| Objective: The purpose of this study was to investigate the needs of preoperative visit in patients with laparoscopic cholecystectomy;in order to determine and improve the content and flow of preoperative visits on We Chat platform;to explore the effect of interactive preoperative visits based on We Chat platform on the acquisition of surgical information,the degree of preoperative preparation,the sleep of the night before surgery and the anxiety of patients undergoing laparoscopic cholecystectomy;investigated the patient's satisfaction with the form of the visit,with the purpose of providing a reference for the promotion and application if new forms of preoperative visits led by network structure.Method: This study is quasi-experiment study.Through the literature review method,we investigated the research status of pre-operative visit work mode at home and abroad,which provided theoretical support for this research.The study used a purposive sampling method,from February to November 2018,50 patients with laparoscopic cholecystectomy who met the inclusion criteria were selected from the areas of the research unit(Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine)that is the hepatobiliary surgery and the general surgery.The respondents of the general surgery were selected as the control group by drawing lots.The respondents of the hepatobiliary surgery were selected as the experimental group by drawing lots.The respondents of the control group were treated with the routine preoperative visit method.The respondents of experimental group were treated with the “interactive preoperative interview based on We Chat platform” on the basis of routine preoperative visit.The anxiety scores of patients with laparoscopic cholecystectomy were evaluated by State Anxiety Scale(S-AI)at the time of three points :before the preoperative interview,after the preoperative visit,and during the waiting period of the operating room.Mean Arterial Pressure(MAP)was a cardiac cycle.The mean value of arterial blood pressure is calculated as(MAP=diastolic pressure+1/3 pulse pressure difference,or MAP=(systolic blood pressure+2*diastolic blood pressure)/3).The patient's mean arterial pressure(MAP)and heart rate(HR)were recorded at these 3 time-points,and comparison of heart rate and mean arterial pressure between the two groups.The roving nurse evaluates the perfection of the preoperative preparation work of the patient on the morning of the surgery according to the Preoperative Preparation Perfection Evaluation Form;The satisfaction questionnaire was used to investigate the satisfaction scores of patients on the second day after operation.The statistical software Epi Data3.1 was used to build the database of this study.The data was entered using the double entry method.And then the software SPSS19.0 was used to statistically analyze the survey data.Result: 1.Results of survey on the status of preoperative visit information in patients undergoing laparoscopic cholecystectomy.In this study,a total of 100 questionnaires for visiting information needs were distributed and 98 questionnaires were returned.The recovery rate was 98%.After deleting the invalid questionnaires,93 valid questionnaire were obtained,the effective rate was 94.89%,and the effective recovery rate was 93%.The questionnaires in the questionnaire for laparoscopic cholecystectomy patients with high proportion of visits were: 1)visit time: 88.17%(82)patients selected 1d before surgery;2)visit form: 90.32%(84)Patients choose oral presentation/visiting manual/visit card/micro video combination;3)visit duration: 75.27%(70)patients can choose to speak clearly,<1h;4)95.6%(89)patients choose Through We Chat to strengthen pre-operative communication with the operating room staff;5)visit content: 92.47%(86)patients need to understand all the content,the more detailed the better,the disease-related content(especially the prognosis of the disease),The relevant content of the operating room environment(operating room temperature),the relevant content of the surgical procedure and the related contents of the possible discomfort are 66.67%(62),69.89%(65),80.65%(75),75.27%(70).2.We Chat platform interactive preoperative visit clinical application results(1)50 case of the patient undergoing laparoscopic cholecystectomy in the control group and 50 cases of the experimental group participated in this study.There were no significant differences in baseline data and anxiety scores,heart rate and mean arterial pressure before laparoscopic cholecystectomy of patients in the two groups(P>0.05).(2)Comparison of surgical knowledge in the two groups: The score of surgery-related knowledge in the experimental group was(52.70±2.83),which was significantly higher than that in the control group(37.72±2.91),and the difference was statistically significant(P<0.01).(3)Comparison of sleep time of the two groups before surgery:6.00h(6.00,7.00)in the control group and 7.00h(7.00,8.00)in the experimental group,the difference was statistically significant,(P<0.01).(4)Completed ratio of preoperative preparation of the experimental group was94%,the control group was70%(x~2=9.756,P=0.002).The higher frequency occurrence of uncompleted items of preoperative preparation were“position traning”,“remove underwear”,“defecation”.(5)The mean arterial pressure of the experimental group patients before preoperative visit,after preoperative visit and during the waiting period in the operating room was 93.22±10.14mmHg,86.89±8.89mmHg,105.56±12.32mmHg,The heart rate was 82.28±12.21beats/min,75.98±11.53beats/min,95.88±15.96beats/min respectively;The mean arterial pressure of the control group patients before preoperative visit,after preoperative visit and during the waiting was93.17±9.78mmHg,92.17±9.69mmHg,119.03±18.25mmHg;The heart rate was84.98±11.24beats/min,83.30±10.95beats/min,104.52±10.04beats/minrespectively.The mean arterial pressure and heart rate of the two groups at three time points were analyzed by repeated measures analysis of variance:the effects of interaction,time effect and intergroup effect were statistically significant(P<0.01).Multivariate analysis of variance showed there was no significant difference between the two groups in the mean arterial pressure and the heart rate(P>0.05)before preoperative visit.The mean arterial pressure and the heart rate in the experimental group were lower than those in the control group(P<0.01)at the time of after preoperative visit and during the waiting period in the operation room.Single factor-repeated measures showed the mean arterial pressure and heart rate of the patients in the two groups were statistically significant at three time points(P<0.01).(6)The anxiety scores of the experimental group patients before the preoperative visit,after the preoperative visit and during the waiting period in the operating room were respectively 44.88±3.03points,39.76±2.18points,49.68±3.39points;the anxiety scores of the control group patients before the preoperative visit,after the visit and during the waiting period of the operating room was45.42±3.10points,43.40±3.23points,56.12±4.65points respectively.The results of repetitive measure analysis of variance showed that the interaction,time effect and inter-group effect of the anxiety scores of patients from the two groups in the three time points was statistically significant(P<0.01);Multivariate analysis of variance showed that there was no significant difference between the two groups before laparoscopic cholecystectomy(P>0.05).The anxiety scores of the patients in the experimental group were lower than those in the control group(P<0.01)at the time of after visiting and waiting in the operating room.Single factor-repeated measures showed:The change of anxiety score of the two groups at 3 time points was statistically significant(P<0.01).(7)The patients satisfaction scores in the experimental group was significantly higher than those in the control group[(19.84±0.55)points vs(17.56±1.73)points],the difference was statistically significant(P<0.01).Conclusion:1.Interactive preoperative visit based on WeChat platform can improve the mastery of preoperative knowledge and the sleep duration of one night before laparoscopic cholecystectomy;2.Interactive preoperative visits based on WeChat platform can significantly reduce the anxiety level of patients undergoing laparoscopic cholecystectomy after preoperative visit and waiting in the operating room;3.Interactive preoperative visit based on WeChat platform can reduce the blood pressure and heart rate of patients undergoing laparoscopic cholecystectomy after preoperative visit and waiting in the operating room to improve the safety of operation and anesthesia process;4.Interactive preoperative visit based on WeChat platform can improve the perfection of preoperative preparation for patients undergoing laparoscopic cholecystectomy,shorten the overall use time of surgery;5.Interactive preoperative visit based on WeChat platform can obviously improve the satisfaction degree of patients. |
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