“1 + 2 + X”协同服务模式对腹腔镜胆囊切除术病人自我管理能力及照护者照护负担的影响

    The influence of the "1 + 2 + X" collaborative service mode on the self-management ability of patients undergoing laparoscopic cholecystectomy and care burden of caregivers

    • 摘要:
      目的: 探讨基于“1 + 2 + X”协同服务模式在腹腔镜胆囊切除术病人自我管理能力及照护者照护负担的应用效果。
      方法: 对112例接受腹腔镜胆囊切除术的病人进行前瞻性研究,采用区组随机分配法,将病人分为观察组与对照组,各56例。对照组实施常规模式护理,观察组实施“1 + 2 + X”协同服务模式护理,比较2组术后恢复、疼痛程度(VAS评分)、自我管理能力(SMBS评分)、健康行为能力(SRAHP评分)与心理状态(SDS评分、SAS评分)、术后并发症、照护者照护负担(ZBI评分)的差异。
      结果: 观察组首次肛门排气时间、首次下床时间、首次排便时间、停止输液时间、住院时间均低于对照组(P < 0.01)。术后6 h、术后24 h和术后3 d,观察组VAS评分均低于对照组(P < 0.05);2组术后24 h和术后3 d VAS评分均较术后6 h降低(P < 0.05),观察组术后3 d VAS评分低于术后24 h(P < 0.05)。2组出院时SMBS评分、SRAHP评分相较于干预前均升高,SDS评分、SAS评分均降低(P < 0.01),且观察组均优于对照组(P < 0.05)。观察组术后并发症总发生率低于对照组(P = 0.04)。2组干预前ZBI评分比较差异无统计学意义(P > 0.05),出院时和出院后7 d,观察组ZBI评分均低于对照组(P < 0.05);2组ZBI评分在各时间点依次降低(P < 0.01)。
      结论: “1 + 2 + X”协同服务模式应用于腹腔镜胆囊切除术围手术期可促进术后恢复,有效提高自我管理能力与健康行为能力,改善心理状态,缓解疼痛程度,降低术后并发症发生率,减轻照护者照护负担。

       

      Abstract:
      Objective To explore the application effects of the "1 + 2 + X" collaborative service mode on the self-management ability of patients undergoing laparoscopic cholecystectomy and care burden of caregivers.
      Methods A prospective study was conducted on 112 patients treated with laparoscopic cholecystectomy. The patients were divided into the observation group and control group by block random allocation, with 56 cases in each group. The control group received conventional mode nursing, while the observation group received "1 + 2 + X" collaborative service mode nursing. The differences in the postoperative recovery, pain degree (VAS score), self-management ability (SMBS score), health behavior ability (SRAHP score), psychological state (SDS score, SAS score), postoperative complications and caregiver care burden (ZBI score) between two groups were compared.
      Results The time of first anal exhaust, time of first getting out of bed, time of first defecation, time of stopping infusion and length of hospital stay in the observation group were all lower than those in the control group (P < 0.01). After 6 hours, 24 hours and 3 days of operation, the VAS scores of the observation group were all lower than those of the control group (P < 0.05). The VAS scores in two groups after 24 hours and 3 days of surgery were lower than those at 6 hours after surgery (P < 0.05), and the VAS score in the observation group at 3 days after surgery was lower than that at 24 hours after f surgery (P < 0.05). At discharge, the SMBS score and SRAHP score in two groups increased compared with those before the intervention, while the SDS score and SAS score decreased (P < 0.01), and which in the observation group was superior to that in control group (P < 0.05). The total incidence of postoperative complications in the observation group was lower than that in the control group (P = 0.04). There was no statistically significant difference in the ZBI score between two groups before the intervention (P > 0.05). At discharge and 7 days after discharge, the ZBI score in the observation group was lower than that in the control group (P < 0.05). The ZBI scores in two groups decreased successively at each time point (P < 0.01).
      Conclusions The application of the "1 + 2 + X" collaborative service mode in the perioperative period of laparoscopic cholecystectomy can promote the postoperative recovery, effectively improve self-management ability and health behavior ability, improve psychological state, relieve pain degree, reduce the incidence of postoperative complications, and alleviate the care burden of caregivers.

       

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