基于加速康复外科理念下的医护一体化护理在腹腔镜胆总管切开取石术患者中的应用效果  

Application effect of integration of medical care based on the concept of anhanced recovery after surgery in patients undergoing laparoscopic common bile duct lithotomy

作　　者：刘钟华 杨婷 LIU Zhonghua;YANG Ting(The First Department of Surgery,Pingxiang City Ganxi Hospital,Jiangxi Province,Pingxiang337019,China;Hemodialysis Room,Pingxiang City Ganxi Hospital,Jiangxi Province,Pingxiang337019,China)

机构地区：[1]江西省萍乡赣西医院院外一科,江西萍乡337019 [2]江西省萍乡赣西医院血透室,江西萍乡337019

出　　处：《中国当代医药》2024年第26期170-174,共5页China Modern Medicine

基　　金：江西省卫生健康委科技计划项目(202212081)。

摘　　要：目的分析基于加速康复外科(ERAS)理念下的医护一体化护理对腹腔镜胆总管切开取石术后患者心理应激及术后恢复应用效果。方法选择2022年1月至2023年7月于萍乡赣西医院普通外科就诊实行腹腔镜胆总管切开取石术的120例患者作为研究对象,根据护理方法将患者分为ERAS组(n=60)和对照组(n=60),对照组采取常规围手术期护理,ERAS组采用基于ERAS理念下的医护一体化护理。比较两组术后住院及康复基本情况、临床疗效、焦虑自评量表(SAS)、抑郁自评量表(SDS)、应激反应相关指标[皮质醇(Cor)、去甲肾上腺素(NE)、游离三碘甲状腺原氨酸(FT3)]水平变化,比较两组的护理满意度和并发症发生率。结果ERAS组患者下床活动时间、拔除腹腔引流管时间及肛门首次排气、排便时间、住院时间均短于对照组,住院费用少于对照组,差异有统计学意义(P<0.05)。ERAS组患者总有效率高于对照组,差异有统计学意义(P<0.05)。ERAS组术后3 d SAS、SDS评分、Cor、NE、FT3水平均低于对照组,差异有统计学意义(P<0.05)。ERAS组患者护理总满意率高于对照组,并发症总发生率低于对照组,差异有统计学意义(P<0.05)。结论在腹腔镜下胆总管切开取石手术中患者中开展基于ERAS理念下的医护一体化护理是安全有效的,有利于缓解患者抑郁、焦虑等不良情绪,加快术后康复,降低应激反应并减少术后并发症发生,提高护理满意度,值得临床推广。Objective To analyze the effect of integration of medical care based on the concept of anhanced recovery after surgery(ERAS)on the psychological stress and postoperative recovery of patients after laparoscopic common bile duct lithotomy.Methods A total of 120 patients who underwent laparoscopic common bile duct lithotomy in the Department of General Surgery of Pingxiang City Ganxi Hospital from January 2022 to July 2023 were selected as the study objects.According to the nursing methods,the patients were divided into ERAS group(n=60)and control group(n=60),and the control group received routine perioperative nursing.In ERAS group,integrated nursing based on ERAS concept was used.Postoperative hospitalization and rehabilitation,clinical efficacy,self-rating anxiety scale(SAS),self-rating depression scale(SDS),and stress response related indexes(cortisol[Cor],norepinephrine[NE],free triiodothyronine[FT3])levels between the two groups were compared.The nursing satisfaction of patients and the complications of treatment were investigated and compared.Results The time of getting out of bed,the time of removing abdominal drainage tube,the time of first anal exhaust and defecation,and the length of hospital stay in ERAS group were shorter than those in control group,and the hospitalization cost was lower than that of control group,the differences were statistically significant(P<0.05).The total effective rate in ERAS group was higher than that in control group,and the difference was statistically significant(P<0.05).SAS,SDS scores,Cor,NE and FT3 levels in ERAS group were lower than those in control group at 3 days after operation,and the differences were statistically significant(P<0.05).The total satisfaction rate of nursing in ERAS group was higher than that in control group,and the total complication rate was lower than that in control group,with statistical significances(P<0.05).Conclusion It is safe and effective to carry out integration of medical care based on ERAS in patients under laparoscopic common bile duct

关 键 词：腹腔镜胆总管切开取石术 医护一体化 加速康复外科理念 心理应激 

分 类 号：R473[医药卫生—护理学]