老年冠状动脉旁路移植围术期快速康复外科管理  

Fast Track Surgery Management in Perioperative Period of Coronary Artery Bypass Grafting on Elderly Patients

作　　者：薛梅[1,2] 赵岳[2] 程蕊[3] 卢文秋[4] 马连娣[1] 张鹏[3] 陈静[1] 

机构地区：[1]天津医学高等专科学校,天津市300222 [2]天津医科大学 [3]天津医科大学总医院 [4]天津市胸科医院

出　　处：《中国全科医学》2016年第14期1672-1675,共4页Chinese General Practice

基　　金：天津市高等学校人文社会科学研究项目(20132818)

摘　　要：目的将快速康复外科（FTS）管理策略应用于冠状动脉旁路移植（CABG）围术期,以减少老年CABG术患者生理和心理的创伤应激,优化CABG管理措施,减少并发症,帮助老年患者快速康复。方法选取2013年3月—2014年3月76例适于行CABG术治疗的老年冠心病患者,简单随机法分为FTS组（n=39）和对照组（n=37）,FTS组接受FTS方案管理,对照组接受传统方案管理。比较两组术前口渴感和饥饿感,术后脑血管并发症、拔管后胸腔积液、创口感染、肺部并发症、ICU停留时间、住院时间、住院费用,采用现场问卷调查法对出院患者进行满意度调查。结果 FTS组术前口渴感和饥饿感发生率〔12.8%（5例）和23.1%（9例）〕均少于对照组〔100.0%（37例）和89.2%（33例）〕,差异有统计学意义（χ^2=58.390、33.561,P〈0.010）。FTS组术后脑血管并发症、肺部并发症发生率、ICU停留时间、住院时间、住院费用均低于对照组,差异有统计学意义（P〈0.05）。满意度调查显示,FTS组患者满意度为97.4%（38例）,对照组患者满意度为86.5%（32例）,两组间差异无统计学意义（χ^2=3.131,P=0.077）。结论 FTS方案的应用可有效促进CABG患者术后的康复,减少老年患者术后并发症发生,缩短住院时间,降低住院费用。Objective Fast track surgery（ FTS） is applied in the management of perioperative period of coronary artery bypass grafting（ CABG） surgery on elderly patients to reduce the physical and mental trauma stress of patients,optimize the management of CABG,reduce the complications,and accelerate the recovery of surgical patients. Methods From March 2013 to March 2014, we enrolled 76 elderly patients with coronary heart disease who were eligible for CABG surgery, and assigned them into FTS group（ n = 39） and control group（ n = 37）. FTS group was administrated with FTS,and control group was administrated with conventional methods. Comparison was made between the two groups in sense of thirst and hunger,postoperative cerebral vascular complications,pleural effusion after extubation,pulmonary complications,ICU residence time,hospitalization time and hospitalization expenses. On- site questionnaire survey was conducted to investigate the satisfaction of patients at discharge. Results FTS group had less sense of thirst and hunger than control group 〔12. 8%（ n = 5） and 23. 0%（ n = 9） vs. 100. 0%（ n = 37） and 89. 2%（ n = 33） 〕（ χ^2= 58. 390,33. 561; P〈0. 010）. FTS group was significantly lower than control group in the incidence rates of postoperative cerebral vascular complications,pulmonary complications,ICU residence time,hospitalization time and hospitalization expenses（ P〈0. 05）. In the satisfaction survey,38（ 97. 4%） patients in FTS group were satisfied and 32（ 86. 5%） patients in control group were satisfied, and no significant difference existed between the two groups in satisfaction rate（ χ^2= 3. 131, P = 0. 077）. Conclusion The application of FTS can effectively promote the rehabilitation of CABG patients after surgery,reduce the postoperative complications,shorten the length of hospital stay,reduce the cost of hospitalization.

关 键 词：冠状动脉旁路移植术 非体外循环 快速康复外科 护理管理研究 围手术期 老年人 

分 类 号：R654.3[医药卫生—外科学]