加速康复外科理念在胃癌患者围术期护理中的应用

Effect of rapid surgical rehabilitation applied in the perioperative nursing of gastric cancer patients

目的探讨加速康复外科理念指导下的护理措施在胃癌患者围术期的应用效果。方法采用随机数字表法将2017年4—12月中国医学科学院北京协和医学院肿瘤医院胰胃外科收治的60例经腹腔镜根治性胃大部切除+D2淋巴结清扫术治疗的胃癌患者分为加速康复外科组和常规组,每组30例。加速康复外科组遵循加速康复外科理念,应用修正的围术期教育、术前呼吸道准备、术后疼痛管理、早期活动、饮食督导及出院随访等方法进行护理,对照组按照传统胃癌围术期护理方法进行常规护理。比较两组患者术后的首次排气时间、首次下床活动时间、住院天数、住院费用、再入院率及术后疼痛评分等。结果加速康复外科组患者术后首次排气时间[(2.8±0.8)d]、首次下床活动时间[(1.3±0.6)d]、住院天数[(10.3±0.6)d]、住院费用[(5.7±0.6)万元]、再入院率(3.3%)及术后第1、3、7天疼痛评分[(3.1±0.8)、(1.3±0.6)、(1.0±0.3)分]均低于对照组[分别为(3.0±1.2)d,(3.2±1.3)d,(12.4±2.2)d,(7.3±1.5)万元,6.7%,(4.0±1.2)、(3.2±1.3)、(2.5±0.9)分],差异有显著性(P<0.05)。结论加速康复外科理念指导下的护理措施应用于胃癌患者围术期,可促进患者康复。

Objective The aim of the present study is to explore,in the perspective of nurses,the effects of application of nursingmeasurements modified with enhanced recovery after surgery(ERAS) concept in the perioperative management of gastric cancer patients.Method Patients with gastric cancer treated by surgery between April 2017 and December 2017 in Cancer Hospital,Chinese Academyof Medical Sciences were divided into two groups randomly.The ERAS group were nursed following the concept of ERAS,applyingmodi?ed perioperative education,preoperative respiratory tract preparation,postoperative pain management,early postoperative activity,diet supervision and follow-up measurements after discharge.The control group was given traditional gastric cancer perioperative nursingmanagements.Postoperative recovery and pain status were compared.Result The ERAS group’s first time of expelling flatuswas(2.8±0.8)days,the ?rst time of getting up was(1.3±0.6) days,the hospitalization duration was(10.3±0.6) days,the hospitalization expenses was(57±6) thousand yuan,rehospitalization rate was 3.3% and postoperative pain score was(3.1±0.8),(1.3±0.6) and(1.0±0.3).The controlgroup’s first time of expelling flatus was(3.0±1.2) days,the first time of getting up was(3.2±1.3) days,the hospitalization duration was(12.4±2.2)days,the hospitalization expenses was(73±15)thousand yuan,rehospitalization rate was 6.7% and postoperative pain score was(4.0±1.2),(3.2±1.3) and(2.5±0.9).There was a statistically signi?cant difference between the two groups in terms of the ?rst time ofexpelling ?atus and getting up,the hospitalization duration,the hospitalization expenses,rehospitalization rate,and postoperative pain score(P<0.05).Conclusion Application of nursing measurements modi?ed withenhanced recovery after surgery(ERAS) concept by nurses inthe perioperative management of gastric cancer patients is beneficial and can promote the postoperative recovery.