快速康复理念在腹腔镜脾切除联合断流术围术期护理中的应用

Clinical effects of perioperative fast track nursing of laparoscopic splenectomy and azygoportal disconnection

目的 探讨腹腔镜脾切除联合断流术患者围术期快速康复护理的要点和临床疗效.方法 回顾性分析2016年1—11月扬州大学临床医学院收治的62例接受改良腹腔镜脾切除联合断流术的肝硬化门静脉高压症患者的临床资料.将实施围术期快速康复护理的32例患者设为观察组,取消鼻胃管插管,给予饮食管理、围术期保温、持续的低流量吸氧、早期活动、围术期补液量的限制与平衡等措施;将未施行快速康复护理的30例患者为对照组,给予常规围术期护理.比较两组临床疗效.结果 所有患者均顺利完成手术,观察组患者手术时间（165.6±12.3） min、术中失血量（109.4±64.8）ml,与对照组[（163.5±12.5） min,（103.7±51.2） ml]比较差异无统计学意义（t值分别为0.675、0.383;P〉0.05）;观察组患者术后进食时间（1.1±0.3） d、下床活动时间（1.2±0.4） d、肛门排气时间（2.4±0.8） d、发热天数（3.5±2.2） d及术后住院天数（9.0±1.6） d,均低于对照组[（1.9±0.6）、（2.6±0.7）、（3.0±0.9）、（4.8±2.2）、（10.4±2.2） d],差异有统计学意义（t值分别为-6.560、-9.795、-2.478、-2.371、-2.893;P〈0.05）.结论 腹腔镜脾切除联合断流术围术期的快速康复护理是术后快速康复的保证.

Objective To explore clinical effects and key points of perioperative fast track nursing of laparoscopic splenectomy and azygoportal disconnection. Methods A total of 62 cirrhotic patients with portal hypertension, who received improved laparoscopic splenectomy and pericardial devascularization between January and November 2016 in Clinical Medical College of Yangzhou University, were retrospectively reviewed and analyzed for clinical data.Patients in the observation group （n=32） were managed with perioperative fast track nursing with canceled nasogastric intubation, being given diet management, keeping warm during perioperative period, continuing low flow rate of oxygen inhalation,early activity,and restriction and balance of perioperative fluid infusion. Patients in the control group （n=30） just received routine perioperative nursing. The clinical effects of two groups were compared. Results Laparoscopic splenectomy and azygoportal disconnection were successful in all patients. There were no significant differences between the observation and control groups in operation time[ （165.6±12.3） min vs. （163.5±12.5） min]and blood loss[ （109.4±64.8） ml vs. （103.7±51.2） ml]（t=0.675, 0.383; P〉 0.05）. First oral intake time after operation was（1.1±0.3） d, postoperative off-bed activity time （1.2±0.4） d, initial passage of flatus time（2.4±0.8） d, postoperative fever （3.5±2.2） d and postoperative hospital stay（9.0±1.6） d in the observation group were all less than those in the control group [（1.9±0.6）,（2.6±0.7）, （3.0±0.9）, （4.8±2.2）, （10.4±2.2） d）]（t=-6.560, -9.795, -2.478,-2.371, -2.893;P〈 0.05）. Conclusions Perioperative fast track nursing of laparoscopic splenectomy and azygoportal disconnection will guarantee fast postoperative recovery.