Study On Effects Of The Application Of Clinical Nursing Pathway On AMI Patients During Peri-operative Period Of Interventional Therapy

Introduction Percutaneous transluminal coronary angioplasty is one of effective therapies for coronary heart disease,has been an important method of reperfusion of acute myocardial infarction and has saved many dying patients with its characteristics of little trauma and obvious therapeutic effects. The nursing around intervention period directly influences the effect of this operation and is the key point of decreasing the complications and elevating achievement ratio.Clinical pathway is a kind of optimized,simplified and synergetic management. As a standard diagnose and treat nursing model, it can powerfully restrain the increase of medical cost, effectively promote the elevation of medical treatment and nursing . The application of clinical pathway gets more and more solicitudes, but it's development and clinical application have not ripened in our country. Exploring the clinical pathway that accords with the national conditions of our country,will have a very prealistic and important meaning for raising medical quality and reduction medical cost , shorten the days in hospital, promoting reasonable use of medical resource and raising that the competition ability of hospital.In 2005,we began to establish and implemented preliminarily the clinical nursing pathway method ,according to domestic and international clinical pathway and combining the actual condition of my hospital . We had established the clinical nursing pathway method of intervention treatment of AMI patient surrounds operation.Objective In this program,we carried out peri-operation clinical nursing pathway pattern for acute myocardial infarction patients with interventional treatment. Through observing the time in hospital and in bed,complications,satisfactory degree and comfortable degree of patient , so the quality of nursing is evaluated,which offers basis and method to raise medical service quality further.Methods The Study collected 80 regular AMI patients of our hospital from January 2,005 to January 2,008, all the patients were treated with PTCA+Stent placement. Interventional channel adopted the puncture of arteria femoralis. Refering to clinical pathway table of oronary artery intervention doctor edition from the affiliated hospital of Ji Ning college,having looked up plenty of information, and consulting experts and the doctors who has rich clinical experience and nurse, combining my courtyard actual condition ,we established " the clinical nursing pathway table of acute myocardial infarction patients during the peri-operation period of intervention treatment ".and nursed these patients, analysed the studying results using SPSS15 .0 software packages to make statistics. According to whether nursing the clinical nursing pathway, they divided into control group ( conventional nursing group ) and experiment group ( clinical pathway group ), make statistics to observe two groups of patient sex, age, coronary embolism quantity and position whether difference , before comparing two groups of patient healthy educational effect and skill, nurse the 3 complication occurence rates of around patient psychological problem change, satisfactory degree and acute myocardial infarction,intervene the occurence rate of complication after treats skill,lie in bed and is in hospital time length as well as hospitalization expenses use.Results We did not see statistics discrepancy in the aspects of sex and age(P >0.05),and coronary embolism quantity and embolism position had comparability(P >0.05); Test group patient stabilized moods, grasped related knowledge and obeyed medical behavior, the ratio was higher than control group obviously , there was statistics meaning(P<0.05); After nursing, the ratios of t patient to worry about operation in occur danger,worry about after-effect and worry about again narrow in test group obviously lower(P<0.05) , two groups of comparison having statistics meaning; After psychology was intervened,SAS and SDS of test group were obviously below, having statistics meaning(P<0.05); Patient for skill before education appraisement,nurse technical appraisement , nurse service attitude appraisement , nurse communication ability appraisement and condition progress understanding and skill rear healthy education and skill rear coordination and process introduction as well as leave hospital education knowledge aspect have the obvious positive correlation with groups, that was,test the satisfactory level of group patient to be higher than control group(P<0.05或P<0.01); The occurence rate with abnormal rhythm of the heart in experiment group was obviously lower than control group(P<0.05), and occurence rates of heart failure and heart source shock also droped,but without statistics meaning.(P>0.05);Experiment group patient occured waist sour backache,constipation and insommia, obviously lower, and the occurence rates oflocal bleed,retention of urine and abdominal distension and vomit also lower, but without statistics meaning;The time of test group patient lying in bed was obviously shorter than control group(P<0.01), and the time in hospital also obvious decreasing(P<0.05); When comparing hospitalization expenses,the total hospitalization expenses of test group was not less than control group(P<0.01), but also cost of per day than control group(P<0.01)。Conclusion1.Implementing the clinical nursing pathway to AMI patients during peri-operative period of PTCA has realized medical nursing campaign melt with standardization,The working way that this program melts and standardizes,have trained consciousness and the initiative of nurse work , nursing work does not be blindly conducted doctor's advice again,is passive to observe condition, and is in a planned way,have foresight nurse and healthy education.2.Implementing the clinical nursing pathway to AMI patients during peri-operative period of PTCA have transfered the subjective activity of patient fully. Refering to Table 4,self nursing level and the psychological condition of patient,grasp disease related knowledge , obey medical behavior etc. have obvious raising. 3.Implementing the clinical nursing pathway to AMI patients during peri-operative period of PTCA promote nursing quality raising, make bed time shorten, complications decrease. Data shows that experiment group patient is in hospital for day to count , lie in bed the occurence rate of time and complication with compare group compare have obvious decreasing, have raised nursing quality.4.Implementing the clinical nursing pathway to AMI patients during peri-operative period of PTCA Have alleviated the burden of patient greatly, time has shortened to be in hospital, have reduced hospitalization expenses to use , have received good social benifit. Study experiment group to be in hospital time is 7.35±4.76 days , compare group obviously below is in hospital time 8.70±5.15 , test group patient not only total hosp -italization expenses use lose obviously in compare group, and is in hospital for duration day cost also lose obviously in compare group. Further statistical result shows that the total hospitalization expenses of two groups of patient is to organize patient expenses for medicine because of testing mainly with difference and disposal cost lose obviously in compare group, but do not see obvious discrepancy in the aspect of two groups inspects consuming and other cost.5.Implementing the clinical nursing pathway to AMI patients during peri-operative period of PTCA have raised healthy educational effect and service satisfactory degree, as table shows, test the complication of group patient and bad reaction decreases obviously, patient comfortable degree and satisfactory degree increase obviously,have satisfied the healthy demand of patient.