肝癌术后早期下床活动方案的构建及应用  

Development and application of evidence-based practice protocol for early mobilization after liver cancer surgery

作　　者：何宁宁[1] 周利平[1] 薛冰 王清[2] 冯丽[1] 任昊桢[1] 施晓雷[1] 陆巍[2] He Ningning;Zhou Liping;Xue Bing;Wang Qing;Feng Li;Ren Haozhen;Shi Xiaolei;Lu Wei(Department of Hepatobiliary Surgery,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院肝胆外科,江苏南京210008 [2]南京大学医学院附属鼓楼医院护理部,江苏南京210008

出　　处：《护理学杂志》2020年第1期24-28,共5页Journal of Nursing Science

基　　金：国家临床重点专科建设项目(苏卫转[2011]99号);南京大学医学院附属鼓楼医院院内护理科研项目(SB175-2)。

摘　　要：目的 制订肝癌术后早期下床活动方案,探讨实施效果.方法 按照入院时间将93例肝癌行肝切除术患者分为对照组45例和观察组48例.对照组实施术后常规活动护理;观察组实施早期下床活动循证实践方案,通过检索数据库获取最佳证据及整合证据,制定肝癌术后早期下床活动实践方案及流程.结果 观察组术后24 h内下床活动率、首次下床时间及术后活动量指标显著优于对照组,术后排气排便时间、胃管留置时间显著短于对照组,术后24h疼痛评分、疼痛控制满意度显著优于对照组(P<0.05,P<0.01);两组早期活动不良事件发生率比较,差异无统计学意义(P>0.05).结论 肝癌术后早期下床活动最佳实践方案的实施,可加快肝癌患者术后康复,促进患者安全(并不增加患者安全事件).Objective To develop early mobilization protocol for liver cancer patients and to explore the application effect.Methods Ninety-three patients with liver cancer undergoing hepatectomy were assigned to a control group of 45 and an intervention group of 48 according to their admission time.The control group was given routine mobilization,while the intervention group was subjected to early mobilization program:the best evidence was retrieved and integrated to develop an evidence-based early mobilization protocol,then work process was revised.Results The intervention group had higher incidence of out-of-bed activity within postoperative 24 h,earlier out-of-bed mobilization,better postoperative activity performance,earlier flatus and defecation,shorter gastric tube indwelling time,lower pain intensity and higher satisfaction with pain control compared with the control group(P<0.05,P<0.01).Adverse events during mobilization had no significant difference between the two groups(P>0.05).Conclusion Implementation of evidence-based early mobilization practice protocol for liver cancer surgery can boost recovery of patients without increa-sing safety events.

关 键 词：肝癌 肝切除术 快速康复 早期活动 循证实践 疼痛 不良事件 

分 类 号：R473.6[医药卫生—护理学] R735.7[医药卫生—临床医学]