徐贤贞　　王利平　　陈玉微　　黄素玉　　阮红娟

[关键词] 先天性梨状窝瘘;品质链;疼痛;满意度

[中图分类号] R739          [文献标识码] B          [文章编号] 1673-9701（2021）14-0164-04

Application of quality chain nursing in the perioperative period of preschool children with congenital piriform fossa fistula

XU Xianzhen   WANG Liping   CHEN Yuwei   HUANG Suyu   RUAN Hongjuan

Department of Otorhinolaryngology-Head and Neck Surgery， Guangdong Provincial People's Hospital （Guangdong Academy of Medical Sciences）， Guangzhou   510080， China

[Abstract] Objective To explore the effect of quality chain nursing in the perioperative period of preschool children with congenital piriform fossa fistula. Methods Sixty-four children with congenital piriform fossa fistula admitted to the Department of Otolaryngology-Head and Neck Surgery from July 2017 to October 2019 were selected as the research objects. They were divided into the control group and the observation group according to the time period， with 32 cases in each group. The control group was given conventional nursing. The observation group was given quality chain nursing based on routine care. The pain scores of children and the nursing satisfaction of the parents at 6 h， 24 h， 48 h after the operation between the two groups were compared. Results The pain scores of children in the observation group at 6h， 24h， and 48h after surgery were significantly lower than those of the control group（all P<0.01）. The nursing satisfaction of parents of the observation group was higher than that in the control group（P<0.05）. Conclusion Quality chain nursing can effectively relieve the postoperative pain of preschool children with congenital piriform fistula and improve nursing satisfaction. It is worthy of clinical application.

[Key words] Congenital piriform fossa fistula; Quality chain; pain; Satisfaction

先天性梨狀窝瘘（Congenital pyriform sinus fistulae，CPSF）为胚胎早期第三、第四咽囊或鳃弓发育异常所致，占所有鳃裂畸形的1%～10%[1]，瘘管走行复杂，与甲状软骨翼板侧缘、甲状软骨下角、喉返神经、喉上神经外侧支、甲状腺等解剖结构毗邻[2]。90%的梨状窝瘘发生在左侧颈部，80%以上在学龄儿童发病[3]。患者多以反复发作的下颈部脓肿和急性化脓性甲状腺炎为首发症状，炎症静止期手术治疗是惟一的治愈手段[4]，传统开放性手术难度高、创伤大，需完整切除瘘管、解剖喉返神经、切除部分甲状腺腺叶，不适用于8岁以下患儿[5]，随着微创技术的发展，内镜烧灼术的应用越来越广泛，具有手术时间短、创伤小、并发症少、颈部无瘢痕、可重复等优点[6]。但若要达到良好的手术效果，除了主刀医生需要具备良好的技术外，围手术期的护理也是重要的影响因素。品质链[7]是将优质护理服务和全面质量管理相结合的护理模式，近年来，品质链护理已应用于多个学科领域，均取得良好效果[8-9]。我科于2018年12月起将品质链护理应用于学龄前先天性梨状窝瘘CO2激光烧灼手术学龄前患儿，效果满意，现报道如下。

1 资料与方法

1.1 一般资料

选取2017年7月至2019年10月我科收治的资料完整的64例学龄前先天性梨状窝瘘患儿为研究对象。纳入标准： 明确诊断为先天性梨状窝瘘，诊断标准[10]：根据患者症状（初次发病常表现为……