恶性阻塞性黄疸患者围手术期常见并发症评分系统的研发及预见性

1、恶性阻塞性黄疸患者围手术期常见并发症评分系统的研发及预见性【中文摘要】恶性阻塞性黄疸患者围手术期并发症发生率高,其中出血、胰瘘、肾功能不全是主要的三大并发症,是造成患者围手术期死亡、延长住院时间、增加住院用度的主要原因。围手术期预见性护理可以有效缩短患者术后住院天数,降低住院用度,减少并发症的发生率及死亡率。通过前期研究,我们已得出恶性阻塞性黄疸患者围手术期出血、肾功能不全的高危因素及Fishers判别分析方程,但对于胰瘘的高危因素尚未明确。此外,如何快速、正确筛选并发症发生的高危人群以及制定适用于该类患者的针对性预见性护理方案,并检验其在临床应用中的效果,尚未见相关报道。本研究主要包括三部分

2、内容:恶性阻塞性黄疸患者围手术期胰瘘高危因素分析、围手术期并发症高危因素评分系统的研发与效果评价及围手术期预见性护理方案的制定及检验。研究目的与方法:1.通过回顾性研究300例恶性阻塞性黄疸行胰十二指肠切除术患者围手术期的一般资料、实验室检查结果、术中情况及术后并发症发生情况,应用SPSS10.0统计软件包对上述临床资料进行Logistic回回分析,并对结果采用Fishers判别分析。旨在得出术后胰瘘的高危因素,把握该类患者术后胰瘘的发生规律,有目的地进行观察和护理,降低胰瘘的发生率。2.与紫金桥软件公司合作,将出血、胰瘘、肾功能不全高危因素分类排版,Fishers判别分析方程编进程序,旨在研

3、发恶性阻塞性黄疸患者围手术期并发症高危因素评分系统软件,并检测软件的灵敏度、特异度、猜测符合率及计算耗时等,以判定软件是否可靠、有效、简便、快捷。3.在临床护理专家的指导下制定恶性阻塞性黄疸患者围手术期常见并发症预见性护理方案。实验组选取2008年6月2008年11月64例恶性阻塞性黄疸患者围手术期资料,对经软件筛选出的并发症发生高危人群实施针对性预见性护理方案,对照组回顾性分析2008年1月2008年5月62例恶性阻塞性黄疸患者围手术期临床资料,旨在探讨该方案在临床护理中的作用和效果。结果:1.本组患者围手术期胰漏发生率为12.3%。Logistic回回分析得到影响该类患者术后发生胰漏的高危

4、因素包括:性别(男性),术前行ERCP/PTCD检查或治疗,既往心脏病史,手术方式(扩大胰十二指肠切除术),病理分化(低),尿素氮变化率(术后第一天浓度-术前浓度)/术前浓度(大)。通过Fishers判别分析得到3个判别函数。2.形成恶性阻塞性黄疸患者围手术期常见并发症高危因素评分系统软件。该软件对出血、胰瘘、肾功能不全检出的灵敏度分别为85.7%、88.89%、100%;特异度分别为94.5%、96.23%、96.5%;诊断正确度分别为93.55%、95.2%、96.77%,每位患者的计算时间缩短426.92s。3.实验组患者应用软件进行分析,筛选得到出血、胰瘘、肾功能不全高危人群分别为9例

5、、10例、7例,两组患者在术后住院天数、监护时间和术后住院用度方面有明显性差异(p【Abstract】 The complications rate of operation in malignant obstructive jaundice patients is very high in the perioperative period. Hemorrhage, pancreatic fistula and renal insuficiency are three most common complications, which can result in perioperative de

6、ath, prolonged length of stay and increased cost of hospitalization. Preventive nursing measures during perioperative can decrease post-operation hospital days, reduce hospitalization cost, and decrease incidence and death rate. Through early study, we have got hemorrhage and renal insuficiencys hig

7、h risk factors of malignant obstructive jaundice patients during their perioperative period, but we havent got the high risk factors of pancreatic fistula. Otherwise, there are few studies on how to scan complications high risk patients quickly and accurately, how to enact and practice preventive nu

8、rsing intervention for malignant obstructive jaundice patients. The study including three parts, which are high risk factors for the pancreatic fistulas studies during perioperative period, invention and application high risk factorsscore system to predict complications, and enact and assess the eff

9、ectiveness of perioperative preventive nursing interventions.Objective and Methods1. The data was collected from 300 patients, which including clinical data, laboratory results, and complications during and after operation. The data were analyzed by SPSS10.0, and the methods of Logistic regression a

10、nalysis and Fishers discriminate analysis were used to investigate the high risk factors of the pancreatic fistula post-operation, and to recognize the regularity of pancreatic fistula. We specifically paid much attention on observation and nursing to cut down the rate of pancreatic fistula.2. Toget

11、her with ZI-Jinqiao software company, grouping and typesetting common complications(hemorrhage, pancreatic fistula and renal insuficiency)high risk factors and Fishers discriminate analysis edit in soft ware, to invention and application of high risk factorsscore system predicting complications in m

12、alignant obstructive jaundice patients, and detect the soft wares by sensitivity, specificity, percent agreement and calculate time, to judge if its reliability, utility, convenience.3. With the help of clinical nurse specialists, we enact preventive nursing project of common complication about mali

13、gnant obstructive jaundice patients. Experimental group choose 64 malignant obstructive jaundice patients perioperative clinical datas between Jun. and Nov. 2008, which give preventive nursing project to high risk patients getting from the soft ware, control group retrospective analysis 62 malignant

14、 obstructive jaundice patients perioperative clinical datas between Jan. and May. 2008, to assess the affect and effect of the preventive nursing project of common.Results1. There were 37 patients(12.3%)with pancreatic fistula after operation. According to stepwise regression analysis, the high risk

15、 factors for the pancreatic fistula after panreatoduodenectomy of malignant obstructive jaundice patients includes gender(male), the experience of ERCP/PTCD examination or treatment, a history of heart disease, the type of operation (extented pancreatoduodenectomy), pathodifferentiation(low), variat

16、ion rates of Blood Urea Nitrogen(high). With the estimation of Fishers discriminate analysis, we could get three discriminate functions.2. We got high risk factorsscore system predicting complications in malignant obstructive jaundice patients. The softwares sensitivity of hemorrhage, pancreatic fistula and renal inadequacy is 85.7%, 88.89% and 100% separately, specificity is 94.7%, 96.36%, and 96.61% separately, percent agreement is 93.55%, 95.2% and 96.77%, per patients