经尿道前列腺电切术围术期ERAS护理
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摘要
目的:观察在经尿道前列腺电切术(TURP)患者围术期中应用快速康复外科理念(ERAS)的临床效果。方法:收集我科2015年11月1日～2017年11月1日收治116例行TURP患者的临床资料。将患者随机分两组,试验组58例,采取术前缩短禁食水时间,减少机械灌肠和镇静,保持患者机体处在最佳状态;术中通过调节室温、液体加温、使用加温毯避免体温丢失并改良手术技巧,降低损害;术后早进食、早运动、恒温膀胱持续冲洗等ERAS理念相关措施。对照组58例,给予传统围术期处理方案。观察两组患者在患者舒适度、术后并发症发生以及对医护满意度方面的差异。结果:试验组和对照组术后首次排气时间分别为(8.5±1.7)h和(10.2±1.5)h,术后便秘发生率分别为17.24%和31.03%,术后膀胱痉挛发生率分别为10.34%和29.31%,术后出血率分别为12.07%和25.86%,膀胱持续冲洗时间分别为(113.76±10.68)h和(129.12±11.54)h。总住院时长分别为(11.34±1.8)d和(11.79±2.1)d。术后首次排气时间、膀胱持续冲洗时间、术后膀胱痉挛发生率以及患者舒适度方面差异有统计学意义(P<0.05);在术后便秘、术后出血、患者总住院时长以及医护工作满意度方面差异无统计学意义(P>0.05)。结论:在TURP患者围术期运用快速康复的理念,可以为患者提供安全、有效、全程的诊疗护理服务,符合快速康复的有关要求,也符合国家医改政策的需要,有一定的临床运用意义。
Objective:To assess the nursing effects of perioperative enhanced recovery after surgery(ERAS) on patients undergoing transurethral resection of the prostate(TURP).Methods:Clinical data were obtained from 116 admitted to and treated by TURP in our department between November 1 of 2015 and 2017.The cases were equally randomized into control observational group and control group.Patients in the observational group received perioperative nursing by ERAS,including water fasting by the scheduled operative time,reduced mechanical bowel washing and use of sedative,optimally maintained body temperature of the patients through theater temperature control,heated infusion and use of temperature control blanket as well as prevention of intraoperative injury,early food intake and encouraged off-bed exercise and continuous bladder irrigation by constant temperature,whereas patients in the control group were treated with conventional perioperative nursing.The two groups were compared concerning the patients′ comfort,incidences of postoperative complications and satisfaction with the surgeons and nurses.Results:The first exhaust time,incidence of postoperative constipation,postoperative bladder spasm,postoperative bleeding,continuous bladder irrigation time and total hospital stay were(8.5±1.7) h,(10.2±1.5) h;17.24%,31.03%;10.34%,29.31%;12.07%,25.86%;(113.76±10.68)h,(129.12±11.54)h;(11.34±1.8)d,(11.79±2.1)d,respectively for the observational group and control group.The difference was significant in the first exhaust time,continuous bladder irrigation time,incidence of postoperative bladder spasm,and patients′ comfort(P<0.05),yet was not significant in postoperative constipation and bleeding,total hospital stay and patients′ satisfaction with the medical care(P>0.05).Conclusion:Perioperative ERAS may lead to full and safe medical service for the patients undergoing TURP.This is consistent with national medical policy and requirements of medical reform,and worthy of clinical recommendation.
Objective:To assess the nursing effects of perioperative enhanced recovery after surgery(ERAS) on patients undergoing transurethral resection of the prostate(TURP).Methods:Clinical data were obtained from 116 admitted to and treated by TURP in our department between November 1 of 2015 and 2017.The cases were equally randomized into control observational group and control group.Patients in the observational group received perioperative nursing by ERAS,including water fasting by the scheduled operative time,reduced mechanical bowel washing and use of sedative,optimally maintained body temperature of the patients through theater temperature control,heated infusion and use of temperature control blanket as well as prevention of intraoperative injury,early food intake and encouraged off-bed exercise and continuous bladder irrigation by constant temperature,whereas patients in the control group were treated with conventional perioperative nursing.The two groups were compared concerning the patients′ comfort,incidences of postoperative complications and satisfaction with the surgeons and nurses.Results:The first exhaust time,incidence of postoperative constipation,postoperative bladder spasm,postoperative bleeding,continuous bladder irrigation time and total hospital stay were(8.5±1.7) h,(10.2±1.5) h;17.24%,31.03%;10.34%,29.31%;12.07%,25.86%;(113.76±10.68)h,(129.12±11.54)h;(11.34±1.8)d,(11.79±2.1)d,respectively for the observational group and control group.The difference was significant in the first exhaust time,continuous bladder irrigation time,incidence of postoperative bladder spasm,and patients′ comfort(P<0.05),yet was not significant in postoperative constipation and bleeding,total hospital stay and patients′ satisfaction with the medical care(P>0.05).Conclusion:Perioperative ERAS may lead to full and safe medical service for the patients undergoing TURP.This is consistent with national medical policy and requirements of medical reform,and worthy of clinical recommendation.
引文
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[7] 毕春娟,张巧红,醋爱英,等.护理风险预警监控在预防下肢深静脉血栓中的应用[J].护理学报,2016,23(4):30-32,33.
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[9] 郑晓蓝,徐碧文,唐小梅.舒适护理对手术室患者舒适度及护理满意度的影响[J].齐鲁护理杂志,2013,19(8):42-43.
[2] YUTAKA ODA,MANABU KAKINOHANA.Introduction of ERAS program into clinical pratice:from preoperative management to postoperative evaluation[J].Journal of Anesthesia,2014,28(1):141-142.
[3] DRAUTZ J,KAFKA-RITSCH R.Amount and influence of perioperative fluid administration on outcome in routine elective colorectal surgery according to an ERAS protocol [J].European Surgery,2015,47(2):56-58.
[4] LUCA GIANOTTI,LUCA NESPOLI.Safety,feasibility,and tolerance of early oral feeding after colorectal resection outside and enhanced recovery after surgery(ERAS)program[J].International Journal of Colorectal Disease,2011,26(6):747-753.
[5] 王音,胡三莲,庄敏,等.前列腺腔内汽化术中两种保温方法的效果比较[J].中华现代护理杂志,2011,17(14):1665-1666.
[6] 田昕玉,郑瑾.FTS理念在泌尿外科后腹腔镜手术病人围术期护理的应用研究[J].护理研究,2012,26(11):3104-3107.
[7] 毕春娟,张巧红,醋爱英,等.护理风险预警监控在预防下肢深静脉血栓中的应用[J].护理学报,2016,23(4):30-32,33.
[8] 丁萍.快速康复外科在泌尿外科患者围术期护理中的应用进展[J].护士进修杂志,2014,29(20):1854-1857.
[9] 郑晓蓝,徐碧文,唐小梅.舒适护理对手术室患者舒适度及护理满意度的影响[J].齐鲁护理杂志,2013,19(8):42-43.