CAJ | 학술논문

目的：探讨个案追踪法在骨科深静脉血栓高危患者大手术后护理质量管理中应用的效果。方法便利抽样选择2013年7－12月入住骨科中心且改良 Wells 量表评分≥3分的高危患者72例为观察组,2013年1－6月入住骨科中心,且改良 Wells 量表评分≥3分的高危患者78例为对照组。观察组运用个案追踪法实施护理干预与质量管理,对照组按照2009年中华医学会骨科学分会推荐的?中国骨科大手术静脉血栓栓塞症预防指南?实施护理干预与质量管理,两组患者均随访6个月,比较实施前后深静脉血栓发生例数及并发症发生率、骨科专科手术护理质量评分。结果观察组发生深静脉血栓1例,对照组发生深静脉血栓9例,两组比较差异有统计学意义(P ＜0．01)；经积极对症治疗后均未出现肺动脉栓塞等其他并发症；痊愈出院后随访6个月,亦未发现其他并发症。两组患者专科手术护理质量评分方面差异有统计学意义(P ＜0．05),观察组优于对照组。结论个案追踪法在临床护理质量监控管理中的应用,能有效降低骨科大手术后静脉血栓栓塞症的发生率,切实指导骨科临床护理实践,规范护士深静脉血栓预防及护理行为,保障患者安全,提高专科护士综合护理能力。
목적：탐토개안추종법재골과심정맥혈전고위환자대수술후호리질량관리중응용적효과。방법편리추양선택2013년7－12월입주골과중심차개량 Wells 량표평분≥3분적고위환자72례위관찰조,2013년1－6월입주골과중심,차개량 Wells 량표평분≥3분적고위환자78례위대조조。관찰조운용개안추종법실시호리간예여질량관리,대조조안조2009년중화의학회골과학분회추천적?중국골과대수술정맥혈전전새증예방지남?실시호리간예여질량관리,량조환자균수방6개월,비교실시전후심정맥혈전발생례수급병발증발생솔、골과전과수술호리질량평분。결과관찰조발생심정맥혈전1례,대조조발생심정맥혈전9례,량조비교차이유통계학의의(P ＜0．01)；경적겁대증치료후균미출현폐동맥전새등기타병발증；전유출원후수방6개월,역미발현기타병발증。량조환자전과수술호리질량평분방면차이유통계학의의(P ＜0．05),관찰조우우대조조。결론개안추종법재림상호리질량감공관리중적응용,능유효강저골과대수술후정맥혈전전새증적발생솔,절실지도골과림상호리실천,규범호사심정맥혈전예방급호리행위,보장환자안전,제고전과호사종합호리능력。
Objective To investigate the effect of case tracing methodology in nursing quality management in pa-tients at high risk of deep vein thrombosis(DVT)after orthopedic surgery.Methods By convenience sampling,72 cases of high-risk hospitalized patients from July to December 2013 were selected as observation group and 78 ca-ses which admitted in hospital from January to June 2013 were selected as control group.The observation group ap-plied with case tracing methodology to implement nursing interventions and quality management.The control group followed the “Chinese guide for venous thromboembolism prevention in major orthopedic surgeries”recommended by the Orthopaedic Surgery Branch of the Chinese Medical Association in 2009 to implement nursing interventions and quality management.Patients in both groups were followed up for six months,and the cases occurred DVT,the incidence rate of complications,and the specialist nursing quality score of orthopedic surgery before and after the implementation were compared between two groups.Results 1 case in the observation group occurred DVT,and 9 cases in the control group occurred DVT (P <0.01).All the patients were had no incidence of pulmonary embolism and other complications,and with 6 months of follow up after discharge with no other complications.The specialist nursing quality score of orthopedic surgery had differences between two groups,and the observation group was higher than control group (P <0.05).Conclusion Application of case tracing methodology in clinical nursing quali-ty control management could effectively reduce the incidence of DVT after major orthopedic surgery,and effectively guide the orthopedic clinical nursing practice,standardized the nursing behavior of the prevention of DVT,which guarantee the patient’s safety and improve the comprehensive nursing care ability of specialist nurses.