ERAS多元化护理临床路径联合身心安抚模式在胆囊结石合并胆总管结石患者腹腔镜联合超细胆道镜手术中的应用  

Application of ERAS diversified nursing clinical pathway combined with psychosomatic pacification model during laparoscopy with ultra-fine choledochoscopy in patients with calculus of gallbladder and common bile duct stone

作　　者：田春艳 李晴 宋兴超 路要武 王娟 Tian Chunyan;Li Qing;Song Xingchao;Lu Yaowu;Wang Juan(Department of Hepatobiliary and Pancreatic Surgery,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University,Xuzhou No.1 People's Hospital,Xuzhou 221000,China)

机构地区：[1]徐州医科大学附属徐州市立医院、徐州市第一人民医院肝胆胰外科,徐州221000

出　　处：《国际护理学杂志》2025年第4期675-681,共7页international journal of nursing

基　　金：江苏省徐州市引进临床医学专家团队基金资助项目(2018TD001)。

摘　　要：目的探讨加速康复外科(ERAS)多元化护理临床路径联合身心安抚模式(PPM)在胆囊结石(CG)合并胆总管结石(CBDS)患者腹腔镜(LC)联合超细胆道镜手术中的应用。方法选取2020年6月至2023年2月徐州医科大学附属徐州市立医院肝胆胰外科拟行LC联合超细胆道镜手术治疗的90例CG合并CBDS患者,根据随机数字表法将其分成对照组和研究组,各45例。对照组给予常规护理,研究组在对照组基础上,给予ERAS-PPM干预。比较两组术后恢复时间、医院焦虑抑郁量表(HADS)、疼痛程度[视觉模拟疼痛量表(VAS)]、舒适度[Kolcaba简化舒适度量表(GCQ)]、疾病不确定感[疾病不确定感量表(MUIS)]、并发症发生情况。结果术后,研究组恢复时间少于对照组(P<0.05)。术后4 h、8 h、12 h,研究组VAS评分均低于对照组(均P<0.05)。术后4 d,两组HADS、MUIS评分低于入院时,且研究组上述评分低于对照组(均P<0.05);两组GCQ评分均高于术后1 d,且研究组高于对照组(P<0.05)。两组并发症总发生率比较差异无统计学意义(P>0.05)。结论在LC联合超细胆道镜围术期,对CG合并CBDS患者实施ERAS-PPM护理能加快术后康复,有效缓解负面情绪,减少对疼痛敏感度,使患者身心舒适,从而避免其对疾病产生不确定感。Objective To explore the application of enhanced recovery after surgery(ERAS)diversified nursing clinical pathway combined with psychosomatic pacification model(PPM)in patients with calculus of gallbladder(CG)complicated with common bile duct stone(CBDS)during laparoscopy(LC)with ultra-fine choledochoscopy.Methods From June 2020 to February 2023,90 patients with CG combined with CBDS who were scheduled to undergo LC combined with ultra-meticulous choledochoscopy in the Department of Hepatobiliary and Pancreatic Surgery,Xuzhou Municipal Hospital Affiliated to Xuzhou Medical University were selected.According to the random number table method,they were divided into the control group and the study group,with 45 cases in each group.The control group was given routine nursing,while the study group was given ERAS-PPM intervention based on the control group.The postoperative recovery time,Hospital Anxiety and Depression Scale(HADS),pain degree[Visual Analogue Scale(VAS)],comfort degree[Kolcaba General Comfort Questionnaire(GCQ)],disease uncertainty[Mishel's Uncertainty in Illness Scale(MUIS)]and complications were compared between the two groups.Results After surgery,the recovery time of the study group was shorter than that of the control group(P<0.05).At 4 hours,8 hours and 12 hours after surgery,the VAS scores of the study group were lower than those of the control group(P<0.05).At 4 days after surgery,the HADS scores and MUIS scores in the two groups were lower than those at admission,and the above scores were lower in the study group than those in the control group(P<0.05).The GCQ scores in both groups were higher than those in 1 day after surgery,and the study group had higher scores than the control group(P<0.05).There was no significant difference in the total incidence of complications between the two groups(P>0.05).Conclusions During the perioperative period of LC combined with ultra-fine choledochoscopy,ERAS-PPM nursing for CG patients with CBDS can accelerate postoperative recovery,effectively relieve negati

关 键 词：ERAS多元化护理临床路径 身心安抚模式 胆囊结石 胆总管结石 腹腔镜联合超细胆道镜手术 

分 类 号：R47[医药卫生—护理学]