加速康复外科对腹腔镜胃肠手术患者术后恢复情况和心理状态的影响  

Effects of enhanced recovery after surgery on postoperative recovery, psychological state of patients with laparoscopic gastrointestinal surgery

作　　者：余敏敏[1] 龚晓莉[1] 徐震[1] Yu Minmin;Gong Xiaoli;Xu Zhen(Huzhou Central Hospital, Huzhou 313000, Zhejiang, China)

机构地区：[1]湖州市中心医院,浙江湖州313000

出　　处：《中国中西医结合急救杂志》2019年第2期218-222,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

摘　　要：目的观察加速康复外科(ERAS)对腹腔镜胃肠手术患者术后恢复情况、心理状态及并发症的影响。方法选择2016年1月至2017年12月湖州市中心医院收治的98例腹腔镜胃肠手术患者,按护理方法不同分为两组,每组49例。常规护理组围手术期接受常规护理;ERAS护理组围手术期接受ERAS的护理。观察两组术后恢复情况、炎症反应和营养状态指标、并发症、心理状态的变化及护理满意度。结果与常规护理组比较,ERAS护理组胃肠道排气时间、进食普通食物时间、切口愈合时间、下床活动时间、住院时间均明显缩短〔胃肠道排气时间(d): 2.43±1.02比3.46± 1.15,进食普通食物时间(d):4.24± 1.36比6.23±1.52,切口愈合时间(d):7.62±1.54 比 9.63±1.63,下床活动时间(d):8.80±2.32 比 11.24±2.02,住院时间(d):10.23±2.12比14.56±2.37,均P<0.05〕。两组术后超敏C-反应蛋白(hs-CRP)呈先升高后降低趋势,转铁蛋白(TRF)、前白蛋白(PA)呈降低先后升高趋势,组内不同时间点比较差异均有统计学意义(均P<0.05),且以ERAS 护理组术后 5 d 的变化较常规护理组更显著〔hs-CRP(mg/L):27.4±6.2 比 35.6±9.1 ,TRF(g/L): 1.89±0.05比1.81 ±0.06, PA(mg/L):340 ±20比280 ±20,均P<0.05〕。ERAS护理组术后恶心呕吐、咽痛发生率明显低于常规护理组〔恶心呕吐:32.65%( 16/49)比 67.35%(33/49),咽痛:12.24%(6/49)比 51.02%(25/49),均 P<0.05〕,两组术后腹胀、切口感染、肺部感染、吻合口痿发生率比较差异均无统计学意义〔腹胀:4.08%(2/49)比6.12%(3/49),切口感染:4.08%(2/49)比 6.12%(3/49),肺部感染:2.04%(1/49)比 6.12%(3/49),吻合口痿:2.04%(1/49)比4.08%(2/49),均P>0.05〕。两组出院时焦虑自评量表(SAS)评分均较术前降低(P<0.05),且ERAS护理组出院时SAS评分明显低于常规护理组(分:39.21±4.64比46.56 ±4.53, P<0.05)。ERAS护理组护理满意率明显高于常规护理组〔95.92%(47/49)比77.55%(38/49), P<0.05〕。结论ERAS应用于腹�Objective To explore the effects of enhanced recovery after surgery (ERAS) on postoperative recovery, psychological state and complications of patients with laparoscopic gastrointestinal surgery. Methods Ninety-eight patients with laparoscopic gastrointestinal surgery admitted to Huzhou Central Hospital from January 2016 to December 2017 were enrolled and they were divided into two groups (49 cases in each group) according to difference in nursing. During peri-operative period, the routine nursing group was given routine nursing;while the ERAS nursing group received the nursing of ERAS. The postoperative recovery, inflammatory response and nutritional status, complications, psychological state and nursing satisfaction were compared between the two groups. Results Compared with the routine nursing group, the gastrointestinal tract exhaust time, common food intake time, incision healing time, ambulation time and hospital stay were significantly shorter in ERAS nursing group [gastrointestinal tract exhaust time (days): 2.43 ± 1.02 vs. 3.46 ± 1.15, common food intake time (days): 4.24 ± 1.36 vs. 6.23 ± 1.52, incision healing time (days): 7.62 ± 1.54 vs. 9.63 ±1.63, ambulation time (days): 8.80 ±2.32 vs. 11.24 ±2.02, hospital stay (days): 10.23 ± 2.12 vs.l4.56 ±2.37, all P < 0.05]. After operation, the high-sensitivity C-reactive protein (hs-CRP) in the two groups was increased first and then decreased, and the levels of transferrin (TRF) and prealbumin (PA) were decreased first and then increased, and the differences were statistically significant at different time points within-groups (P < 0.05), and the changes of indexes in the 5 days after operation in the ERAS nursing group were more significant than those in the routine nursing group [hs-CRP (mg/L): 27.4 ± 6.2 vs. 35.6 ± 9.1. TRF (g/L): 1.89 ±0.05 vs. 1.81 ± 0.06, PA (mg/L): 340 ± 20 vs. 280 ± 20, all P < 0.05]. The postoperative incidences of nausea and vomiting and sore throat in ERAS nursing group were significantly lower than those in routin

关 键 词：加速康复外科 腹腔镜胃肠手术 并发症 

分 类 号：R459.3[医药卫生—治疗学]