经口内镜下肌切开术治疗贲门失弛缓症的护理体会

Nursing experience in patients following peroral endoscopic myotomy for achalasia

目的:分析经口内镜下肌切开术(POEM)治疗贲门失弛缓症(AC)的护理干预效果。方法:选取2014年8月～2017年10月我院择期行POEM的AC患者24例为研究对象,其中2014年8月～2016年10月就诊的10例患者为对照组,实施常规护理; 2016年11月～2017年10月就诊的14例患者为研究组,予以术前胃镜彻底冲洗食管、缓解心理焦虑与恐惧等护理。比较两组患者AC临床症状评分(Eckardt评分)、食管下端括约肌压力(LESP)、体质量指数(BMI)及术后3个月并发症情况。采用生活质量量表(QOL)、汉密顿焦虑量表(HAMA)、汉密顿抑郁自评量表(HAMD)评估并比较其生活质量及情绪状态。结果:研究组手术时间、住院时间短于对照组(P<0.05),术前收缩压、舒张压、心率低于对照组(P<0.05);研究组Eckardt评分、LESP低于对照组,而BMI高于对照组(P<0.05);研究组QOL评分高于对照组,而HAMA、HAMD评分较对照组低(P<0.05)。结论:对AC患者POEM围术期给予改良临床护理,能改善其临床症状、LESP、BMI及情绪,提高患者术后生活质量,值得在临床推广应用。

Objective： To assess the outcomes of nursing patients with aehalasia treated by peroral endoscopic myotomy（POEM）. Methods ：Twenty-four aehalasia patients treated with elective POEM were enrolled, and assigned to control group（ n=10, treated between August 2014 and October 2017） and observational group（n= 14, treated between November 2016 and October 2017）. Patients in the control group receive conventional nursing procedure, while those in the observational group were nursed with endoscopic irrigation of the oesophagus, relief of psychological anxiety and fear before operation. The two groups were compared regarding the score of clinical symptoms （ Eekardt score）, lower esophageal sphincter pressure （ LESP）, body mass index （BMI） ,incidences of complication following surgery and 3 months after operation. Quality of life scale （QOL）, l lamilton anxiety scale （HAMA） and l lam- ihon depression scale （IIAMD） were used to assess the quality of life and emotional state, and results were also compared between groups. Results：Patients in the observational group had shorter operative time, shortened hospital stay,lower intraoperative systolic and diastolic blood pressure and heart rate,lower Eekardt scoring and LESP, higher QOL, and decreased scoring on llAMA and IIAMD compared to those in the control group（all P〈0.05）. Conclusion： Perioperatively targeted clinical nursing of achalasia patients undergoing POEM may significantly improve the clinical symptoms, LESP, BMI and mood, as well as enhance the postoperative quality of life,suggesting that this nursing program is worthy of clinical recommendation.