加速康复外科理念在胃癌患者围术期护理中的应用
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摘要
目的探讨加速康复外科理念指导下的护理措施在胃癌患者围术期的应用效果。方法采用随机数字表法将2017年4—12月中国医学科学院北京协和医学院肿瘤医院胰胃外科收治的60例经腹腔镜根治性胃大部切除+D2淋巴结清扫术治疗的胃癌患者分为加速康复外科组和常规组,每组30例。加速康复外科组遵循加速康复外科理念,应用修正的围术期教育、术前呼吸道准备、术后疼痛管理、早期活动、饮食督导及出院随访等方法进行护理,对照组按照传统胃癌围术期护理方法进行常规护理。比较两组患者术后的首次排气时间、首次下床活动时间、住院天数、住院费用、再入院率及术后疼痛评分等。结果加速康复外科组患者术后首次排气时间[(2.8±0.8)d]、首次下床活动时间[(1.3±0.6)d]、住院天数[(10.3±0.6)d]、住院费用[(5.7±0.6)万元]、再入院率(3.3%)及术后第1、3、7天疼痛评分[(3.1±0.8)、(1.3±0.6)、(1.0±0.3)分]均低于对照组[分别为(3.0±1.2)d,(3.2±1.3)d,(12.4±2.2)d,(7.3±1.5)万元,6.7%,(4.0±1.2)、(3.2±1.3)、(2.5±0.9)分],差异有显著性(P<0.05)。结论加速康复外科理念指导下的护理措施应用于胃癌患者围术期,可促进患者康复。
Objective The aim of the present study is to explore, in the perspective of nurses, the effects of application of nursingmeasurements modi?ed with enhanced recovery after surgery(ERAS) concept in the perioperative management of gastric cancer patients.Method Patients with gastric cancer treated by surgery between April 2017 and December 2017 in Cancer Hospital, Chinese Academyof Medical Sciences were divided into two groups randomly. The ERAS group were nursed following the concept of ERAS, applyingmodi?ed perioperative education, preoperative respiratory tract preparation, postoperative pain management, early postoperative activity,diet supervision and follow-up measurements after discharge. The control group was given traditional gastric cancer perioperative nursingmanagements. Postoperative recovery and pain status were compared. Result The ERAS group's ?rst time of expelling ?atuswas(2.8±0.8)days, the ?rst time of getting up was(1.3±0.6) days, the hospitalization duration was(10.3±0.6) days, the hospitalization expenses was(57±6) thousand yuan,rehospitalization rate was 3.3% and postoperative pain score was(3.1±0.8),(1.3±0.6) and(1.0±0.3). The controlgroup's ?rst time of expelling ?atus was(3.0±1.2) days, the ?rst time of getting up was(3.2±1.3) days, the hospitalization duration was(12.4±2.2)days,the hospitalization expenses was(73±15)thousand yuan,rehospitalization rate was 6.7% and postoperative pain score was(4.0±1.2),(3.2±1.3) and(2.5±0.9). There was a statistically signi?cant difference between the two groups in terms of the ?rst time ofexpelling ?atus and getting up, the hospitalization duration, the hospitalization expenses, rehospitalization rate, and postoperative pain score(P<0.05). Conclusion Application of nursing measurements modi?ed withenhanced recovery after surgery(ERAS) concept by nurses inthe perioperative management of gastric cancer patients is bene?cial and can promote the postoperative recovery.
Objective The aim of the present study is to explore, in the perspective of nurses, the effects of application of nursingmeasurements modi?ed with enhanced recovery after surgery(ERAS) concept in the perioperative management of gastric cancer patients.Method Patients with gastric cancer treated by surgery between April 2017 and December 2017 in Cancer Hospital, Chinese Academyof Medical Sciences were divided into two groups randomly. The ERAS group were nursed following the concept of ERAS, applyingmodi?ed perioperative education, preoperative respiratory tract preparation, postoperative pain management, early postoperative activity,diet supervision and follow-up measurements after discharge. The control group was given traditional gastric cancer perioperative nursingmanagements. Postoperative recovery and pain status were compared. Result The ERAS group's ?rst time of expelling ?atuswas(2.8±0.8)days, the ?rst time of getting up was(1.3±0.6) days, the hospitalization duration was(10.3±0.6) days, the hospitalization expenses was(57±6) thousand yuan,rehospitalization rate was 3.3% and postoperative pain score was(3.1±0.8),(1.3±0.6) and(1.0±0.3). The controlgroup's ?rst time of expelling ?atus was(3.0±1.2) days, the ?rst time of getting up was(3.2±1.3) days, the hospitalization duration was(12.4±2.2)days,the hospitalization expenses was(73±15)thousand yuan,rehospitalization rate was 6.7% and postoperative pain score was(4.0±1.2),(3.2±1.3) and(2.5±0.9). There was a statistically signi?cant difference between the two groups in terms of the ?rst time ofexpelling ?atus and getting up, the hospitalization duration, the hospitalization expenses, rehospitalization rate, and postoperative pain score(P<0.05). Conclusion Application of nursing measurements modi?ed withenhanced recovery after surgery(ERAS) concept by nurses inthe perioperative management of gastric cancer patients is bene?cial and can promote the postoperative recovery.
