改良围术期快速康复护理对腹腔镜胆囊切除术患者躁动及疼痛程度的影响
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摘要
目的研究改良围术期快速康复护理在腹腔镜胆囊切除术患者中的应用效果。方法将我院收治的70例腹腔镜胆囊切除术患者采用随机数字表法分为观察组(改良围术期快速康复护理)和对照组(常规围术期护理),各35例。比较两组的护理效果。结果观察组患者术中出血量及住院费明显少于对照组,术后住院时间显著短于对照组(P<0.05);观察组术后首次排气时间、术后进食时间及术后下地活动时间均短于对照组(P<0.05);术后当天和出院时,两组患者VAS评分显著低于术前1 d,且观察组低于对照组(P<0.05);观察组RASS评分显著低于对照组(P<0.05)。结论改良围术期快速康复护理在腹腔镜胆囊切除术患者中的应用效果显著,不仅可以减轻患者术后疼痛、缓解躁动情绪,还可促进其早期康复。
Objective To study the effect of modified perioperative fast track nursing on restlessness and pain of patients undergoing laparoscopic cholecystectomy. Methods A total of 70 patients underwent laparoscopic cholecystectomy were divided into observation group(modified perioperative fast track nursing) and control group(routine perioperative nursing) by random number table method, with 35 cases in each group. The nursing effects of two groups were compared.Results The blood volume and hospitalization expenses in the observation group were significantly less than those in the control group, and the hospitalization time was significantly shorter than that in the control group(P <0.05). The first exhaust time, the eating time and the activity time after operation in the observation group were shorter than those in the control group(P<0.05). At the day after operation and discharge time, the VAS scores in the two groups were lower than those at 1 d before operation, and those in the observation group were lower than the control group(P <0.05); the RASS scores of the observation group were significantly lower than those of the control group(P <0.05). Conclusion Modified perioperative fast track nursing in the patients undergoing laparoscopic cholecystectomy has a significant effect. It can not only relieve pain and restlessness of patients, but also promote early rehabilitation of patients.
Objective To study the effect of modified perioperative fast track nursing on restlessness and pain of patients undergoing laparoscopic cholecystectomy. Methods A total of 70 patients underwent laparoscopic cholecystectomy were divided into observation group(modified perioperative fast track nursing) and control group(routine perioperative nursing) by random number table method, with 35 cases in each group. The nursing effects of two groups were compared.Results The blood volume and hospitalization expenses in the observation group were significantly less than those in the control group, and the hospitalization time was significantly shorter than that in the control group(P <0.05). The first exhaust time, the eating time and the activity time after operation in the observation group were shorter than those in the control group(P<0.05). At the day after operation and discharge time, the VAS scores in the two groups were lower than those at 1 d before operation, and those in the observation group were lower than the control group(P <0.05); the RASS scores of the observation group were significantly lower than those of the control group(P <0.05). Conclusion Modified perioperative fast track nursing in the patients undergoing laparoscopic cholecystectomy has a significant effect. It can not only relieve pain and restlessness of patients, but also promote early rehabilitation of patients.
引文
[1]杨金霞,王英.老年腹腔镜胆囊切除患者围术期护理需求的调查与分析[J].中国微创外科杂志,2015,15(4):382-385.
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[4]KOKKI M,BROMS S,ESKELINEN M,et al.Analgesic concentrations of oxycodone-A prospective clinical PK/PD study in patients with laparoscopic dholecystectomy[J].Basic Clin Pharmacol Toxicol,2012,110(5):469-475.
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[6]袁耀宗.中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J].胃肠病学,2015,20(5):292-296.
[7]严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):273.
[8]KHAN BA,GUZMAN O,CAMPBELL NL,et al.Comparison and agreement between the richmond agitation-sedation scale and the riker sedationagitation scale in evaluating patients'eligibility for delirium assessment in the ICU[J].Chest,2012,142(1):48-54.
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[10]张旭飞.腔镜胆囊次全切除术在急性复杂性胆囊炎患者治疗中的疗效观察[J].结直肠肛门外科,2016,22(S2):74-75.
[11]WRIGHT B.Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?[J].BMJ Open,2016,6(9):e007969.
[12]吕和平.疼痛管理小组对腹腔镜胆囊切除术后病人疼痛影响的观察[J].中南医学科学杂志,2015,43(6):716-718.
[13]SATTARI H,HAGHBIN MA,ETMINAN M,et al.Survey of the Effect of intraoperative intravenous lidocaine infusion on postoperative pain in laparoscopic cholecystectomy surgery[J].Pediatr Res,2015,13(10):937-948.
