临床护理路径对微创胃肠手术患者应激反应的影响

Effects of clinical nursing pathway on the stress response of patients with micro-invasive gastrointestinal surgery

目的观察临床护理路径对微创胃肠手术患者围手术期应激反应的影响。方法选择2012年6月~2013年12月于我科行腹腔镜胃肠手术治疗的50例患者,根据住院号的奇偶分为对照组和观察组,每组25例。对照组给予常规护理,观察组在此基础上采用临床护理路径,比较两组患者围手术期应激反应。结果对照组T2时心率（HR）、平均动脉压（MAP）、血糖、肾上腺素、去甲肾上腺素和皮质醇水平均较T1时明显增高,T3时明显降低;观察组各项指标变化趋势同对照组,但波动幅度明显减小,与对照组比较差异有统计学意义（P〈0.05）。两组患者入院初SAS评分和生活质量量表得分比较,差异无统计学意义（P〉0.05）;出院前观察组患者的SAS评分和生活质量量表得分低于对照组,差异有统计学意义（P〈0.05）。结论在进行微创胃肠手术患者围手术期间采用临床护理路径方案,可降低负性情绪,提高生活质量,有利于患者安全平稳地度过手术期。

Objective To observe the effects of clinical nursing pathway on the peri-operative stress response of pa- tients with micro-invasive gastrointestinal surgery. Methods Fifty patients received laparoscopic gastrointestinal surgery from June 2012 to December 2013 in our department were divided into control group（25 cases） and observation group （25 cases） according to admission number. The control group received routine nursing while observation group received clinical nursing pathway based on routine nursing. The stress response was compared between two groups. Results In control group, the heart rate, mean arterial pressure, blood glucose, epinephrine, norepinephrine and cortisol levels at T2 were significantly higher than those at T1. All above indicators were significantly reduced at T3. The variation trend of all above indicators in observation group was the same as that in control group. The amplitude of variation of all above indicators in observation group was significantly smaller than that in control group（P〈0.05）. There was no sig- nificant difference in SAS score or life quality score between those two groups at admission（P〉0.05）. The SAS score and life quality score of observation group were significantly lower than those of control group before discharge（P〈0.05）. Conclusion The implementation of clinical nursing pathway can relieve the peri-operative stress response and nega- tive emotion of patients with micro-invasive gastrointestinal surgery and help patients improve life quality and undergo surgery safely.