| Objective1. To analyze and discuss the high risk factors of postoperative abdominal infection,bile leakage, delayed gastric emptying, heamorrhage and pancreatic fistula in malignantobstructive jaundice patients after radical resection, and to establish the correspondingFisher’s discriminant analysis equations;2. To formulate the intervention plans of malignant obstructive jaundice patientsundergoing radical resection;3. To optimize the new edition about high risk factors’ scoring system ofcomplications in malignant obstructive jaundice patients after radical resection, and toverify its effects.Methods1. A retrospective analysis of406malignant obstructive jaundice patients after radicalresection from Jan.2009to Dec.2011was carried out. The clinical data about patients’general conditions, introperative conditions, postoperative conditions and laboratoryparameters, etc were collected. Statistical package of PASW Statistics (18.0) was used,containing T test, chi-square test, nonparametric test and logistic regression analysis, andthe Fisher’s discriminant analysis.2. Based on the clinical experience of postoperative treatment and nursing inmalignant obstructive jaundice patients after radical resection, combined with informationfrom literatures, a preliminary protocol was made which includes the routine interventionplan and the postoperative complications intervention plans (abdominal infection, bileleakage, delayed gastric emptying, heamorrhage and pancreatic fistula). Modification andthe final version formulation were done by Delphi experts consultation.3. Cooperating with a professional software company (Shanghai Runbai SoftwareCompany), we optimized the original scoring system by the research results. In the end, wefininshed the newest complications’ scoring system of malignant obstructive jaundicepatients after radical resection.Randomly selection of23malignant obstructive jaundice patients as the experimentalgroup,16patients as the control group from Jan.8th to Mar,30th.,2013. Patients in experimental group received test of the scoring system, and using the intervention plansaccording to the predicted results. Meanwile, patients in the control group recerived routineclinical care. At last, we compared their outcomes.A questionnaire on nurses’ feedback of using this scoring system was designed. Itcontains the feelings of using this system, the advantages and disadvantages of the system,whether they want to use it in the future, etc. Percentage for statistical description wasused.Results1. We studied406malignant obstructive jaundice patients after radical resection.through the retrospective analysis, we got as follows:(1)The abdominal infection morbidity of patients in this research is13.3%. The highrisk factors are preoperative biliary dranaige,(OR=2.261,95%CI:1.230,4.159); operationtime of more than5hours,(OR=2.191,95%CI:1.176,4.082); obvious variation ofperiopeative PAB value,(OR=2.202,95%CI:1.184,4.095).(2)The bile leakage morbidity of patients in this research is11.1%. The high riskfactors are obvious variation of perioperaitve WBC value,(OR=3.428,95%CI:1.624,7.236); obvious variation of perioperative TBL value,(OR=2.991,95%CI:1.422,6.291).(3)The delayed gastric empyting morbidity of patients in this research is8.9%. Thehigh risk factors are history of diabetes mellitus,(OR=11.903,95%CI:5.511,25.710);②Pancreaticoduodenectomy,(OR=2.236,95%CI:1.022,4.892); massive amouts ofintroperative blood loss,(OR=2.922,95%CI:1.297,6.584).(4)The heamorrhage morbidity of patients in this research is15.5%. The high riskfactors are pancreaticoduodenectomy(OR=6.228,95%CI:2.107,18.406); obvious variationof perioperative Hgb value(OR=2.531,95%CI:1.339,4.782); obvious variation ofperioperative PLT value(OR=2.155,95%CI:1.138,4.083); obvious variation ofperioperative PAB value (OR=3.223,95%CI:1.695,6.127).(5)As pancreatic fistula happened after pancreaticoduodenectomy, thus in thisresearch morbidity of pancreatic fistula in112pancreaticoduodenectomy patients is35.71%. The high risk factors are age(OR=2.998,95%CI:1.161,7.744); introperativeblood transfusion,(OR=3.113,95%CI:1.059,9.146); pancreatic fistula(OR=5.599,95%CI:1.975,15.872)。 (6)The Fisher’s discriminant analysis equations were also established.2. The routine intervention plans for malignant obstructive jaundice patients afterradical resection was formulated which mainly contains treatment, observation and nursingmeasurements on the surgery day,1pod,2-3pod,4-6pod and discharg day. And theintervention plans of the five common complications contain examination items,observation contents and intervention measurements.3. The new scoring system of high risk factors has good authenticity and reliabitlityfor detecting abdominal infection, bile leakage, delayed gastric emptying, heamorrhageand pancreatic fisluta. The values of sensitivity are81.5%,68.9%,72.2%,85.7%,92.0%,respectively; values of specificity are96.3%,97.5%,96.8%,93.6%,95.8%, respectively andvalues of diagonostic accuracy are0.778,0.664,0.690,0.793,0.878, respectively.Conclusions1. We found that high risk factors of abdominal infection are preoperative biliarydrainage, prolonged operaion time and obvious variation of perioperative PAB value; highrisk factors of bile leakage are obvious variation of perioperative WBC and TBL value;high risk factors of delayed gastric emptying are history of diabetes mellitus,pancreaticoduodenectomy and massive amounts of intraoperative blood loss; high riskfactors of heamorrhage are pancreaticoduodenectomy, obvious variation of perioperativeHgb, PLT, PAB values; high risk factors of pancreatic fistula of malignant obstructivejaundice patients after radical resection are age, introperative blood tansfusion andpancreas texture;With these factors and equations, the possibility of complications can becanculated by the computer quickly and efficiently.2. The intervention plans are the summary of clinical treatment and care in reality,which can provide instruction for the nurses.3. The newly completed scoring system improved the function, supplied a much moreoverall judgment of high risk patients to predict complications, and provided treat andnurse measurements with the intervention plans by the software automaticlly.4. The application results showed that hospitalization days and complicationmorbidity in the experimental group were less than those in the control group, P<0.05.5. Based on26clinical nurses’ feedback, they thought the scoring system isconvenient and useful. It can help the nurses know what to do when the software revealsthat this patient has a high risk of complication. |
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