护理风险管理对下肢动脉粥样硬化性闭塞症患者介入术后对比剂肾病发生率的影响
| 作者: |
1韦小妹,
1谢艳
1 海南医学院第一附属医院介入治疗科，海口 570102 |
| 通讯: |
韦小妹
Email: 2283909889@qq.com |
| DOI: | 10.3978/j.issn.2095-6959.2019.11.027 |
| 基金: | 海南省教育厅科研基金(Hnky2015-35)。 |
摘要
目的：分析护理风险管理对下肢动脉粥样硬化性闭塞症(lower extremity arteriosclerotic occlusive disease，LEAOD)患者介入术后对比剂肾病(contrast-induced nephropathy，CIN)发生率的影响。方法：将2014年1月至2018年12月在海南医学院第一附属医院接受介入手术治疗的60例LEAOD患者按入院时间均分2组。其中2017年1月至2018年12月入院患者设为观察组，2014年1月至2016年12月入院患者设为对照组。对照组为常规临床护理管理，观察组则基于失效模式与效应分析(Failure Mode and Effect Analysis，FMEA)进行护理风险管理，比较两组介入手术治疗情况及CIN发生率。结果：两组病变肢体数、血管闭塞长度、血管闭塞长度>20 cm所占比重、病变范围、介入治疗方式、介入治疗成功率及症状缓解率比较差异均无统计学意义(P>0.05)；本次护理风险管理共检测到术前宣教内容缺失，术前病史询问不全面，对比剂的选取、限量、重复使用，围术期药物使用，常规护理(只有护理常规无护理临床路径)不完善，护理管理的质量控制力度不佳6个失效模式，经决策树分析均有行动的必要；危机值(RPN)为245~810；改善措施可行性分析分值为104~120；且观察组CIN发生率显著低于对照组(χ2=4.705，P=0.030)。结论：较常规护理管理，基于FMEA进行护理风险管理可对CIN相关风险进行控制或排除，降低CIN发生率。
关键词：
护理风险管理；下肢动脉粥样硬化性闭塞症；介入术后；对比剂肾病
Effects of nursing risk management on incidence rate of contrast-induced nephropathy after interventional operation in patients with lower extremity atherosclerotic occlusive disease
CorrespondingAuthor: WEI Xiaomei Email: 2283909889@qq.com
DOI: 10.3978/j.issn.2095-6959.2019.11.027
Foundation: This work was supported by the Research Fund of the Education Department of Hainan Province, China (Hnky2015-35).
Abstract
Objective: To analyze the effects of nursing risk management on incidence rate of contrast-induced nephropathy (CIN) after interventional operation in patients with lower extremity arteriosclerotic occlusive disease (LEAOD). Methods: Sixty patients with LEAOD who underwent interventional operation in the hospital from January 2014 to December 2018 were divided into two groups according to the admission time. Patients admitted between January 2017 and December 2018 were set as an observation group, and patients admitted between January 2014 to December 2016 were set as a control group. The control group was given routine clinical nursing management while the observation group was given nursing risk management based on Failure Mode and Effect Analysis (FMEA). The treatment status of interventional operation and incidence rate of CIN were compared between the 2 groups. Results: There were no statistically significant differences in the quantity of lesioned limbs, length of vascular occlusion, proportion of vascular occlusion length >20 cm, lesion range, interventional therapy methods, success rate of interventional therapy and symptom relief rate between the 2 groups (P>0.05). Six failure modes of a lack of preoperative education information, incomprehensive inquiry of preoperative medical history, selection, limitation and repeated use of contrast agents, perioperative drug use, incomplete routine nursin (only with nursing routine but without nursing clinical pathway), and poor quality control of nursing management were detected in nursing risk management, and they were necessary for actions by decision tree analysis. The risk priority number (RPN) was 245–810. The feasibility analysis score of improvement measures was 104–120. The incidence rate of CIN in the observation group was significantly lower than that in the control group (χ2=4.705, P=0.030). Conclusion: Compared with routine nursing management, nursing risk management based on FMEA can control or eliminate CIN related risks and reduce the incidence rate of CIN.
Keywords：
nursing risk management; lower extremity atherosclerotic occlusive disease; after interventional operation; contrast-induced nephropathy