A Study On The High Risk Factors' Score System And Preventive Nursing Project Of Common Complications About Malignant Obstructive Jaundice Patients In The Perioperative Period

The complications rate of operation in malignant obstructive jaundice patients is very high in the perioperative period. Hemorrhage, pancreatic fistula and renal insuficiency are three most common complications, which can result in perioperative death, prolonged length of stay and increased cost of hospitalization. Preventive nursing measures during perioperative can decrease post-operation hospital days, reduce hospitalization cost, and decrease incidence and death rate. Through early study, we have got hemorrhage and renal insuficiency's high risk factors of malignant obstructive jaundice patients during their perioperative period, but we haven't got the high risk factors of pancreatic fistula. Otherwise, there are few studies on how to scan complications high risk patients quickly and accurately, how to enact and practice preventive nursing intervention for malignant obstructive jaundice patients. The study including three parts, which are high risk factors for the pancreatic fistula's studies during perioperative period, invention and application high risk factors'score system to predict complications, and enact and assess the effectiveness of perioperative preventive nursing interventions.Objective and Methods1. The data was collected from 300 patients, which including clinical data, laboratory results, and complications during and after operation. The data were analyzed by SPSS10.0, and the methods of Logistic regression analysis and Fisher's discriminate analysis were used to investigate the high risk factors of the pancreatic fistula post-operation, and to recognize the regularity of pancreatic fistula. We specifically paid much attention on observation and nursing to cut down the rate of pancreatic fistula.2. Together with ZI-Jinqiao software company, grouping and typesetting common complications(hemorrhage, pancreatic fistula and renal insuficiency)high risk factors and Fisher's discriminate analysis edit in soft ware, to invention and application of high risk factors'score system predicting complications in malignant obstructive jaundice patients, and detect the soft ware's by sensitivity, specificity, percent agreement and calculate time, to judge if it's reliability, utility, convenience.3. With the help of clinical nurse specialists, we enact preventive nursing project of common complication about malignant obstructive jaundice patients. Experimental group choose 64 malignant obstructive jaundice patients perioperative clinical datas between Jun. and Nov. 2008, which give preventive nursing project to high risk patients getting from the soft ware, control group retrospective analysis 62 malignant obstructive jaundice patients perioperative clinical datas between Jan. and May. 2008, to assess the affect and effect of the preventive nursing project of common.Results1. There were 37 patients(12.3%)with pancreatic fistula after operation. According to stepwise regression analysis, the high risk factors for the pancreatic fistula after panreatoduodenectomy of malignant obstructive jaundice patients includes gender(male), the experience of ERCP/PTCD examination or treatment, a history of heart disease, the type of operation (extented pancreatoduodenectomy), pathodifferentiation(low), variation rates of Blood Urea Nitrogen(high). With the estimation of Fisher's discriminate analysis, we could get three discriminate functions.2. We got high risk factors'score system predicting complications in malignant obstructive jaundice patients. The software's sensitivity of hemorrhage, pancreatic fistula and renal inadequacy is 85.7%, 88.89% and 100% separately, specificity is 94.7%, 96.36%, and 96.61% separately, percent agreement is 93.55%, 95.2% and 96.77%, per patient's calculate time decurtated 426.92s.3. We analyzed the data of experimental group with the score system, getting the hemorrhage, pancreatic fistula and renal insuficiency high risk patients 9, 10 and 7. There were significant difference in statistical treatment(P<0.05)between experimental group and control group at the postoperative hospital length, monitoring time, postoperative cost. Postoperative complications incidence decreased, hospitalize patients satisfaction rate increased.Conclusion1. Avoid ERCP/PTCD examination or therapy if it is not necessary. Control heart disease. We should pay special attention to details during the operation and give continuous close observation for the patients in the postoperative period so as to practice extented pancreatoduodenectomy, pathodifferentiatio(nlow), variation rates of Blood Urea Nitrogen(high). According to Fisher's discriminate analysis, we can predict the risk of pancreatic fistula after operation. Together with the studies, we also find a scientific and utility method to predict the complication during and after operation.2. The soft ware can be used for a quick and convenience screen of patients with high risks of perioperative complication, predicting patients'perioperative condition.3. The preventive nursing project can reduce postoperative hospital length and monitoring time, reduce postoperative cost and postoperative complications incidence, and enhance the satisfaction rate of hospitalized patients.