胸外科ERAS理念下的多模式镇痛管理及护理
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摘要
目的探讨胸外科ERAS理念下的多模式镇痛管理及护理方法,观察其应用效果,为临床应用提供参考依据。方法选取南京医科大学第一附属医院胸外科2016年1月至2018年1月收治的90例肺癌患者为研究对象,均接受肺叶切除,给予多模式镇痛,按随机数字表分为观察组和对照组,每组45例。观察组采用加速康复外科理念实施围术期护理,对照组仅给予常规护理。比较两组患者的术后镇痛效果、快速康复指标(首次下床时间、住院时间)和并发症发生情况。结果观察组的NRS评分(3.24±0.78分)和中重度疼痛发生率(6.67%,3/45)均显著低于对照组[(4.67±0.80)分和(20%,9/45),均P<0.05],首次下床时间(18.14±7.82)h和平均住院时间(9.14±3.68)d均短于对照组[(26.90±11.19)h和(11.97±5.04)d,P<0.05]。观察组并发症1例,对照组3例,但差异无统计学意义(P>0.05)。结论胸外科ERAS理念下实施多模式镇痛管理及护理可显著减轻肺癌根治术患者的术后疼痛,促进患者术后快速康复。
Objective To explore the multi-modal analgesia management and nursing methods for thoracic surgery under the concept of ERAS, which provides reference for clinical application. Methods Ninety patients with lung cancer admitted to the Department of Thoracic Surgery were selected as study subjects. All patients underwent lobectomy and received multimodal analgesia. According to the random number table method, they were divided into observation group and control group with 45 cases in each group. The patients in observation group were treated with the concept of accelerated rehabilitation surgery for perioperative caring. While the patients in control group received routine care merely. The postoperative analgesic effect, rapid recovery index(first-time out of bed, length of stay) and complications were compared between the two groups. Results The NRS score(3.24±0.78) and the incidence of severe pain in observation group(6.67%) were significantly lower than those in the control group, which were(4.67±0.80) and 20%,respectively(P<0.05). The first-time out of bed and the average length of stay were shorter than those of the control group(P<0.05). Complications occurred 1 case in the doservation group and 3 cases in the control group, but there was no significant difference(P>0.05).Conclusions Multi-modality analgesia management and nursing method under the concept of ERAS for thoracic surgery can significantly relieve postoperative pain in patients undergoing radical surgery for lung cancer and promote rapid recovery after surgery.
Objective To explore the multi-modal analgesia management and nursing methods for thoracic surgery under the concept of ERAS, which provides reference for clinical application. Methods Ninety patients with lung cancer admitted to the Department of Thoracic Surgery were selected as study subjects. All patients underwent lobectomy and received multimodal analgesia. According to the random number table method, they were divided into observation group and control group with 45 cases in each group. The patients in observation group were treated with the concept of accelerated rehabilitation surgery for perioperative caring. While the patients in control group received routine care merely. The postoperative analgesic effect, rapid recovery index(first-time out of bed, length of stay) and complications were compared between the two groups. Results The NRS score(3.24±0.78) and the incidence of severe pain in observation group(6.67%) were significantly lower than those in the control group, which were(4.67±0.80) and 20%,respectively(P<0.05). The first-time out of bed and the average length of stay were shorter than those of the control group(P<0.05). Complications occurred 1 case in the doservation group and 3 cases in the control group, but there was no significant difference(P>0.05).Conclusions Multi-modality analgesia management and nursing method under the concept of ERAS for thoracic surgery can significantly relieve postoperative pain in patients undergoing radical surgery for lung cancer and promote rapid recovery after surgery.
引文
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[2] 杜娜,郭成林,杨梅,等.加速康复外科在中国大陆胸外科临床现状——基于胸外科医生及护士调查分析[J].中国肺癌杂志,2017,20(3):157-162.
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[5] 陆海波,陈默,司波,等.多模式镇痛对肺癌根治术患者术后疼痛和免疫功能的影响[J].中国临床研究,2015,11(28):1493-1495.
[6] Taniguchi H ,Sasaki T ,Fujita H ,et al.Modified ERAS protocol using preoperative oral rehydration therapy:outcomes and issues[J].J Anesth,2014,28(1):143-147.
[7] 夏燕,常淑文,叶敬霆,等.快速康复外科在肺癌手术患者中应用效果的Meta分析[J].中国肺癌杂志,2016,19(12):827-836.
[8] 陆蓓,马圣香,徐菁莉,等.胸腹腔镜联合食管癌术后患者的快速康复护理[J].中国肿瘤外科杂志,2013,5(6):399-400.
[9] 陈锋.加速康复外科(ERAS)理念在肺癌患者围手术期的应用效果[D].济南:山东大学,2017.
[10] Ljungqvist O,Scott M,Fearon KC.Enhanced recovery after surgery:A review[J].JAMA Surg,2017,152(3):292-298.
[11] 中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志,2016,15(1):1-6.
[12] Traeger AC,Hübscher M,Henschke N,et al.Effect of primary care-based education on reassurance in patients with acute low back pain:systematic review and meta-analysis[J].JAMA Intern Med,2015,175(5):733-743.
[13] 车国卫.加速肺康复外科临床实践及证据[J].中国肺癌杂志,2017,20(6):371-375.
[2] 杜娜,郭成林,杨梅,等.加速康复外科在中国大陆胸外科临床现状——基于胸外科医生及护士调查分析[J].中国肺癌杂志,2017,20(3):157-162.
[3] Jones KR,Vojir CP,Hutt E,et al.Determining mild,moderate,and severe pain equivalency across pain-intensity tools in nursing home residents[J].J Rehabil Res Dev,2007,44(2):305-314.
[4] 王文昊,朱自江,袁继宝,等.快速康复外科理念在胸腔镜下肺癌根治围手术期的临床应用[J].实用医药杂志,2017,34 (6) :513-515.
[5] 陆海波,陈默,司波,等.多模式镇痛对肺癌根治术患者术后疼痛和免疫功能的影响[J].中国临床研究,2015,11(28):1493-1495.
[6] Taniguchi H ,Sasaki T ,Fujita H ,et al.Modified ERAS protocol using preoperative oral rehydration therapy:outcomes and issues[J].J Anesth,2014,28(1):143-147.
[7] 夏燕,常淑文,叶敬霆,等.快速康复外科在肺癌手术患者中应用效果的Meta分析[J].中国肺癌杂志,2016,19(12):827-836.
[8] 陆蓓,马圣香,徐菁莉,等.胸腹腔镜联合食管癌术后患者的快速康复护理[J].中国肿瘤外科杂志,2013,5(6):399-400.
[9] 陈锋.加速康复外科(ERAS)理念在肺癌患者围手术期的应用效果[D].济南:山东大学,2017.
[10] Ljungqvist O,Scott M,Fearon KC.Enhanced recovery after surgery:A review[J].JAMA Surg,2017,152(3):292-298.
[11] 中国研究型医院学会肝胆胰外科专业委员会.肝胆胰外科术后加速康复专家共识(2015版)[J].中华消化外科杂志,2016,15(1):1-6.
[12] Traeger AC,Hübscher M,Henschke N,et al.Effect of primary care-based education on reassurance in patients with acute low back pain:systematic review and meta-analysis[J].JAMA Intern Med,2015,175(5):733-743.
[13] 车国卫.加速肺康复外科临床实践及证据[J].中国肺癌杂志,2017,20(6):371-375.