基于加速康复外科理念腹腔镜胃癌患者术后拔除尿管时机的探讨  

Opportunity of ureterectomy for laparoscopic gastric cancer patients based on enhanced recovery after surgery

作　　者：刘鹏 徐丽群[1] 魏玉哲[1] Liu Peng;Xu Liqun;Wei Yuzhe(Second District Intensive Care Unit,Harbin Medical University Cancer Hospital,Harbin 150040,China)

机构地区：[1]哈尔滨医科大学附属肿瘤医院重症医学科二区,150040

出　　处：《中国实用护理杂志》2020年第19期1457-1462,共6页Chinese Journal of Practical Nursing

基　　金：黑龙江省自然科学基金项目(LH2019H043)。

摘　　要：目的探讨加速康复外科理念在腹腔镜胃癌患者术后不同时期拔除导尿管的安全性与可行性。方法选取2017年12月至2019年1月在哈尔滨医科大学附属肿瘤医院行腹腔镜胃癌根治术的患者219例为研究对象,将所有患者按照随机数字表法分为A、B、C 3组各73例,每组脱落1例,最终每组72例完成研究。A组术后12 h拔除尿管,B组术后24 h拔除尿管,C组术后48 h拔除尿管。比较3组患者排尿相关指标和康复指标。结果首次拔除尿管后自行排尿例数、尿潴留重新置管例数、尿路刺激症例数、尿常规异常例数、排尿疼痛评分比较差异无统计学意义(P>0.05);A组患者下床活动时间、首次通气时间、术后住院天数、总住院天数、住院治疗总费用分别为(10.26±4.51)h、(28.74±8.04)h、(4.94±1.73)d、(6.68±1.93)d、(7.19±0.31)万元,B组分别为(16.37±5.13)h、(39.16±11.52)h、(5.27±1.97)d、(7.83±1.88)d、(7.51±0.36)万元,C组分别为(24.19±5.77)h、(54.37±17.49)h、(6.48±1.73)d、(8.16±1.81)d、(7.98±0.42)万元,3组比较差异有统计学意义(F值为12.376~131.721,均P<0.01)。结论加速康复外科理念下腹腔镜胃癌患者术后早期拔除导尿管是安全可行的,能促进患者早期康复,减少住院时间,降低患者的总体经济负担。Objective To explore the safety and feasibility of the concept of enhanced recovery after surgery in the removal of catheters at different stages after laparoscopic gastric cancer surgery.Methods A total of 219 patients who underwent laparoscopic radical gastrectomy in Harbin Medical University Cancer Hospital from December 2017 to January 2019 were selected as the research subjects.All patients were divided into groups A,B,and C according to the random number table with 73 cases each.One case in each group fell off,and 72 cases in each group finished the study.In group A,the ureter was removed 12 hours after operation;in group B,the ureter was removed 24 hours after operation;in group C,the ureter was removed 48 hours after operation.The urination-related indicators and rehabilitation indicators among the three groups of patients were compared.Results There was no significant difference in the number of cases of urinary urination,the number of urinary retention and reinsertion cases,the number of urinary tract irritation,the number of urinary routine abnormalities,and the urination pain score after the first urinary extubation(P>0.05).The patients in group A got out of bed activity time,first ventilation time,postoperative hospital stays,total hospital stays,total hospitalization costs were(10.26±4.51)h,(28.74±8.04)h,(4.94±1.73)d,(6.68±1.93)d,(7.19±0.31)ten thousand yuan,group B were(16.37±5.13)h,(39.16±11.52)h,(5.27±1.97)d,(7.83±1.88)d,(7.51±0.36)ten thousand yuan,and group C were(24.19±5.77)h,(54.37±17.49)h,(6.48±1.73)d,(8.16±1.81)d,(7.98±0.42)ten thousand yuan.There were statistically significant differences among the three groups(F values were 12.376-131.721,all P<0.01).Conclusions It is safe and feasible to remove the catheter early after laparoscopic gastric cancer surgery under the concept of enhanced recovery after surgery.It can promote the early recovery of patients,reduce hospitalization time and reduce the overall economic burden of patients.

关 键 词：ERAS 腹腔镜 胃肿瘤 导尿管 护理 

分 类 号：R473.73[医药卫生—护理学]