臨床護理路徑在鎮痛鎮靜條件下超聲消融子宮肌瘤中的應用

宋晶彥+鞠進+侯海霞

摘要：目的 探討臨床護理路徑在鎮痛鎮靜條件下高強度聚焦超聲消融（HIFU）子宮肌瘤中的應用效果。方法 將210例接受鎮痛鎮靜條件下HIFU治療子宮肌瘤患者隨機分為對照組和觀察組各105例，對照組實施常規護理方法，觀察組采用臨床護理路徑進行護理，比較兩組臨床護理效果。結果 入院當天兩組患者焦慮自評分（SAS）比較，差異無統計學意義（P>0.05）；出院當天觀察組患者的SAS評分低于對照組，差異有統計學意義（P<0.05）。觀察組患者圍手術期不良反應發生率明顯低于對照組，對健康知識的掌握率和護理滿意度明顯優于對照組，差異有統計學意義（P<0.05）。結論 對鎮痛鎮靜條件下HIFU治療子宮肌瘤患者應用臨床護理路徑實施全程護理，可改善患者焦慮情緒，降低不良反應的發生率，提高患者對健康知識的掌握率和護理滿意度，提高臨床護理質量，改善患者就醫感受，促進醫患和諧，值得臨床推廣應用。

關鍵詞：臨床護理路徑；高強度聚焦超聲；子宮肌瘤

中圖分類號：R473.73 文獻標識碼：A 文章編號：1006-1959（2017）13-0054-03

Abstract：Objective To investigate the clinical nursing path in ablation of high intensity focused ultrasound（HIFU）under the condition of analgesic and sedative effect in uterine leiomyoma.Methods 210 cases underwent HIFU treatment under sedation and analgesia in patients with uterine leiomyoma were randomly divided into control group and observation group of 105 cases，the control group implemented routine nursing method，the observation group used clinical nursing the path of nursing，clinical nursing effect was compared between the two groups.Results On the day of admission of two groups of patients with Self Rating Anxiety Scale （SAS），the difference was not statistically significant（P>0.05）；on the day of discharge SAS scores of the observation group lower than in the control group，the difference was statistically significant（P<0.05）.The observation group of patients with perioperative adverse reaction rate was significantly lower than the control group，the health knowledge rate and nursing satisfaction were significantly better than the control group，the difference was statistically significant（P<0.05）.Conclusion The application of clinical nursing path in patients with uterine leiomyoma therapy on analgesia and sedation HIFU under the condition of the implementation of the whole nursing care can improve the anxiety of patients， reduce the incidence of adverse reactions and improve patients' health knowledge rate and nursing satisfaction，improve the quality of clinical care， improve patient feeling and promote harmony between doctors and patients，it is worthy of clinical application.

Key words：Clinical nursing pathway；High intensity focused ultrasound；Uterine leiomyoma

子宮肌瘤是一種婦科最為常見的良性腫瘤，以育齡期婦女為主要人群，發病率有關報道中證實在30%～40%[1]。目前主要采用手術治療方法，包括子宮切除術和肌瘤剔除術，而肌瘤剔除術作為一種能保留子宮的生理功能以及身體的完整性的治療方法，更能為患者所接受[2]，但無論是傳統的開腹和腔鏡微創子宮切除術對女性尤其育齡期女性，在生理、心理上均有較大影響。近年來，高強度聚焦超聲消融（High intensity focused ultrasound，HIFU）技術已被多項研究及臨床應用證實其作為一種新型的無創治療技術，已經廣泛應用于子宮肌瘤的治療，通過超聲消融子宮肌瘤，無需開刀，無需打孔，成功實現體外無創治療，該技術在保證治療效果的同時，又能保證患者子宮的完整性，且治療時間短、恢復快，是治療子宮肌瘤安全、有效的技術[3-4]。臨床護理路徑（clinical nursing pathway，CNP）又稱臨床程序，是為已確診為某種疾病的一組患者制定的，以患者為中心，從入院到出院的一整套住院護理模式，是近年來發展起來的一種新型的、科學、高效的護理質量管理模式[5]。我……