探讨由专病护士主导的恶性梗阻性黄疸经皮肝穿刺胆道引流（PTBD）患者个案管理的应用和效果。

首次诊断为恶性梗阻性黄疸并行PTBD治疗的60例患者中，30例为个案管理组，由专病护士实施一对一管理，建立个案管理档案，全程参与住院诊疗护理计划的落实与协调，并保证出院后的管理监督。30例为对照组，由普通责任护士实施常规的整体护理和出院随访。6个月后，比较两组的疼痛评分（NRS）、远期生活质量评分(KPS)、总住院日、总住院费用、预约复诊率、非计划急诊入院率等指标的差异。

个案管理组低于对照组的指标有：NRS评分（1.90±1.24 vs. 2.83±1.91）、总住院日（17.4±3.5 vs. 19.9±5.7天）、总住院费用（2.10±0.81 vs. 2.53±0.85万元）、非计划性急诊入院率（6.67% vs. 26.67%）；高于对照组的指标包括：KPS评分（75.33±10.74 vs. 67.33±11.4）、预约复诊率（100% vs. 90%），差异均有统计学意义。

由专病护士主导的恶性梗阻性黄疸PTBD患者个案管理，有利于节约医疗资源，提高患者生活质量，值得借鉴推广及进一步研究。

To explore the application and effect of case management of PTBD patients with malignant obstructive jaundice by Special Disease Nurse.

The case management group was implemented by a Special Disease Nurse who setting up a case management file, participating in the implementation and coordination of inpatient care plan, and to ensure the management and supervision after discharge. The control group was followed up by the general duty nurse to carry out the routine holistic nursing and hospital discharge. Comparing two groups in the objective indicators about pain rating scale (NRS), long-term quality of life score (KPS), stay hospital days, total hospitalization expenses, appointment visit rate, and unscheduled emergency admission rate after 6 months.

The indicators of the case management group were lower than the control group: NRS score(1.90±1.24 vs. 2.83±1.91), stay hospital days (17.4±3.5 vs. 19.9±5.7), total hospitalization expenses (2.10±0.81 vs. 25.3±0.85), and unscheduled emergency admission rate (6.67% vs. 26.67%). There were some indicators higher than the control group: KPS score (75.33±10.74 vs 67.33±11.43) and appointment visit rate(100% vs. 90%). The difference is statistically significant (P<0.05).

Special Disease Nurse play a leading role in the implementation of case management in PTBD patients with malignant obstructive jaundice is conducive to saving medical resources and improving the quality of life of patients. It is worth popularizing for reference and further study.