原发性肝癌围手术期加速康复外科指导下集束化护理策略效果分析
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摘要
目的探讨原发性肝癌围手术期加速康复外科(ERAS)指导下集束化护理策略的效果分析。方法选取2015年9月-2017年3月于新疆维吾尔自治区人民医院就诊的共132例原发性肝癌拟行手术患者作为研究对象,按随机数字表法将所有患者分为对照组(n=58例)和研究组(n=74例)。对照组患者给予常规护理,研究组患者给予ERAS指导下的集束化护理,对比2组患者术后胃肠道功能恢复、预后情况、术前、术后ADL评分、术后24 h和术后48 h NRS评分、短期预后及术后并发症发生情况。结果研究组患者肛门首次排便、排气时间和肠鸣音恢复时间均明显短于对照组,有统计学差异(P<0.05)。研究组患者下床活动时间和术后住院时间与对照组相比均有统计学差异(P<0.05)。2组患者术前ADL评分比较无统计学差异(P>0.05),研究组患者术后3 d ADL评分明显高于对照组,有统计学差异(P<0.05)。2组患者术后24 h、术后48 h NRS评分比较均无统计学差异(P>0.05)。2组患者中均无30天内再次入院和围手术期死亡病例。研究组患者术后总体并发症发生率明显低于对照组(χ~2=4.228,P<0.05),研究组患者手术特有并发症发生率与对照组相比无统计学差异(χ~2=0.267,P>0.05),研究组患者一般并发症发生率明显低于对照组,且有统计学差异(χ~2=4.277,P<0.05)。结论在原发性肝癌患者中应用加速康复外科的集束化护理是可行的、有效的、安全的,与常规护理相比有优越性,值得推广。
Objective To study efficiency and feasibility of FTS(Fast track surgery) guided bundles of care after surgery for patients with primary liver cancer. Methods A total of 132 patients with primary liver cancer between September 2015 and March 2017 of People′s Hospital of Xinjiang were randomly divide into two groups. Control group was treated with traditional nursing, while study group with FTS guided bundles of care. The relative data were compared. Results The recovery time of gastrointestinal function such as anus bowel movement time, anus exhaust time and bowel sounds recovery time in the study group were all much shorter than in the control group, with statistical difference(P<0.05). The bed activity time and discharge time in the study group were both much shorter than in the control group, with statistical difference(P<0.05). The ADL score of two groups had no statistical difference(P>0.05), ADL score in the study group after operation was much higher than in the control group, and ADL scores of the two groups after operation were both much lower than pre-operation respectively, with statistical difference(P<0.05). NRS score of the two groups of 24 hours and 48 hours had no statistical difference(P>0.05). There was no readimission cases in 30 days and perioperative death cases of the two groups. The total postoperative complication rate in the study group was much lower than in the control group(χ~2=4.228, P<0.05), surgical complication rate of the study group had no statistical difference compared with the control group(χ~2=0.267, P>0.05), general complication rate in the study group was much lower than in the control group, with statistical difference(χ~2=4.277, P<0.05). Conclusion In patients with primary liver cancer, it is feasible, effective and safe to apply FTS guided bundles of care, which has significant advantages compared with conventional nursing.
Objective To study efficiency and feasibility of FTS(Fast track surgery) guided bundles of care after surgery for patients with primary liver cancer. Methods A total of 132 patients with primary liver cancer between September 2015 and March 2017 of People′s Hospital of Xinjiang were randomly divide into two groups. Control group was treated with traditional nursing, while study group with FTS guided bundles of care. The relative data were compared. Results The recovery time of gastrointestinal function such as anus bowel movement time, anus exhaust time and bowel sounds recovery time in the study group were all much shorter than in the control group, with statistical difference(P<0.05). The bed activity time and discharge time in the study group were both much shorter than in the control group, with statistical difference(P<0.05). The ADL score of two groups had no statistical difference(P>0.05), ADL score in the study group after operation was much higher than in the control group, and ADL scores of the two groups after operation were both much lower than pre-operation respectively, with statistical difference(P<0.05). NRS score of the two groups of 24 hours and 48 hours had no statistical difference(P>0.05). There was no readimission cases in 30 days and perioperative death cases of the two groups. The total postoperative complication rate in the study group was much lower than in the control group(χ~2=4.228, P<0.05), surgical complication rate of the study group had no statistical difference compared with the control group(χ~2=0.267, P>0.05), general complication rate in the study group was much lower than in the control group, with statistical difference(χ~2=4.277, P<0.05). Conclusion In patients with primary liver cancer, it is feasible, effective and safe to apply FTS guided bundles of care, which has significant advantages compared with conventional nursing.
引文
[1] 张慧玲,王雪华,顾娇娇,等.快速康复外科早期进食及活动对肝癌切除术后康复的影响[J].全科护理,2015,5(22):2194-2196.
[2] 吴明晶.术后早期进食护理对肝癌手术患者术后并发症及营养状态的影响[J].中国妇幼健康研究,2016,5(S1):475-476.
[3] KAPRITSOU M,KORKOLIS D P,GIANNAKOPOULOU M,et al.Fast-track recovery after major liver and pancreatic resection from the nursing point of view[J].Gastroenterol Nurs,2014,37(3):228-233.
[4] 麦结珍,李巧云,温文敏.快速康复外科在腹腔镜肝癌切除术围手术期康复护理的应用[J].消化肿瘤杂志(电子版),2015,13(4):223-226.
