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[摘要] 目的 观察精细化和全面护理的实施效果，分析该护理模式在改善消化道出血患者临床症状中的价值。 方法 选取2018年1月至2019年1月于本院收治的消化道出血患者140例，采用随机数字表法将患者分为常规组与观察组，每组各70例。常规组予以常规护理，观察组予以精细化和全面护理。比较两组生活质量改善状况、随访1个月、6个月、12个月的再出血率及依从性。 结果 护理后观察组生活质量评分及依从性明显高于常规组，差异有统计学意义（P=0.001）。观察组随访1年的再出血率明显低于常规组，差异有统计学意义（P=0.022）。 结论 在消化道出血患者的护理过程中，采取精细化和全面护理干预能够提高患者对疾病的重视度和自护能力，使其受到全方面的精细护理，生活质量改善显著。该护理模式对改善临床症状具有一定价值，值得大力推广。
[关键词] 精细化护理;全面护理;消化道出血;临床症状;再出血;生活质量
[Abstract] Objective To observe the implementation effect of meticulous and comprehensive nursing， and analyze the value of this nursing model in improving the clinical symptoms of patients with gastrointestinal hemorrhage. Methods A total of 140 patients with gastrointestinal hemorrhage admitted to this hospital from January 2018 to January 2019 were selected and divided into the conventional group（70 cases， receiving conventional care） and the observation group （70 cases， receiving meticulous and comprehensive nursing） by random number table method. The improvement of the quality of life， the rebleeding rate at one month， six months， 12 months follow-up， and compliance between groups were compared. Results The quality of life score and compliance in the observation group after nursing were higher than those in the routine group， and the difference were statistically significant （P=0.001） . In terms of clinical symptoms， the 1-year follow-up rebleeding rate in the observation group was significantly lower than that in the conventional group， and the difference was statistically significant（P=0.022）. Conclusion In the nursing process of patients with gastrointestinal hemorrhage， meticulous and comprehensive nursing intervention can improve the patient’s attention to the disease and self-care. The patient receives intensive care from all aspects， and the quality of life improves significantly. It can be seen that this nursing model has a specific value in improving clinical symptoms and is worth promoting vigorously.
[Key words] Meticulous nursing; Comprehensive care; Gastrointestinal hemorrhage; Clinical symptoms; Rebleeding; Quality of life
消化道出血分為上消化道出血和下消化道出血两种，其中上消化道出血患病率更高。消化道出血是由消化道炎症、机械性损伤、肿瘤、结肠疾病感染、溃疡等原因引起的[1]。由于出血部位、出血量以及出血速度上存在差异，患者临床表现各有不同。在临床上消化道出血引起的休克较为常见，病情凶险，死亡率高。一旦出血量超过1000 mL或循环血量的20%，就会出现循环衰竭[2]。消化道出血发生突然，出血量大时血液持续喷射，易窒息，其生命随时受到威胁，及时予以规范性治疗是关键。但由于部分患者存在焦虑抑郁情绪，也有患者对疾病的认知较低，亦或是被抢救成功后放松警惕防范意识不足，因此在疾病治疗过程中存在护理风险。常规护理在消化道出血的护理中较为常见，但常规护理围绕患者生命安全进行，对患者的主观意识干预力度较弱[3]，该护理模式并不面面俱到且难以实现护理的精细化。本研究通过观察精细化和全面护理的实施效果，分析该护理模式在改善消化道出血患者临床症状中的价值，现报道如下。 1 资料与方法
1.1 一般资料
选取2018年1月至2019年1月于本院收治的消化道出血患者140例，采用随机数字表法将患者分为常规组与观察组，每组各70例。常规组予以常规护理，观察组予以精细化和全面护理。其中常规组男42例，女28例，年龄21～79岁，病程1～4年;观察组男45例，女25例，年龄23～76岁，病程1～3年。两组患者一般资料比较，差异均无统计学意义（P>0.05），具有可比性。见表1。本研究经我院医学伦理委员会审理和批准。
