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目的评价胸腔镜肺叶切除术(VATS)手术器械包模块化管理临床应用及其效果。方法选择60例行肺叶切除术的肺病患者,其中男性29例,女性31例;年龄22~78岁,平均年龄50.3岁。以2013年2月以前的VATS手术器械包作为常规组(30例),2013年2月后VATS手术器械包作为模块化组(30例),即能量系统、成像系统、组织分离与止血系统及基础器械包等4种模块化器械包,组合使用。观察两组手术总时间、肺叶切除手术时间及出血量;器械包的质量、清点及清洗器械时间。结果①手术总时间在常规组显著长于模块化组[(110.59±20.33)min vs(80.67±9.21)min,P<0.05];②肺叶切除术平均时间及平均出血量在常规组与模块化组之间比较[(40.13±15.67)min vs(35.33±11.21)min,(53.67±21.71)mL vs(60.47±18.24)mL],差异无统计学意义(P>0.05);③常规组器械包总质量显著高于模块化组[(3.63±0.67)kg vs(2.85±0.71)kg,P<0.05],常规组手术器械包器械使用率显著低于模块化组[(14.13±2.67)%vs(93.47±3.33)%,P<0.05];④清点及清洗器械时间在常规组均显著长于模块化组[(15.33±5.13)min vs(8.21±2.77)min,(30.67±8.71)min vs(14.56±6.89)min],两组比较差异均有统计学意义(P<0.05)。结论 VATS器械包模块化管理显著提高护士工作效率且不影响肺叶切除时间及出血量。
Objective To evaluate the clinical application of modular management of VATS surgical instruments and its effects. Methods Sixty patients undergoing pulmonary lobectomy were selected, including 29 males and 31 females, aged from 22 to 78 years with an average age of 50.3 years. The VATS surgical instrument package before February 2013 was used as the conventional group (30 cases). After February 2013, the VATS surgical instrument package was used as the modular group (30 cases), namely the energy system, imaging system, tissue separation and hemostasis system and Basic equipment package 4 kinds of modular equipment package, combined use. The total operation time, the time of lobectomy operation and the amount of bleeding were observed. The quality, inventory and time of instrument cleaning were also observed. Results ① The total operation time in the conventional group was significantly longer than that in the modular group [(110.59 ± 20.33) min vs (80.67 ± 9.21) min, P <0.05]; ② The average time of lobectomy and the average bleeding volume were significantly lower in the conventional and modular groups (40.13 ± 15.67) min vs (35.33 ± 11.21) min, (53.67 ± 21.71) mL vs (60.47 ± 18.24) mL, respectively. There was no significant difference between the two groups (P> 0.05) (3.63 ± 0.67) kg vs (2.85 ± 0.71) kg, P <0.05]. The rate of device usage in the conventional surgical instruments was significantly lower than that in the modular group [(14.13 ± 2.67)% vs ( 93.47 ± 3.33)%, P <0.05]. ④ The time of inventory and cleaning instruments in the conventional group was significantly longer than that in the modular group [(15.33 ± 5.13) min vs (8.21 ± 2.77) min vs (30.67 ± 8.71) min vs ± 6.89) min], the differences between the two groups were statistically significant (P <0.05). Conclusions Modular management of VATS kits significantly improves the work efficiency of nurses and does not affect the time of lobectomy and the amount of bleeding.