集束化护理改善胃癌术后患者肠内营养耐受性的效果研究

Effects of bundle care on improving tolerance of enteral nutrition in postoperative patients with gastric carcinoma

目的 探讨集束化护理改善胃癌术后患者肠内营养耐受性的应用效果. 方法 将2016年5月—2017年1月在安徽省立医院胃肠外科行胃癌腹腔镜手术的180例患者根据随机数字表分成对照组和观察组,各90例.对照组患者术后采用肠内营养常规护理,观察组在常规护理的基础上实施集束化护理.比较两组患者的术后首次肛门排气时间、经口进食时间、胃肠道并发症发生情况、肠内营养日需要量完成情况、术后住院时间、住院费用和满意度.结果 观察组术后首次通气时间、首次进口进食时间为（62.77±17.29）、（62.77±10.11） h,早于对照组的（68.30±23.11）、（67.29±17.92） h,差异有统计学意义（t值分别为2.03、2.08;P〈0.05）.观察组患者恶心/呕吐、腹胀、腹泻的发生率（4.44%、11.11%、5.56%）低于对照组（13.33%、22.22%、15.56%）,两组比较差异有统计学意义（χ2值分别为4.39、4.72、4.77;P〈0.05）.观察组患者的肠内营养日需要量完成率为（98.74±1.07）%,优于对照组的（93.71±1.24）%,差异有统计学意义（t=27.57,P〈0.01）.观察组术后平均住院时间为（7.12±1.36） d,短于对照组的（9.02±2.21） d,差异有统计学意义（t=6.95,P〈0.01）;观察组住院费用为（3.81±1.12）万元,低于对照组的（4.12±1.09）万元,差异有统计学意义（t=2.25,P〈0.05）.观察组患者术后3 d和出院时满意度均高于对照组,差异有统计学意义（P〈0.05）.结论 胃癌术后早期肠内营养的实施集束化护理能提高肠内营养耐受性,提高患者的肠内营养日需要量完成率,缩短术后肛门排气时间及术后住院时间,降低住院费用,提高患者满意度.

Objective To explore the effects of bundle care on improving the tolerance of enteral nutrition （EN） in postoperative patients with gastric carcinoma. Methods Totally 180 patients who received laparoscopic surgery for gastric carcinoma in the Department of Gastrointestinal Surgery of Anhui Provincial Hospital from May 2016 to January 2017 were equally divided into a control group and an observation group according to the random number table. Patients in the control group received conventional nursing with enteral nutrition, while patients in the observation group received bundle care on the basis of conventional nursing. The time of first anal exhaust, time of oral intake, incidence of gastrointestinal complications, completion of daily EN consumption, duration of hospital stays, hospital expenses and satisfaction after surgery were then compared between the patients in the two groups. Results The time of first anal exhaust and oral intake of the patients in the observation group was （62.77±17.29） and （62.77±10.11）h, respectively, earlier than that of the patients in the control group, [（68.30±23.11） and （67.29±17.92）h; t=2.03, 2.08; P〈 0.05]. The incidence of sickness or emesis, abdominal distension and diarrhea of the patients in observation group was （4.44%, 11.11%, 5.56%）, lower than that of the patients in the control group, [（13.33%, 22.22%, 5.56%）; χ2=4.39, 4.72, 4.77; P〈0.05]. The completion rate of daily EN consumption of the patients in the observation group was （98.74±1.07）%, better than that of the patients in the control group [（93.71±1.24）%, t=27.57,P〈 0.01]. The average duration of hospital stays of the patients in the observation group was（7.12±1.36） days, shorter than that of the patients in the control group [（9.02±2.21） days; t=6.95,P〈0.01]. The hospital expense of the patients in the observation group was （38 100±11 200） RMB, less than that of the patients in the control group, [（41 200±10 900） RMB; t=2.25,P〈 0.05]. The patients in the observation group showed higher satisfaction 3 days after surgery and at discharge than the patients in the control group （P〈0.05）. Conclusions Bundle care can help to improve the EN tolerance, shorten the time of anal exhaust and the duration of hospital stays, reduce hospital expenses, and enhance patients＇ satisfaction in the process of early enteral nutrition after surgery.