加速康复外科理念下日间腹腔镜胆囊切除术患者术后早期活动方案可行性研究  

Feasibility study of early postoperative activity plan for daytime laparoscopic cholecystectomy patients under the enhanced recovery after surgery concept

作　　者：李娅 陆静[1] 朱红梅 周川宇 LI Ya;LU Jing;ZHU Hongmei;ZHOU Chuanyu(Basic Surgery Department of Deyang People's Hospital,Sichuan Deyang 618099,China)

机构地区：[1]德阳市人民医院基本外科,四川德阳618099

出　　处：《临床普外科电子杂志》2022年第1期90-95,共6页Journal of General Surgery for Clinicians(Electronic Version)

摘　　要：目的 探讨将加速康复外科(enhanced recovery after surgery,ERAS)理念应用于日间腹腔镜胆囊切除术(laparoscopic cholecystectomy,LC)患者术后早期活动的康复治疗方案中的可行性。方法 选取德阳市人民医院2018年1月至2021年1月进行LC治疗的患者100例,按照护理方法不同分为对照组和ERAS组各50例。ERAS组患者采用日间病房ERAS理念进行围手术期管理,对照组患者在普通病房接受传统的围手术期管理。比较两组患者术中、术后相关指标,以及ERAS理念对患者术后早期活动的影响。结果 ERAS组患者术后下床时间最早为6.8h,最晚为26.3h,平均(8.2±0.8)h,其中术后下床时间12h内占90%,术后下床时间12~24h为6%,均明显高于对照组(P <0.05);ERAS组中具有早期活动意愿的患者占88.0%(44/50),首次下床活动满意率为84.0%(42/50),康复自我效能评分为(70.22±5.32)分,明显高于对照组(P <0.05);ERAS组患者进食时间、术后胃肠道通气时间明显短于对照组,术后6h、12h疼痛评分更低,切口愈合时间更短,差异有显著性(P <0.05)。两组患者术后无出血、尿潴留、血肿出现。ERAS组术后仅有1例患者出现恶心,1例患者出现腹胀,不良反应发生率明显低于对照组(P <0.05)。结论 将ERAS理念应用于日间病房LC患者术后早期活动的康复治疗方案中,具有较高的可行性,有利于患者术后恢复,改善患者预后。Objective To explore the feasibility of applying the enhanced recovery after surgery(ERAS) concept to the rehabilitation treatment plan for early postoperative activities of daytime laparoscopic cholecystectomy(LC) patients. Method Randomly enrolled 100 patients undergoing LC in Deyang People’s Hospital from January 2018 to January 2021, according to different nursing methods, they were divided into control group and ERAS group, with 50 cases in each group. Patients in ERAS group were treated with the concept of daytime ward ERAS for perioperative management,and patients in control group were treated with traditional perioperative management in general ward.The intraoperative and postoperative related indexes of the two groups and the effect of ERAS concept on the early postoperative activities of the patients were compared. Result The earliest time of getting out of bed in ERAS group was 6.8 h and the latest was 26.3 h, The average time of getting out of bed was(8.2 ± 0.8) h, including 90% within 12 hours and 6% within 12 ~ 24 hours, which were significantly higher than those in the control group(P < 0.05);88.0%(44/50) of patients in ERAS group had the intention of early activities, the satisfaction rate of first getting out of bed activities was 84.0%(42/50),and the rehabilitation self-efficacy score was(70.22 ± 5.32), which was significantly higher than that in the control group(P < 0.05);The eating time and postoperative gastrointestinal ventilation time in ERAS group were significantly shorter than those in the control group, the pain score at 6 h and 12 h after operation was lower, and the incision healing time was shorter, the difference was significant(P < 0.05).There were no complications such as bleeding, urinary retention, hematoma in the two groups. Only 1 patients developed nausea in ERAS group, and 1 patients had abdominal distension, the incidence of adverse reactions was significantly lower than that of the control group(P < 0.05). Conclusion It is feasible to apply the ERAS concept to the reh

关 键 词：加速康复外科理念 日间病房 腹腔镜胆囊切除术 术后早期活动 

分 类 号：R47[医药卫生—护理学]