乳腺良性病变患者在病房实施日间手术的管理及效果评价
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摘要
目的探索在乳腺外科病房对乳腺良性病变患者实施日间手术管理的可行性及有效性。方法抽取医院乳腺外科实施日间手术管理的180例乳腺良性病变患者作为试验组,并同期选配180例实施常规住院手术管理的乳腺良性病变患者作为对照组。试验组的日间手术管理方法,患者术前检查、健康教育、麻醉咨询等医疗服务提前到门诊完成,专设医疗与护理小组,在手术室行日间手术,术后常规护理,评估满足出院标准后于术后第2天08:00出院。结果试验组手术等待时间、住院时间、直接医疗费用均少于对照组,差异有统计学意义(P<0.001)。试验组患者满意度(100%)高于对照组(95%),差异有统计学意义(P<0.01)。试验组术后并发症发生率(0.6%)低于对照组(2.8%),但差异无统计学意义(P>0.05)。结论在乳腺外科病房对乳腺良性病变患者实施日间手术管理具有可行性、安全性及有效性,可提高医疗资源的利用效率。
Objective To explore the feasibility and effectiveness of day surgery management in breast surgery ward for patients with benign breast lesions. Methods To recruit 180 patients with benign breast lesions who underwent day surgery management in the department of breast surgery of our hospital as the experimental group,180 cases managed by routine inpatient surgery were selected as the control group. The experimental group adopted the management method of day surgery,of which the preoperative examination,health education,anesthesia consultation and other medical services of the patients were completed in advance in the outpatient department. A special medical and nursing team was set up to perform the day surgery management,the patients underwent the day surgery in the operating room with routine postoperative care and were discharged at 8:00 a.m. on the second day after surgery when the postoperative evaluation results met the discharge criteria. Results The surgery waiting time,hospitalization time and direct medical expenses of the experimental group were all less than those of the control group,with statistically significant differences(P <0.001). Patients' satisfaction in the experimental group(100%) was higher than that in the control group(95%),and the difference was statistically significant(P<0.01).The incidence of postoperative complications in the experimental group(0.6%) was lower than that in the control group(2.8%),but the difference was not statistically significant(P >0.05). Conclusion It is feasible,safe and effective to perform day surgery management for patients with benign breast lesions in the breast surgery ward,which could also optimize the utilization efficiency of medical resources.
Objective To explore the feasibility and effectiveness of day surgery management in breast surgery ward for patients with benign breast lesions. Methods To recruit 180 patients with benign breast lesions who underwent day surgery management in the department of breast surgery of our hospital as the experimental group,180 cases managed by routine inpatient surgery were selected as the control group. The experimental group adopted the management method of day surgery,of which the preoperative examination,health education,anesthesia consultation and other medical services of the patients were completed in advance in the outpatient department. A special medical and nursing team was set up to perform the day surgery management,the patients underwent the day surgery in the operating room with routine postoperative care and were discharged at 8:00 a.m. on the second day after surgery when the postoperative evaluation results met the discharge criteria. Results The surgery waiting time,hospitalization time and direct medical expenses of the experimental group were all less than those of the control group,with statistically significant differences(P <0.001). Patients' satisfaction in the experimental group(100%) was higher than that in the control group(95%),and the difference was statistically significant(P<0.01).The incidence of postoperative complications in the experimental group(0.6%) was lower than that in the control group(2.8%),but the difference was not statistically significant(P >0.05). Conclusion It is feasible,safe and effective to perform day surgery management for patients with benign breast lesions in the breast surgery ward,which could also optimize the utilization efficiency of medical resources.
引文
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[17]郭晶,刘素珍,李继平,等.日间手术医院社区一体化协作网的建立及管理[J].中华护理杂志,2013,48(11):986-988.
[18]李茜,刘思,马洪升.收益管理理论在日间手术运营模式中的运用[J].华西医学,2013,28(8):1293-1295.
[19]Mourregot A,Lemanski C,Gutowski M,et al.Day-care for breast cancer:ambulatory surgery and intra-operative radiation.Techniques and preliminary results of the Centre Vald'Aurelle--Montpellier[J].J Visc Surg,2014,151(1):3-10.
[2]刘常清,任宏飞,李继平,等.日间手术管理模式与发展现状[J].护理研究,2016,30(10A):3466-3469.
[3]Kovacevic I,Simic D,Petkovic M.Anesthesia in day surgery in children[J].Srp Ark Celok Lek,2004,132(1):54-57.
[4]Liao MN,Chen PL,Chen MF,et al.Supportive care for Taiwanese women with suspected breast cancer during the diagnostic period:effect on healthcare and support needs[M].Oncol Nurs Forum,2009.
[5]王薇,耿中利,王进,等.687例乳腺良性肿瘤微创手术的临床应用及价值[J].复旦学报(医学版),2012,39(1):48-52.
[6]邵云,许春伟,姜春婷,等.2392例乳腺肿瘤临床病理特征分析[J].临床与病理杂志,2015,35(5):772-778.
[7]杜峰,黄雅娟,魏玲丽.良性乳腺肿瘤患者手术方式与术后美容效果的临床研究[J].中国当代医药,2013,20(25):43-44.
[8]Hainsworth AJ,Lobo CR,Williams P,et al.‘23 h Model'for breast surgery:an early experience[J].Breast,2013,22(5):898-901.
[9]Eriksson H,Tenhunen A,Korttila K.Balanced analgesia improves recovery and outcome after outpatient tubal ligation[J].Acta Anaesth Scand,1996,40(2):151-155.
[10]Ballardini B,Cavalli M,Manfredi GF,et al.Surgical treatment of breast lesions at a Day Centre:experience of the European Institute of Oncology[J].Breast,2016,27:169-174.
[11]Perkins FM,Gopal A.Postsurgical chronic pain:a model for investigating the origins of chronic pain[J].Region Anesth Pain,2003,7(3):122-126.
[12]Kumar C,Page R,Smith I,et al.Day case and short stay surgery:2[J].Anaesthesia,2011,66(5):417-434.
[13]Marla S,Stallard S.Systematic review of day surgery for breast cancer[J].Int J Surg,2009,7(4):318-323.
[14]戴燕,李继平,刘素珍,等.华西医院日间手术服务模式的构建[J].四川医学,2013,34(7):1124-1126.
[15]马洪升.日间医疗服务的展望[J].华西医学,2016,31(4):601-602.
[16]Barry M,Weber WP,Lee S,et al.Enhancing the clinical pathway for patients undergoing axillary lymph node dissection[J].Breast,2012,21(4):440-443.
[17]郭晶,刘素珍,李继平,等.日间手术医院社区一体化协作网的建立及管理[J].中华护理杂志,2013,48(11):986-988.
[18]李茜,刘思,马洪升.收益管理理论在日间手术运营模式中的运用[J].华西医学,2013,28(8):1293-1295.
[19]Mourregot A,Lemanski C,Gutowski M,et al.Day-care for breast cancer:ambulatory surgery and intra-operative radiation.Techniques and preliminary results of the Centre Vald'Aurelle--Montpellier[J].J Visc Surg,2014,151(1):3-10.