鼻肠管堵塞预防执行单的设计及应用研究

doi:10.3761/j.issn.0254-1769.2021.10.002

摘要/Abstract

摘要：

目的设计鼻肠管堵塞预防执行单,探讨其在根治性胃癌切除术后患者中的应用效果。方法通过文献回顾、专家咨询等方法设计鼻肠管堵塞预防执行单。2020年10月—2021年2月,便利选取河南省某三级甲等医院肿瘤外科2个病区,A病区57例根治性胃癌切除术后患者为试验组,B病区55例根治性胃癌切除术后患者为对照组。试验组在常规鼻肠管护理基础上采用鼻肠管堵塞预防执行单,对照组采用常规鼻肠管护理。比较两组鼻肠管堵塞发生率与处理鼻肠管堵塞的耗时、试验组干预前后护士鼻肠管堵塞防控认知及行为得分,评价试验组护士对执行单的满意度。结果试验组鼻肠管堵塞发生率低于对照组（P<0.05）,试验组护士处理鼻肠管堵塞耗时短于对照组（P<0.05）,试验组干预后护士鼻肠管堵塞防控认知及行为得分高于干预前（P<0.05）。试验组护士对执行单的满意度得分为（36.16±1.92）分,处于较高水平。结论鼻肠管堵塞预防执行单的应用,可有效降低鼻肠管堵塞发生率,缩短处理鼻肠管堵塞耗时,提高护士鼻肠管堵塞防控认知及行为。

关键词: 胃肿瘤, 插管法,胃肠, 堵管, 防控措施, 执行单

Abstract:

Objective To explore and apply the nursing prevention and control measurement for patients with obstruction of nasointestinal tube after radical gastrectomy for gastric cancer. Methods Through literature review and Delphi expert consultation,the nursing prevention and control measurement was designed for patients with obstruction of nasointestinal tube after radical gastrectomy for gastric cancer. 2 wards of tumor surgery in a Leval A tertiary hospital in Henan Province from October 2020 to February 2021 were conveniently selected,with Ward A including 57 gastric cancer patients as the intervention group and Ward B including 55 gastric cancer patients as the control group. The intervention group received the measurement based on the conventional nasointestinal tube care of the control group. The rate of tube obstruction between Ward A and B,the average time in handling the tube obstruction,and the nurses’ cognition and behavior scores in the intervention before and after the intervention,the satisfaction of the nurses with the measurement in the intervention group were compared. Results The rate of tube obstruction in the intervention group was significantly lower than that in the control group （P<0.05）. The average time spent by nurses in the intervention group to deal with the tube obstruction was significantly less than that in the control group（P<0.05）. The cognition and behavior scores of nurses in the intervention group for the prevention and control of nasointestinal tube obstruction were higher than those before the intervention,and the difference was statistically significant（P<0.05）. The satisfaction score of nurses in the intervention group on the record was （36.16±1.92）. Conclusion The application of the nursing prevention and control measurement for patients with obstruction of nasointestinal tube after radical gastrectomy for gastric cancer can effectively reduce the rate of tube obstruction in patients with nasointestinal tube,reduce the average time spent in dealing with the tube obstruction,and improve nurses’ cognition and behavior of nasointestinal tube obstruction prevention and control.

Key words: Stomach Neoplasms, Intubation,Gastrointestinal, Tube Obstruction, Prevention and Control Measures, Measurement

张媛, 韩梦丹, 赵倩, 李梅, 冯铮铮, 徐翠红, 杜久丽, 王苏璇. 鼻肠管堵塞预防执行单的设计及应用研究[J]. 中华护理杂志, 2021, 56(10): 1453-1459.

ZHANG Yuan, HAN Mengdan, ZHAO Qian, LI Mei, FENG Zhengzheng, XU Cuihong, DU Jiuli, WANG Suxuan. Design and application of nursing prevention and control measurement for patients with obstruction of nasointestinal tube after radical gastrectomy for gastric cancer[J]. Chinese Journal of Nursing, 2021, 56(10): 1453-1459.

图/表 3

图1 鼻肠管堵塞预防执行单注：护士根据自身操作的实际情况在对应的位置标记“√”,需在“___”标注时请标注清楚。防控措施标准：

Figure 1 Implementation list of nursing prevention and control measures for nasointestinal obstruction after radical gastrectomy

