Abstract
Objective To construct a scientific and standardized early warning process for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) based on the integrated medical and nursing model, and systematically evaluate its application effect in clinical practice, aiming to provide empirical evidence for optimizing the perioperative nursing management of pancreatic surgery. Methods A historical controlled study design was adopted. The medical records of 120 patients who underwent PD surgery and were admitted to the Department of Hepatobiliary and Pancreatic Surgery of a tertiary grade A hospital from January 2024 to December 2025 were retrospectively collected. They were divided into a control group (from January to December 2024, n=60) and an experimental group (from January to December 2025, n=60) according to the admission time. The control group received routine postoperative nursing and monitoring, while the experimental group was intervened with the integrated medical-nursing early warning process on the basis of routine nursing. The early diagnosis time of POPF, the incidence of grade B/C clinically relevant postoperative pancreatic fistula (CR-POPF), the postoperative hospital stay, and the satisfaction degree of medical-nursing collaboration were compared between two groups. Results The diagnosis time of POPF ［(3. 20±0. 80) d vs. (4. 50±1. 20) d, MD=-1. 30, 95%CI: -1. 67～-0. 93, t=6. 98, P＜0. 01］and postoperative hospital stay［(18. 50±4. 20) d vs. (23. 40±6. 10) d, MD=-4. 90, 95%CI: -6. 79～-3. 01, t=5. 12, P＜0. 01］in the experimental group were shorter than those in the control group. The incidence of grade B/C CR-POPF(10. 00% vs. 23. 33%) and reintervention rate within 30 days after surgery(3. 33% vs. 13. 33%)in the experimental group were lower than those in the control group, but no statistically significant difference was found(P＞0. 05). The satisfaction degree of medical-nursing collaboration ［(92. 40±5. 60) vs. (81. 20±7. 30), MD=11. 20, 95%CI: 8. 85～13. 55, t=9. 43, P＜0. 01)in the experimental group was higher than that in the control group. The early warning system had a sensitivity of 90. 00%, a specificity of 98. 00%, a positive predictive value of 24. 32%, and issued an early warning an average of 1. 5 days in advance. Conclusion The early warning process for POPF after PD based on the integrated medical and nursing model can effectively integrate medical and nursing resources, and realize the early collaborative response of risk signals. This process may shorten the identification period of pancreatic fistula, reduce the risk of severe pancreatic fistula, accelerate the patient's rehabilitation process, and improve the team collaboration efficiency and nursing professional level, which has important clinical promotion value. (目的 构建一套科学、规范的基于医护一体化模式的胰十二指肠切除术(PD)术后胰瘘(POPF)早期预警流程, 并系统评价其在临床实践中的应用效果, 旨在为优化胰腺外科围手术期护理管理提供实证依据。方法 采用历史性对照研究设计。回顾性收集2024年1月—2025年12月某三级甲等医院肝胆胰外科收治的120例行PD手术患者的病历资料。根据入院时间分为对照组(2024年1月—12月, n=60)与试验组(2025年1月—12月, n=60)。对照组实施常规术后护理与监测; 试验组在常规护理基础上, 应用本研究构建的医护一体化早期预警流程进行干预。比较两组患者的POPF早期诊断时间、B/C级临床相关性胰瘘(CR-POPF)发生率、术后住院时间以及医护协作满意度。结果 试验组胰瘘诊断时间［(3. 20±0. 80) d vs. (4. 50±1. 20) d, MD=-1. 30, 95%CI: -1. 67～-0. 93, t=6. 98, P＜0. 01］、术后住院时间［(18. 50±4. 20) d vs. (23. 40±6. 10) d, MD=-4. 90, 95%CI: -6. 79～-3. 01, t=5. 12, P＜0. 01］均低于对照组, B/C级胰瘘发生率(10. 00% vs. 23. 33%)及术后30 d再干预率(3. 33% vs. 13. 33%)呈下降趋势, 但差异无统计学意义(P＞0. 05)。医护协作满意度评分［(92. 40±5. 60) 分 vs. (81. 20±7. 30)分, MD=11. 20, 95%CI: 8. 85～13. 55, t=9. 43, P＜0. 01］高于对照组。预警系统敏感度为90. 00%, 特异度为98. 00%, 阳性预测值为24. 32%, 平均提前1. 5 d发出预警。结论 基于医护一体化模式构建的PD术后POPF早期预警流程, 能够有效整合医护资源, 实现风险信号的早期捕捉与联动响应。该流程能缩短胰瘘的识别窗口期, 降低严重胰瘘的发生风险, 加速患者康复进程, 并提升团队协作效能与护理专业化水平, 具有重要的临床推广价值。)