[14]BHATTACHARJEE HK,JALALUDEEN A,BANSAL V,et al.Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy:a randomised controlled trial[J].Surg Endo,2016,31(3):1-9.
[15]SZENTAL JA,WEBB A,WEERARATNE C,et al.Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index(ANI誖)monitoring:a randomized clinical trial[J].Br J Anaesth,2015,114(4):640-645.
[16]卢永华,王英.触摸及音乐疗法对腹腔镜胆囊切除术患者焦虑及预后的影响[J].国际护理学杂志,2017,36(23)3278-3280.
[17]吴友祥,杨俊杰,晏彬,等.腹腔镜微创手术治疗老年急性胆囊炎患者的疗效及对机体免疫功能的影响[J].中国临床新医学,2017,10(4):347-350.
[18]王洁.快速康复外科护理对腹腔镜胆囊切除术病人术前焦虑与术后康复的影响[J].全科护理,2014,12(16):1472-1473.
[2]丛丹,王征.快速康复外科在腹腔镜胆囊切除术围手术期护理中的应用[J].中国微创外科杂志,2014,14(11):1058-1059.
[3]HELMY SA.Prophylactic anti-emetic efficacy of ondansetron in laparoscopic cholecystectomy under total intravenous anaesthesia.Arandomised,double-blind comparison with droperidol,metoclopramide and placebo[J].Anaesthesia,1999,54(3):266-271.
[4]KOKKI M,BROMS S,ESKELINEN M,et al.Analgesic concentrations of oxycodone-A prospective clinical PK/PD study in patients with laparoscopic dholecystectomy[J].Basic Clin Pharmacol Toxicol,2012,110(5):469-475.
[5]向莉.快速康复护理对腹腔镜胆囊切除术术后康复中的效果研究[J].实用临床医药杂志,2015,19(4):66-68.
[6]袁耀宗.中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2014年,上海)[J].胃肠病学,2015,20(5):292-296.
[7]严广斌.视觉模拟评分法[J].中华关节外科杂志:电子版,2014,8(2):273.
[8]KHAN BA,GUZMAN O,CAMPBELL NL,et al.Comparison and agreement between the richmond agitation-sedation scale and the riker sedationagitation scale in evaluating patients'eligibility for delirium assessment in the ICU[J].Chest,2012,142(1):48-54.
[9]马雪,胡占升.腹腔镜胆囊切除术与开腹胆囊切除术治疗老年急性胆囊炎的疗效比较[J].实用医学杂志,2015,31(6):931-933.
[10]张旭飞.腔镜胆囊次全切除术在急性复杂性胆囊炎患者治疗中的疗效观察[J].结直肠肛门外科,2016,22(S2):74-75.
[11]WRIGHT B.Does preoperative depression and/or serotonin transporter gene polymorphism predict outcome after laparoscopic cholecystectomy?[J].BMJ Open,2016,6(9):e007969.
[12]吕和平.疼痛管理小组对腹腔镜胆囊切除术后病人疼痛影响的观察[J].中南医学科学杂志,2015,43(6):716-718.
[13]SATTARI H,HAGHBIN MA,ETMINAN M,et al.Survey of the Effect of intraoperative intravenous lidocaine infusion on postoperative pain in laparoscopic cholecystectomy surgery[J].Pediatr Res,2015,13(10):937-948.
[14]BHATTACHARJEE HK,JALALUDEEN A,BANSAL V,et al.Impact of standard-pressure and low-pressure pneumoperitoneum on shoulder pain following laparoscopic cholecystectomy:a randomised controlled trial[J].Surg Endo,2016,31(3):1-9.
[15]SZENTAL JA,WEBB A,WEERARATNE C,et al.Postoperative pain after laparoscopic cholecystectomy is not reduced by intraoperative analgesia guided by analgesia nociception index(ANI誖)monitoring:a randomized clinical trial[J].Br J Anaesth,2015,114(4):640-645.
[16]卢永华,王英.触摸及音乐疗法对腹腔镜胆囊切除术患者焦虑及预后的影响[J].国际护理学杂志,2017,36(23)3278-3280.
[17]吴友祥,杨俊杰,晏彬,等.腹腔镜微创手术治疗老年急性胆囊炎患者的疗效及对机体免疫功能的影响[J].中国临床新医学,2017,10(4):347-350.
[18]王洁.快速康复外科护理对腹腔镜胆囊切除术病人术前焦虑与术后康复的影响[J].全科护理,2014,12(16):1472-1473.