多学科协作下快速康复外科联合健康教育对腹腔镜下肝切除术患者恢复及并发症的影响

Effect of enhanced recovery after surgery under multidisciplinary team combined with health education on recovery and complications of patients undergoing laparoscopic hepatectomy

目的分析多学科协作下快速康复外科(ERAS)联合健康教育对腹腔镜下肝切除术患者术后恢复及并发症的影响。方法回顾分析常州市第二人民医院于2019年2月至2020年10月收治的112例拟行腹腔镜下肝切除术患者,根据护理方法的不同分为观察组(56例)、对照组(56例)。2组患者均行综合护理及健康指导,观察组另外增加多学科协作下ERAS干预。对比患者的手术情况、术后恢复指标、视觉模拟评分法(VAS)评分和并发症发生情况。结果观察组的术前准备时间短于对照组、术中出血量少于对照组,均存在统计学差异(P均<0.05)。观察组的首次进食时间、首次肛门排气时间、拔除腹腔引流管时间均早于对照组,住院时间短于对照组,均存在统计学差异(P均<0.05)。2组患者在术后1 h、6 h、12 h和24 h的VAS评分均较术前1 h升高(P均<0.05),但观察组在上述时间点的VAS评分均低于对照组,均存在统计学差异(P均<0.05)。观察组术后腹胀发生率低于对照组,存在统计学差异(P<0.05)。结论多学科协作下ERAS联合健康教育能够缩短行腹腔镜下肝切除术患者的术后恢复所需时间,降低其术后疼痛感和术后腹胀发生率。

Objective To analyze the effect of enhanced recovery after surgery(ERAS)under multidisciplinary team combined with health education on the postoperative recovery and complications of patients undergoing laparoscopic hepatectomy.Methods A total of 112 patients who were scheduled for laparoscopic hepatectomy in Changzhou Second People’s Hospital from February 2019 to October2020 were retrospectively analyzed.According to different nursing methods,they were assigned into an observation group(56 cases)and a control group(56 cases).Both groups received comprehensive nursing and health education,and the observation group additionally received ERAS intervention under multidisciplinary team.The operation-related indicators,postoperative recovery indicators,visual analogue scale(VAS)scores,and complications were compared between the two groups.Results The preoperative preparation time of the observation group was shorter than that of the control group,and the intraoperative blood loss was less than that of the control group(both P<0.05).The first feeding time,first anal exhaust time and the removal time of abdominal drainage tube in the observation group were earlier than those in the control group,and the length of hospital stay was shorter than that in the control group(all P<0.05).The VAS scores of the two groups at 1,6,12,and 24 hr after operation were higher than those at 1 hr before operation(all P<0.05),but the VAS scores of the observation group at the above time points were lower than those of the control group(all P<0.05).The incidence of postoperative abdominal distension in the observation group was lower than that in the control group(P<0.05).Conclusion ERAS combined with health education can shorten the postoperative recovery time of patients undergoing laparoscopic hepatectomy,and reduce the postoperative pain and the incidence of postoperative abdominal distension.