快速康复外科理念在肝癌切除术围手术期护理中的应用

The application of fast track surgery theory to the perioperative nursing of hepatectomy for hepatocellular carcinoma

目的探讨快速康复外科(fast track surgery,FTS)理念运用于肝癌切除术围手术期护理措施中的效果和安全性。方法 2013年1月至2015年6月行肝脏切除术的肝癌患者共80例,按照手术时间分为对照组和观察组各40例。对照组采用一般围手术期护理模式,观察组采用FTS理念指导下的围手术期护理模式,比较两组患者的术中、术后情况,并发症发生率和血清学指标。结果对照组患者腹腔引流管拔除时间、术后下床活动时间、肛门排气时间、进食时间、排便时间、住院天数和住院费用均高于观察组,发生肝功能损害人数多于观察组,差异有统计学意义(P<0.05);两组患者手术方式、术中出血量、术中输血量、手术时间和肝门阻断时间比较,差异无统计学意义(P>0.05);两组患者术后3 d的C反应蛋白、前蛋白和谷丙转氨酶比较,差异有统计学意义(P<0.05)。结论 FTS理念运用于肝癌切除术围手术期护理中能有效改善患者的术后应激反应,减少术后不良反应,加快肝功能恢复,从而改善患者的预后。

Objective Purpose To explore the effect and safety of application of the theory of fast track surgery （FTS） to peri- operative nursing care in hepatectomy for patients with hepatocellular carcinoma. Methods Eighty patients with the resection of liver cancer from January 2013 to June 2015 were randomly divided into observation or control groups ,40 in each group. The control group used general perioperative nursing mode while the observation group used perioperative nursing mode under the guidance of FTS theory. The intraoperative and postoperative status, incidence of complications and serum indexes were compared between the two groups. Re- suits The time of removal of the drainage tube, time of postoperative ambulation, anal exhaust time, eating time, defecation time, hospi- talization days and hospitalization costs in the control group were longer, more or higher than those in the observation group （P〈0. 05 ）. The incidence of liver function damage in control group was higher than that in the observation group. All differences were statistically significant （P 〈 0. 05 ）. However, there was no significant difference in the operation mode, the amount of blood loss during operation, the amount of blood transfusion, the time of operation and the time of the hepatic portal occlusion between the two groups （ P〉0. 05 ）. There was significant difference in the value of CRP, pre-protein and ALT between the two groups （ P 〈 0.05 ）. ConclusionFTS concept used in perioperative nursing of liver resection of patients with liver cancer can be effective in improving the postoperative stress re- sponse, reduce postoperative adverse reactions, and accelerate the recovery of patients with liver function as well as improve the patient＇s prognosis.