医护一体模式在结直肠癌患者加速康复围手术期管理中应用的效果评价

The effects of doctor-nurse integrated care management model on fast track perioperative management of colorectal cancer patients

目的 探讨医护一体管理模式在结直肠癌患者加速康复流程（FT）围手术期管理中的应用效果.方法 回顾性分析2014年1～9月四川大学华西医院胃肠外科中心结直肠专业组收治的1 12例结直肠癌患者（创新组）和2011年1～9月收治的96例结直肠癌患者（对照组）的临床资料,比较2组患者术后早期康复指标、住院时间、30 d再入院率、住院费用及患者满意度等指标.结果 创新组患者的首次经肛排气时间、首次排便时间、首次经口进食时间、首次下床活动时间、拔除胃管时间、拔除引流管时间均早于对照组,其差异有统计学意义,P＜0.05,而2组尿管拔除时间比较差异无统计学意义,P＞0.05;住院时间方面,创新组平均住院时间（6.05±2.05）d,低于对照组的（7.85±3.22）d,2组比较差异有统计学意义,t=2.586,P＜0.05.术前等待时间创新组为（1.35±0.45）d,低于对照组的（2.56±0.63）d,2组比较,t=2.116,P＜0.05,差异有统计学意义.创新组患者满意度评分（94.12±3.12）分,高于对照组的（86.36±5.51）分,差异有统计学意义,t=2.589,P＜0.05.结论 医护一体模式能够促进结直肠癌FT患者的早期康复,缩短住院时间,减少住院费用,提升患者满意度.

Objective To explore effects of doctor-nurse integrated care management model on fast track （FT） perioperative management of colorectal cancer patients.Methods Between January 2014 and September 2014,112 colorectal cancer patients （innovation group） underwent doctor-nurse integrated care and FT management in West China Hospital were analyzed retrospectively;who were compared with 96 patients （control group） underwent FT management from the same period of 2011.Early postoperative rehabilitation indicators,length of hospital stay,30d readmission rates,total hospitalization costs and patients satisfaction were compared.Results Innovation group of patients for the first time of post-operative flatus,defecation,oral feeding,ambulation,gastric and drainage tubes removal time were all earlier than those in control group,P ＜0.05,while the difference of urinary catheter tube removal time between the two groups was not statistically significant,P ＞ 0.05;the length of hospital stay in innovation group（6.05±2.05） d was significantly shorter than that in control group （7.85±3.22） d,P ＜ 0.05;preoperative hospital stay in innovation group was （1.35±0.45） d,shorter than that in control group （2.56±0.63）d,P ＜ 0.05;the patients satisfaction points in innovation group was （94.t2±3.12） points,which was higher than that in control group （86.36±5.51） points,t=2.589,P ＜0.05.Conclusion Doctor-nurse integrated care management model can improve postoperative rehabilitation effects,can reduce average hospital stay,total hospitalization costs and improve patients satisfaction.