compared.Selfdesigned questionnaireswere used to assess patients'degree of cognition for related knowledge.Results The incidence of bile duct injury,biliary fistulae,and incision infection after the implementation of CQI were significantly lower than those before the implementation(P＜0.05).The scores for knowledge about disease,operation,postoperative nursing,diet,and prevention after CQI were significantly higher than those before CQI(P＜0.05).Conclusion CQI can improve the cognition degree of disease related know ledge in patients receiving laparoscopic cholecystectomy,which is conducive to reduce the incidence of postoperative complications.

[Keywords]gallbladder;resection;continuous quality improvement;complication;postcholecystectomy syndrome

1　资料与方法

1.1病例资料以2012年12月～2013年12月作为CQI实施前，选取医院择期行腹腔镜胆囊切除术患者67例作为研究对象，男性29例，女性38例，年龄22～69（43.05±3.18）岁；疾病类型：胆囊结石9例，胆囊炎14例，胆囊息肉3例，慢性结石性胆囊炎41例；受教育程度：小学及以下15例，初中至高中25例，大专及以上27例。以2014年1月～2015年1月作为CQI实施后，选取医院择期行腹腔镜胆囊切除术患者70例作为研究对象，男性28例，女性42例，年龄20～71（44.84±3.57）岁；疾病类型：10例胆囊结石，13例胆囊炎，5例胆囊息肉，42例慢性结石性胆囊炎；受教育程度：小学及以下16例，初中至高中24例，大专及以上30例。两组性别、年龄、疾病类型、受教育程度无统计学差异（P＜0.05）。

1.2护理对CQI实施前的患者，在围手术期给予腹腔镜胆囊切除术常规护理；……