加速康复外科在腹腔镜肾癌根治术中的应用效果

EFFECT OF ENHANCED RECOVERY AFTER SURGERY IN PATIENTS TREATED WITH LAPAROSCOPIC RADICAL NEPHRECTOMY

目的探讨在后腹腔镜肾癌根治术中实施加速康复外科(ERAS)的效果。方法将63例行后腹腔镜肾癌根治术的病人随机分为对照组和ERAS组。对照组采用传统护理模式对病人实施常规护理,ERAS组在常规护理的基础上实施基于ERAS理念的优化护理措施。对两组病人术后进食时间、留置尿管及引流管时间、下床活动时间、住院时间、术后并发症发生率及病人满意度进行比较。结果 ERAS组术后进食时间、留置尿管及引流管时间、下床活动时间及平均住院时间均明显短于对照组(t=2.10~3.78,P<0.05)。ERAS组病人术后静脉炎发生率明显低于对照组(χ~2=6.644,P<0.05),尿路感染、出血、切口感染的发生率虽低于对照组,但差异无统计学意义(P>0.05)。ERAS组和对照组病人对医护工作满意度得分分别为(97.5±1.5)和(78.5±2.5)分,差异有统计学意义(t=28.54,P<0.01)。结论 ERAS在后腹腔镜肾癌根治术中的应用,促进了临床多学科协作,在不增加术后并发症的情况下,加速了病人术后康复,明显缩短了住院时间,降低了住院费用,使医护与病人的沟通加强,拉近了护患关系,病人满意度明显提高。

Objective To investigate the effect of enhanced recovery after surgery（ERAS）in patients treated with retroperitoneal laparoscopic radical nephrectomy.Methods A total of 63 patients treated with retroperitoneal laparoscopic radical nephrectomy were randomly divided into control group and ERAS group.The control group was given conventional nursing care,and the ERAS group was provided with both the conventional care and ERAS-based optimal nursing care.Time to postoperative first eating,durations of indwelling urinary catheter use and drainage tube use,time to ambulation,length of hospital stay,incidence of postoperative complications,and patients＇ degree of satisfaction were compared between the two groups.Results Compared with the control group,the ERAS group had significantly shorter time to postoperative first eating,durations of indwelling urinary catheter use and drainage tube use,time to ambulation,and mean length of hospital stay（t=2.10-3.78,P〈0.05）.The incidence rate of postoperative phlebitis was significantly lower in the ERAS group than in the control group（χ^2=6.644,P〈0.05）.The ERAS group had lower incidence rates of urinary tract infection,bleeding,and incision infection after surgery than the control group,but with no significant difference between the two groups（P〈0.05）.The degree of satisfaction was significantly different between the ERAS and control groups（97.5±1.5 vs 78.5±2.5;t=28.54,P〈0.01）.Conclusion Application of ERAS in patients treated with retroperitoneal laparoscopic radical nephrectomy has promoted clinical multidisciplinary collaboration,accelerated postoperative recovery with no increase in postoperative complications,significantly reduced hospital stay and costs,and strengthened communication and relationship between patients and medical staff,which has significantly improved patients＇ satisfaction.