表1 两组医护人员一般资料比较

Table 1 Comparison of general data of the two groups of medical staff

表2 两组患者一般资料比较

Table 2 Comparison of general data between the two groups

参考文献 17

[1]	季加孚, 胡祥, 陈凛, 等. 胃切除术后消化道重建技术专家共识[J]. 中国实用外科杂志, 2014, 34(3):205-212.
	Ji JF, Hu X, Chen L, et al. The expert consensus on the technique of digestive tract reconstruction after gastrostomy[J]. Chin J Pract Surg, 2014, 34(3):205-212.
[2]	程兮, 杨卫平, 罗茜, 等. 螺旋型鼻肠管在胃癌根治术加速康复中的临床价值[J]. 中华消化外科杂志, 2015, 14(1):61-65.
	Cheng X, Yang WP, Luo X, et al. Clinical value of helical nasointestinal tube placement in the enhanced recovery of patients with the radical gastrostomy for gastric cancer[J]. Chin J Dig Surg, 2015, 14(1):61-65.
[3]	顾晓英, 李培. 胃癌术后鼻肠管堵塞的原因及护理研究进展[J]. 护理研究, 2016, 30(28):3463-3466.
	Gu XY, Li P. Causative analysis and nursing research progress on nasointestinal tube obstruction in patients with postoperative gastric cancer[J]. Chin Nurs Res, 2016, 30(28):3463-3466.
[4]	Scott R, Bowling TE. Enteral tube feeding in adults[J]. J R Coll Physicians Edinb, 2015, 45(1):49-54. DOI PMID
[5]	Borges JLA, De Souza IAO, Costa MCV, et al. Causes of nasoenteral tube obstruction in tertiary hospital patients[J]. Eur J Clin Nutr, 2020, 74(2):261-267. DOI PMID
[6]	欧玉凤, 赵慧华, 许丽娜. 不同溶液用于鼻肠管肠内营养患者封管的效果评价[J]. 中国实用护理杂志, 2020, 36(9):646-650.
	Ou YF, Zhao HH, Xu LN. Evaluation of the effect of different solutions for endoscopic nutrition in nasal and intestinal patients[J]. Chin J Pract Nurs, 2020, 36(9):646-650.
[7]	Boullata JI, Carrera AL, Harvey L, et al. ASPEN safe practices for enteral nutrition therapy formula:see text[J]. J Parenter Enteral Nutr, 2017, 41(1):15-103. DOI URL
[8]	Hayes KD, Hayes DD. Best practices for unclogging feeding tubes in adults[J]. Nursing, 2018, 48(6):66.
[9]	汤婷, 刘扣英, 窦蓓, 等. 慢性阻塞性肺疾病患者自我护理量表的构建及信效度检验[J]. 中华护理杂志, 2021, 56(2):233-238.
	Tang T, Liu KY, Dou B, et al. Development of a self-care scale for patients with chronic obstructive pulmonary disease and the test of its reliability and validity[J]. Chin J Nurs, 2021, 56(2):233-238.
[10]	彭南海, 黄迎春. 肠外与肠内营养护理学[M]. 南京: 东南大学出版社, 2016.
	Peng NH, Huang YC. Parenteral and enteral nutrition nursing[M]. Nanjing: Southeast University Press, 2016.
[11]	卢学萍, 黄霞, 贾培培, 等. 经皮冠状动脉介入治疗患者延续护理质量评价指标体系的构建[J]. 中华护理杂志, 2021, 56(1):73-79.
	Lu XP, Huang X, Jia PP, et al. Construction of an evaluation index system for hospital-community linkage continued nursing quality after percutaneous coronary intervention[J]. Chin J Nurs, 2021, 56(1):73-79.
[12]	杨屹珺, 景峰, 傅晓菁, 等. 清单式管理在减少急诊危重患者空肠营养堵管中的应用[J]. 中华急危重症护理杂志, 2021, 2(1):26-31.
	Yang YJ, Jing F, Fu XJ, et al. The effect of checklist management in reducing the obstruction of jejunal feeding tube in emergency critical patients[J]. Chin J Emerg Crit Care Nurs, 2021, 2(1):26-31.
[13]	Hossaini Alhashemi S, Ghorbani R, Vazin A. Improving knowledge,attitudes,and practice of nurses in medication administration through enteral feeding tubes by clinical pharmacists:a case-control study[J]. Adv Med Educ Pract, 2019, 10:493-500. DOI URL
[14]	Best C. How to set up and administer an enteral feed via a nasogastric tube[J]. Nurs Stand, 2017, 31(45):42-47.
[15]	蒋理立, 李卡, 杨婕, 等. 冲管方式对胃癌术后患者鼻肠管堵塞的影响[J]. 华西医学, 2015, 30(12):2324-2325.
	Jiang LL, Li K, Yang J, et al. Effect of flushing on nasal and intestinal canal blockage in patients with gastric cancer after operation[J]. West China Med J, 2015, 30(12):2324-2325.
[16]	盛玉, 卞兰峥, 魏莉, 等. 不同容量注射器冲管对儿科患者留置空肠营养管堵管再通的效果评价[J]. 中华临床营养杂志, 2019, 27(3):184-187.
	Sheng Y, Bian LZ, Wei L, et al. Effects of different volume syringe on recanalization of indwelling jejunal feeding tube in pediatric patients[J]. Chin J Clin Nutr, 2019, 27(3):184-187.
[17]	祝利红, 沈新, 周玉意. 不同温度的胰酶NaHCO3溶解液对鼻肠管堵管的应用研究[J]. 肠外与肠内营养, 2020, 27(4):240-242,247.
	Zhu LH, Shen X, Zhou YY. Application of trypsin solution containing sodium bicarbonate at different temperatures in the obstruction of nasojejunal feeding tube[J]. Parenter Enter Nutr, 2020, 27(4):240-242,247.