[5] KAMBAKAMBA P,SLANKAMENAC K,TSCHUOR C,et al.Epidural analgesia and perioperative kidney function after major liver resection [J].Br J Surg,2015,102(7):802-812.
[6] VIVERT E,BOLESLAWSKI E,COSSE C,et al.Arterial lactate concentration at the end of an elective hepatectomy is an early predictor of the postoperative course and a potential surrogate of intraoperative events[J].Ann Surg,2015,262(5):787-793.
[7] RHODWS D,CHENG A C,MCLELLAN S,et al.Reducing staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae:sucessful implementation of a care bundle at a large Australian health service [J].J Hosp Infect,2016,94(1):86-91.
[8] EOM J S,LEE M S,CHUN H K,et al.The impact of a ventilator bundle on preventing ventilator-associated pneumonia:a multicenter study[J].Am J Infect Control,2014,42(1):34-37.
[9] MORTENSEN K,NILSSON M,SLIM K,et al.Consensus guidelines for enhanced recovery after gastrectomy:Enhanced Recovery after Surgery(ERAS(R)) Society Recommendations[J].Br J Surg,2014,101(10):1209-1229.
[10] BONA S,MOLTENI M,ROSATI R,et al.Introducing an enhanced recovery after surgery program in colorectal surgery:a single center experience[J].World J Gastroentero,2014,20(46):17578-17587.
[11] HUGHES M J,MCNALLY S,WIGMORE S J.Enhanced recovery following liver surgery :a systematic review and meta-analysi[J].HPB(Oxford),2014,16(8):699-706.
[12] DASARI B V,RAHMAN R,KHAN S,et al.Safety and feasibility of an enhanced recovery pathway after a liver resection:prospective cohort study[J].HPB(Oxford),2015,17(8):700-706.
[13] 王红丽,陈玲,徐春艳,等 .基于德尔菲法构建加速康复外科肝癌患者围手术期护理方案[J].新疆医科大学学报,2019,42(3):415-419.
[14] MELLOUL E,HUBNER M,SCOTT M,et al.Guidelines for perioperative care for liver surgery:enhanced recovery after surgery (ERAS) society recommendations[J].World J Surg,2016,40(10):2425-2440.
[15] PAGE A J,EJAZ A,SPOLVERATO G,et al.Enhanced recovery after surgery protocols for open hepatectomy-physiology ,immunomodulation ,and implementation[J].J Gastrointest Surg,2015,19(2):387-399.
[2] 吴明晶.术后早期进食护理对肝癌手术患者术后并发症及营养状态的影响[J].中国妇幼健康研究,2016,5(S1):475-476.
[3] KAPRITSOU M,KORKOLIS D P,GIANNAKOPOULOU M,et al.Fast-track recovery after major liver and pancreatic resection from the nursing point of view[J].Gastroenterol Nurs,2014,37(3):228-233.
[4] 麦结珍,李巧云,温文敏.快速康复外科在腹腔镜肝癌切除术围手术期康复护理的应用[J].消化肿瘤杂志(电子版),2015,13(4):223-226.
[5] KAMBAKAMBA P,SLANKAMENAC K,TSCHUOR C,et al.Epidural analgesia and perioperative kidney function after major liver resection [J].Br J Surg,2015,102(7):802-812.
[6] VIVERT E,BOLESLAWSKI E,COSSE C,et al.Arterial lactate concentration at the end of an elective hepatectomy is an early predictor of the postoperative course and a potential surrogate of intraoperative events[J].Ann Surg,2015,262(5):787-793.
[7] RHODWS D,CHENG A C,MCLELLAN S,et al.Reducing staphylococcus aureus bloodstream infections associated with peripheral intravenous cannulae:sucessful implementation of a care bundle at a large Australian health service [J].J Hosp Infect,2016,94(1):86-91.
[8] EOM J S,LEE M S,CHUN H K,et al.The impact of a ventilator bundle on preventing ventilator-associated pneumonia:a multicenter study[J].Am J Infect Control,2014,42(1):34-37.
[9] MORTENSEN K,NILSSON M,SLIM K,et al.Consensus guidelines for enhanced recovery after gastrectomy:Enhanced Recovery after Surgery(ERAS(R)) Society Recommendations[J].Br J Surg,2014,101(10):1209-1229.
[10] BONA S,MOLTENI M,ROSATI R,et al.Introducing an enhanced recovery after surgery program in colorectal surgery:a single center experience[J].World J Gastroentero,2014,20(46):17578-17587.
[11] HUGHES M J,MCNALLY S,WIGMORE S J.Enhanced recovery following liver surgery :a systematic review and meta-analysi[J].HPB(Oxford),2014,16(8):699-706.
[12] DASARI B V,RAHMAN R,KHAN S,et al.Safety and feasibility of an enhanced recovery pathway after a liver resection:prospective cohort study[J].HPB(Oxford),2015,17(8):700-706.
[13] 王红丽,陈玲,徐春艳,等 .基于德尔菲法构建加速康复外科肝癌患者围手术期护理方案[J].新疆医科大学学报,2019,42(3):415-419.
[14] MELLOUL E,HUBNER M,SCOTT M,et al.Guidelines for perioperative care for liver surgery:enhanced recovery after surgery (ERAS) society recommendations[J].World J Surg,2016,40(10):2425-2440.
[15] PAGE A J,EJAZ A,SPOLVERATO G,et al.Enhanced recovery after surgery protocols for open hepatectomy-physiology ,immunomodulation ,and implementation[J].J Gastrointest Surg,2015,19(2):387-399.