預約拔管系統在輸尿管術后患者拔管管理中的應用

□ 傅亞飛 FU Ya-fei

Objective To establish an extubation appointment system through programming software of computer information system, so as to achieve orderly management of patients with stent tube indwelled after urinary calculi surgery, to improve the efficiency of stent tube extubation and patient satisfaction,and to reduce missing and late extubation. Methods Extubation appointment system was added as a system module to Hospital Information System (HIS)to conduct manual appointment of extubation time and to control daily person-time of extubation. The patients with stent tube indwelled after urinary calculi surgery from January 2017 to June 2017 were managed orderly and counted for analysis. Results From January 2017 to June 2017, HIS extubation appointment system was applied, and the satisfaction of patients and medical staff and social benefits improved compared with the same period of 2016.The numbers of medical disputes and patient complaints decreased compared with the same period of 2016. Conclusion The HIS extubation appointment system can prevent missing extubation and improve satisfaction of patients and medical staff in the management of patients with stent tube indwelled after urinary calculi surgery.

泌尿系結石病人術后大部分需留置輸尿管內支架管，起到引流尿液[1]、殘留小結石及防止輸尿管狹窄和漏尿等作用。一般病人術后4～6周需來院拔除支架管[2]。以往是在出院時告訴病人可拔管時間，病人大約術后4～6周內來院拔管，由泌尿外科治療室完成。由于未實行有序預約，每天來拔管的病人數參差不齊，導致膀胱鏡配置不合理，患者遲拔、漏拔管，導致發生并發癥，造成醫患糾紛。

針對以上問題，我們認為建立HIS預約拔管系統，以醫院信息系統（HIS）為支撐平臺，以無線局域網為網絡平臺，由醫院局域網連接移動控制主機、無線交換機以及醫生護士工作站組成信息移動支撐系統[3]，對出院病人進行有序預約，可有序管理支架管存留病人，控制每天拔管人數，預留急診病人的器械，經過實踐，效果顯著，受到了病人、醫生、護士的好評。

資料與方法

1.一般資料。2017年1月至2017年6月我科體內留置輸尿管支架管需拔管病人606例，其中男性405例，女性201例，年齡28～81歲。置入的輸尿管支架型號為F5-F6。其中單側置管571例，雙側置管35例。

2.方法

2.1 科室對需要預約拔管及拔管的相關要求和注意事項進行梳理，根據科室現有條件及膀胱鏡數量決定每天預約人數，雙休日、節假日不預約，系統留有病人聯系電話、住院號、手術日期、手術方式、置管部位、留管狀態、預約拔管日期等信息。

2.2 病區醫生、護士、信息部門人員三方討論，提出預約拔管要求和注意事項，信息部門根據科室要求，應用計算機軟件，在醫囑系統中增加模塊[4]，建立預約拔管系統，可以對病人信息進行登記、預約，拔管狀態顯示未拔或已拔信息，便于醫生掌握病人動態，見圖1。……