引文
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[2]臧潞,马君俊,郑民华.腹腔镜胃癌手术热点问题的再思考[J].中华胃肠外科,2017,20(8):841-846.
[3]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016版)[J].中华消化外科杂志,2016,15(6):527-533.
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[6]娄方丽,田辉.癌症病人疼痛管理态度研究进展[J].护理研究,2017,31(36):4591-4595.
[7]俞维飞,李益萍,谢浩芬,等.不置胃管并早期假食在腹腔镜胃癌手术中的应用[J].中华临床营养杂志,2014,22(4):246-248.
[8]Oh TK,Jeon JH,Lee JM,et al.Chronic smoking is not associated with increased postoperative opioid use in patients with lung cancer or esophageal cancer[J].Pain Physician,2018,21(1):E49-E55.
[9]Bu J,Li N,Huang X,et al.Feasibility of fast-track surgery in elderly patients with gastric cancer[J].J GastrointestSurg,2015,19(8):1391-1398.
[10]王婷,邱文娟,顾君君,等.ICU护士对心脏手术患者及家属实施术前宣教的效果观察[J].齐鲁护理杂志,2015,21(2):38-40.
[11]李益萍,邱江锋,曹晖.加速康复外科在腹腔镜胃癌根治术围手术期中的应用[J].中华胃肠外科杂志,2016,19(3):269-273.
[12]Kim SB,Kim SM.Short-term analysis of food tolerance and quality of life after laparoscopic greater curvature plication[J].Yonsei Med J,2016,57(2):430-440.
[13]徐敏,赵慧莉,张仪芝.56例食管癌患者术后延续饮食指导的实践[J].中华护理杂志,2016,51(4):400-403.
[14]韦旭楠,王昕.化解“看病难,看病贵”的方法及路径浅析[J].中国医刊,2016,5(51):111-112.
[15]宋秋香,康海芬,孙慧卿.快速康复外科在胃肠道术后病人早期康复活动中的应用效果[J].护理研究,2017,31(21):2670-2671.
[2]臧潞,马君俊,郑民华.腹腔镜胃癌手术热点问题的再思考[J].中华胃肠外科,2017,20(8):841-846.
[3]中国加速康复外科专家组.中国加速康复外科围手术期管理专家共识(2016版)[J].中华消化外科杂志,2016,15(6):527-533.
[4]Li YJ,Huo TT,Xing J,et al.Meta-analysis of efficacy and safety of fast-track surgery in gastrectomy for gastric cancer[J].World JSurg,2014,38(12):3142-3151.
[5]Liu G,Jian F,Wang X,et al.Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer:a randomized controlled trial[J].Onco Targets Ther,2016,9(2):3345-3351.
[6]娄方丽,田辉.癌症病人疼痛管理态度研究进展[J].护理研究,2017,31(36):4591-4595.
[7]俞维飞,李益萍,谢浩芬,等.不置胃管并早期假食在腹腔镜胃癌手术中的应用[J].中华临床营养杂志,2014,22(4):246-248.
[8]Oh TK,Jeon JH,Lee JM,et al.Chronic smoking is not associated with increased postoperative opioid use in patients with lung cancer or esophageal cancer[J].Pain Physician,2018,21(1):E49-E55.
[9]Bu J,Li N,Huang X,et al.Feasibility of fast-track surgery in elderly patients with gastric cancer[J].J GastrointestSurg,2015,19(8):1391-1398.
[10]王婷,邱文娟,顾君君,等.ICU护士对心脏手术患者及家属实施术前宣教的效果观察[J].齐鲁护理杂志,2015,21(2):38-40.
[11]李益萍,邱江锋,曹晖.加速康复外科在腹腔镜胃癌根治术围手术期中的应用[J].中华胃肠外科杂志,2016,19(3):269-273.
[12]Kim SB,Kim SM.Short-term analysis of food tolerance and quality of life after laparoscopic greater curvature plication[J].Yonsei Med J,2016,57(2):430-440.
[13]徐敏,赵慧莉,张仪芝.56例食管癌患者术后延续饮食指导的实践[J].中华护理杂志,2016,51(4):400-403.
[14]韦旭楠,王昕.化解“看病难,看病贵”的方法及路径浅析[J].中国医刊,2016,5(51):111-112.
[15]宋秋香,康海芬,孙慧卿.快速康复外科在胃肠道术后病人早期康复活动中的应用效果[J].护理研究,2017,31(21):2670-2671.