基于奥马哈系统的个案管理在肝硬化合并消化道出血患者中的应用  

Application of nursing case management mode framed by Omaha system in patients with hepatocirrhosis complicated with gastrointestinal bleeding

作　　者：陶震华[1] 汤红[1] 张露洁[1] 许芳[1] Tao Zhenhua Tang Hong Zhang Lujie Xu Fang(Department of Gastroenterology, Second People＇s Hospital of Wuxi City, Wuxi 214002, China)

机构地区：[1]江苏省无锡市第二人民医院消化内科,214002

出　　处：《中华现代护理杂志》2017年第10期1372-1376,共5页Chinese Journal of Modern Nursing

摘　　要：目的 探讨奥马哈系统在肝硬化合并消化道出血患者个案管理中的应用效果,为临床护理提供依据.方法 选取2014年7月—2016年7月笔者所在医院消化内科收治的肝硬化合并消化道出血患者72例.采用随机数字表法分为观察组和对照组,各36例.对照组采用常规个案管理模式,观察组采用以奥马哈系统为框架的个案管理模式.比较干预前后观察组患者护理问题得分情况,并且比较干预后两组患者生存质量、住院时间、住院费用及出院3月内再就诊次数.结果 观察组患者住院期间存在的护理问题主要分布于环境、社会心理、生理及健康相关行为领域.干预后观察组患者各项护理问题得分高于干预前,差异有统计学意义（t值分别为12.470、10.720、17.520、7.600、7.549、12.146、16.857、5.607、14.683、7.085、11.667、11.024、12.723;P〈0.05）.干预后,观察组患者日常生活能力（19.18±5.67）分、社会活动状况（13.96±3.89）分、抑郁心理症状（11.69±3.97）分、 焦虑心理症状（9.34±2.88）分及生存质量总分（54.17±5.45）分,均低于对照组患者日常生活能力（27.21±3.84）分、社会活动状况（18.53±3.58）分、抑郁心理症状（17.64±2.75）分、焦虑心理症状（15.72±2.93）分及生存质量总分（79.10±8.63）分,差异有统计学意义（t值分别为7.036、5.187、7.392、9.317、14.654;P〈0.05）.干预后,观察组患者住院时间（8.7±3.9）d、住院费用（5419.5±2539.2）元及再就诊次数（0.4±0.2）次,均低于对照组住院时间（10.8±3.4）d、住院费用（7312.4±4280.1）元及再就诊次数（0.7±0.3）次,差异有统计学意义（t值分别为2.435、2.282、4.992;P〈0.05）.结论 应用以奥马哈系统为框架的个案管理护理模式能有效提高患者生存质量,降低患者住院时间、住院费用及再入院率.Objective To explore the application of nursing case management mode framed by Omaha system in patients with hepatocirrhosis complicated with gastrointestinal bleeding, so as to provide evidence-based basis for clinical nursing.Methods A total of 72 hepatocirrhosis complicated with gastrointestinal bleeding patients were collected from July 2014 to July 2016 in our hospital. All the patients were randomized divided into observation group （36 cases） and experimental group （36 cases）. The patients of observation group were given case management mode framed by Omaha system, while the patients of control group were given conventional case management model. Analysis and evaluation of scores were implemented before and after the nursing intervention in observation group. The quality of life, hospitalization days and number of hospitalizations after discharge were compared between two groups.Results The nursing problems of observation group during hospitalization were mainly distributed in the environment, social psychology, physiology and health related behaviors. After nursing intervention, there were significant differences in all nursing outcomes for nursing problems （t=12.470,10.720,17.520,7.600,7.549,12.146, 16.857,5.607,14.683,7.085,11.66,11.024,12.723;P〈0.05） . After intervention in observation group, the activity of daily living was （19.18±5.67）, social activity （13.96±3.89）, depression symptom （11.69±3.97）, anxiety symptom （9.34±2.88）, and survival quality （54.17±5.45）, which were less than （27.21±3.84）,（18.53±3.58）,（17.64±2.75）,（15.72±2.93）,（79.10±8.63） （t=7.036,5.187,7.392,9.317, 14.654;P〈0.05）. After intervention, the length of hospitalization was （8.7±3.9）d, the cost （5419.5± 2539.2）Yuan and the revisit times （0.4±0.2）, which were less than （10.8±3.4）d, （7312.4±4280.1）Yuan and （0.7±0.3） of control group （t=2.435,2.282,4.992;P〈0.05）.Conclusions Compared with conventional methods, the case management fra

关 键 词：肝硬化 奥马哈系统 个案管理 消化道出血 

分 类 号：R473.5[医药卫生—护理学]