纳入标准：①所有患者均符合《消化道出血的鉴别诊断与治疗（精）》[4]中相关诊断标准;②所有患者均签署知情同意书;③所有患者意识良好，不存在精神疾病，能够沟通，表达能力良好。
排除标准：①存在心、肝、肾等重要器官功能性障碍疾病[5]者;②中途退出研究者;③病历资料缺失、不完整者。
1.2 方法
1.2.1常规组护理方案
[关键词] 精细化护理;全面护理;消化道出血;临床症状;再出血;生活质量
[Abstract] Objective To observe the implementation effect of meticulous and comprehensive nursing， and analyze the value of this nursing model in improving the clinical symptoms of patients with gastrointestinal hemorrhage. Methods A total of 140 patients with gastrointestinal hemorrhage admitted to this hospital from January 2018 to January 2019 were selected and divided into the conventional group（70 cases， receiving conventional care） and the observation group （70 cases， receiving meticulous and comprehensive nursing） by random number table method. The improvement of the quality of life， the rebleeding rate at one month， six months， 12 months follow-up， and compliance between groups were compared. Results The quality of life score and compliance in the observation group after nursing were higher than those in the routine group， and the difference were statistically significant （P=0.001） . In terms of clinical symptoms， the 1-year follow-up rebleeding rate in the observation group was significantly lower than that in the conventional group， and the difference was statistically significant（P=0.022）. Conclusion In the nursing process of patients with gastrointestinal hemorrhage， meticulous and comprehensive nursing intervention can improve the patient’s attention to the disease and self-care. The patient receives intensive care from all aspects， and the quality of life improves significantly. It can be seen that this nursing model has a specific value in improving clinical symptoms and is worth promoting vigorously.
[Key words] Meticulous nursing; Comprehensive care; Gastrointestinal hemorrhage; Clinical symptoms; Rebleeding; Quality of life
消化道出血分為上消化道出血和下消化道出血两种，其中上消化道出血患病率更高。消化道出血是由消化道炎症、机械性损伤、肿瘤、结肠疾病感染、溃疡等原因引起的[1]。由于出血部位、出血量以及出血速度上存在差异，患者临床表现各有不同。在临床上消化道出血引起的休克较为常见，病情凶险，死亡率高。一旦出血量超过1000 mL或循环血量的20%，就会出现循环衰竭[2]。消化道出血发生突然，出血量大时血液持续喷射，易窒息，其生命随时受到威胁，及时予以规范性治疗是关键。但由于部分患者存在焦虑抑郁情绪，也有患者对疾病的认知较低，亦或是被抢救成功后放松警惕防范意识不足，因此在疾病治疗过程中存在护理风险。常规护理在消化道出血的护理中较为常见，但常规护理围绕患者生命安全进行，对患者的主观意识干预力度较弱[3]，该护理模式并不面面俱到且难以实现护理的精细化。本研究通过观察精细化和全面护理的实施效果，分析该护理模式在改善消化道出血患者临床症状中的价值，现报道如下。 1 资料与方法
1.1 一般资料
选取2018年1月至2019年1月于本院收治的消化道出血患者140例，采用随机数字表法将患者分为常规组与观察组，每组各70例。常规组予以常规护理，观察组予以精细化和全面护理。其中常规组男42例，女28例，年龄21～79岁，病程1～4年;观察组男45例，女25例，年龄23～76岁，病程1～3年。两组患者一般资料比较，差异均无统计学意义（P>0.05），具有可比性。见表1。本研究经我院医学伦理委员会审理和批准。
纳入标准：①所有患者均符合《消化道出血的鉴别诊断与治疗（精）》[4]中相关诊断标准;②所有患者均签署知情同意书;③所有患者意识良好，不存在精神疾病，能够沟通，表达能力良好。
排除标准：①存在心、肝、肾等重要器官功能性障碍疾病[5]者;②中途退出研究者;③病历资料缺失、不完整者。
1.2 方法
1.2.1常规组护理方案