标准化护理程序在肥胖患者腹腔镜下胃旁路术中的应用效果评价

Evaluation of the application effect of standardized nursing procedures on laparoscopic Roux-en-Y gastric bypass in obese patients

目的：探讨适合中国肥胖患者的腹腔镜下胃旁路手术的术中标准化护理操作流程。方法选择2010年5月-2013年1月完成腹腔镜下胃旁路术（ RYGB）的143例患者，早期按常规护理流程进行术中护理，在实施50例手术后，总结术中护理配合的经验教训，改进优化流程，建立了适合我院RYGB手术的术中标准化护理程序，比较实施前后两组的手术时间、术中出血量、住院费用、术后住院时间。结果标准化组平均手术时间（150．2±50．9） min，平均出血量（30．6±10．4） ml，平均住院费用（40748．3±5514．6）元，均低于对照组的（235．4±98．5）min，（50．7±10．7）ml，（44900．8±6176．4）元，两组比较差异有统计学意义（ t 分别为6．782，7．270，2．666；P＜0．01）；标准化组术后平均住院时间（3．7±1．3）d，对照组（3．9±1．3）d，差异无统计学意义（t＝0．709，P＞0．05）。结论实施标准化护理程序可以有效缩短手术时间，降低术中出血量，降低住院费用，提高手术效率。

Objective To explore the suitable standardized nursing procedures on laparoscopic Roux -en-Y gastric bypass （ RYGB） in obese patients in China .Methods One hundred and forty-three patients with laparoscopic RYGB from May 2010 to January 2013 were chosen and divided into the control group （n=50, at the early stage ） and the observation group （ n=93 , at the late stage ） .The control group received the routine nursing, and the observation group received the standardized nursing procedures which was established through the summary of the experience of nursing cooperation during the operation and was suitable for the RYGB in our hospital.The operating time, blood loss, hospitalization expense and postoperative hospital stay were compared in two groups .Results The average operating time , blood loss and hospitalization expense were respectively （150.2 ±50.9）min, （30.6 ±10.4）ml, （40 748.3 ±5 514.6）yuan in the observation group , and were lower than （235.4 ±98.5） min, （50.7 ±10.7） ml, （44 900.8 ±6 176.4） yuan in the control group, and the differences were statistically significant （t=6.782, 7.270, 2.666, respectively;P〈0.01）.The postoperative hospital stay was （3.7 ±1.3）d in the observation group, and were （3.9 ±1.3）d in the control group, and the difference was not statistically significant （t =0.709, P 〉0.05）.Conclusions The implementation of standardized nursing procedures can effectively shorten the operating time , reduce the blood loss and hospitalization expense , and improve the operation efficiency .