| Objective:(1)To construct a precise blood glucose management mode based on Omaha system for patients after pancreatic resection.(2)The Omaha system based precise blood glucose management mode was applied to patients after pancreatectomy to evaluate the application effect of the mode.Methods:(1)Using the convenient sampling method,the medical records of patients diagnosed with pancreatic cancer and undergoing pancreatectomy were selected.The medical records were from the Department of Hepatobiliary Surgery of a grade A tertiary hospital in Wuxi City from October 2020 to November 2021.And the sensitive indicators related to postoperative blood glucose in the medical records were sorted out.The relevant problems of blood glucose management in literature were summarized by literature review.In order to literature review,we searched the literature included in VIP Database for Chinese Technical Periodicals,China National Knowledge Internet,Wanfang Data Knowledge Service Platform,PubMed and Web of Science.Semi-structured interview was used to interview senior hepatobiliary surgeons,nursing experts,related patients and their families.Then the collected data were compared with each index of Omaha problem classification system to sort out the postoperative blood glucose sensitive index record table.The idea of precision nursing was introduced to develop a preliminary accurate blood glucose management mode for patients after pancreatic resection based on Omaha system.The blood glucose sensitive index record table and blood glucose management mode were optimized by Delphi expert letter consultation method.Finally,a precise blood glucose management model based on the Omaha system(final draft)was formed.(2)According to the inclusion and exclusion criteria,64 patients in the Department of hepatobiliary surgery of a grade A tertiary hospital in Wuxi were selected as the research objects.The research objects were divided into the control group and the intervention group,with 32 patients in each group.The control group was given the current routine blood glucose management,and the intervention group was given the Omaha system-based precision blood glucose management mode(final draft).The differences of postoperative complication ratio,blood glucose level,postoperative anal exhaust time and postoperative hospital stay between the two groups were observed and compared.After that,the application effect of precise blood glucose management model(final draft)was clarified.Results:(1)After reviewing the medical records,31 sensitive indexes related to postoperative blood glucose were collected.Literature review and screening of 15 references.The semi-structured interview sorted out 16 blood glucose management questions.We then compared the collected blood glucose sensitivity indicators with the Omaha Problem Classification System indicators.Among the results,48.39% were completely consistent,32.26% were partially consistent,and19.35% were inconsistent.The incongruent indicators were classified into the first-level indicators of the Omaha system after group discussion.After the data were integrated,a record table of blood glucose sensitivity indexes after pancreatic resection was formed,including 4primary indexes,38 secondary indexes and 139 tertiary indexes.Based on the data,a preliminary blood glucose management mode was developed and an expert consultation was conducted.A total of 19 experts were consulted.The results of the second round of consultation were consistent,and the consultation was concluded.The recovery rate of the first round was100%,and that of the second round was 84.21%.The expert authority coefficient Cr of the first round was about 0.80,and the expert authority coefficient Cr of the second round was 0.82.The coefficient of variation of the first and second rounds of correspondence with experts was less than 0.25,and the Kendall harmony coefficient fluctuated around 0.5.The final draft of the accurate blood glucose management mode was formed by integrating the feedback from the letter,which included three parts: the establishment of the management team,the management plan and the evaluation index of the management effect.(2)Precision blood glucose management mode(final draft)was applied in the patients after pancreatic resection.Before intervention,general data of the two groups were collected,and there was no statistical difference between the two groups(P > 0.05).Post intervention,postoperative complications of the two groups were observed.Incision infection and chest infection occurred in 12 and 9 patients in the intervention group,and 25 and 18 patients in the control group,respectively.The proportion of patients with incision infection(40.00%)and chest infection(30.00%)in the intervention group was lower than that in the control group(83.33%)and chest infection(60.00%),respectively(P < 0.05).The occurrence of hyperglycemia and hypoglycemia in the two groups was observed.6 patients in the intervention group and 14 patients in the control group had abnormal hyperglycemia.The proportion of patients in the intervention group with abnormal hyperglycemia(20.00%)was lower than that in the control group(46.67%)(P < 0.05).7 patients in the intervention group and 6 patients in the control group had hypoglycemia.The proportion of patients with hypoglycemia in the intervention group(23.33%)was not significantly different from that in the control group(20.00%)(P > 0.05).The overall blood glucose levels of the two groups were observed after surgery.The average blood glucose levels of the intervention group on day 2,day 3 and day 5were(7.754±3.145)mmol/L,(8.723±2.346)mmol/L and(9.985±1.610)mmol/L,respectively.The average blood glucose level of the control group was(11.530±4.855)mmol/L,(11.015±8.723)mmol/L and(12.946±2.518)mmol/L,respectively.The blood glucose level of the two groups was compared at each measuring point,and the blood glucose level of the intervention group was lower than that of the control group(P < 0.05).The postoperative clinical indexes of the two groups were observed.The postoperative anal exhaust time of the intervention group was(2.70±0.83)d,which was lower than that of the control group(4.00±1.53)d,the difference was statistically significant(P < 0.05).The postoperative hospital stay in the intervention group was(21.00±10.19)d,which was lower than(41.00±21.91)d in the control group(P < 0.05).Conclusion:(1)The Omaha system was in good agreement with the sensitive indexes of blood glucose management after pancreatectomy.Medical history review,literature review,semi-structured interview and Delphi letter inquiry method ensure the scientific nature of the blood glucose management mode constructed.Combined with precision nursing,a comprehensive,accurate and feasible blood glucose management mode can be built.(2)The precise blood glucose management mode built based on the Omaha system can reduce the incision infection and abdominal infection of patients after pancreatic resection,effectively improve the blood glucose level of patients,and promote the recovery of gastrointestinal function and early rehabilitation of patients. |
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