同质医疗理念创新型护理实践对腹腔镜胆囊切除患者围术期应激反应的影响

Effect of innovative nursing practice on stress response of patients undergoing laparoscopic cholecystectomy

背景腹腔镜手术具有创伤小,出血少,并发症少和术后容易恢复等优点,尽管手术已经趋势成熟,但是很多患者会表现出特有的高度心理敏感性以及强烈的手术应激等特点,担心出现术后综合症,如食欲欠佳,腹泻等.同质医疗理念是由医护人员共同组建,共同协作开展临床医疗护理工作的团队.本研究基于同质医疗理念的创新护理模式应用于胆囊切除手术患者的实际护理中,以期为临床工作人员提供重要价值.目的探讨同质医疗理念创新型护理实践对腹腔镜胆囊切除患者围术期应激反应的影响.方法选择2017-04/2019-04在浙江省义乌市中心医院行腹腔镜胆囊切除患者80例为研究对象,根据住院顺序编号输入Excel表,采用随机数字表随机分为对照组和观察组各40例.对照组给予常规护理,如健康教育、心理疏导、饮食护理、术前护理和评估、病情护理、用药护理、术中术后常规护理和生命体征监测等护理.观察组在对照组基础上给予同质医疗理念的创新型护理实践.观察2组患者在术前(T0)1 d,气腹后(T1)10 min,手术结束时(T2)5 min时3个时间点应激指标变化情况,包括心率(heart rate,HR)、平均动脉压(mean arterial pressure,MAP)和血糖变化,同时抽取静脉血检测血浆去甲肾上腺素(noradrenaline,NE)、肾上腺素(adrenaline,E)水平和皮质醇水平.结果对照组患者在T1,T2时HR、MAP和血糖均高于T0,但在T2时间点较T1有所下降,仍较T0时间点水平高(P<0.05);而观察组HR、MAP和血糖变化趋势与对照组相同,但各时间差异无统计学意义(P>0.05);观察组HR、MAP和血糖在T1、T2时间点均低于对照组(P<0.05).与T0时间点比较,对照组在T1、T2时间点NE,E及皮质醇浓度均上升(P<0.05);观察组在T1时间点上升(P<0.05),在T2时间点下降(P<0.05).与对照组T1、T2时间点比较,观察组患者NE、E及皮质醇浓度均降低(P<0.05).结论同质医疗理念的创新型护理实践能显著降低腹腔镜胆囊切除患者围术期应激反应,有利于促进患者术后身体康复.

BACKGROUND Laparoscopic surgery has the advantages of less trauma,less bleeding,fewer complications,and faster postoperative recovery.Although laparoscopic surgery has become mature,many patients still show unique characteristics of high psychological sensitivity and strong surgical stress,and worry about postoperative syndrome,such as poor appetite,diarrhea and so on.The concept of homogeneous medical care is a team jointly established by medical staff to carry out clinical medical care.In this study,the innovative nursing model based on the concept of homogeneous medical care was applied to the actual nursing of patients undergoing cholecystectomy in order to provide a reference for clinical staff.AIM To explore the influence of innovative nursing practice on stress response of patients undergoing laparoscopic cholecystectomy.METHODS A total of 80 patients who underwent laparoscopic cholecystectomy at Yiwu Central Hospital of Zhejiang Province from April 2017 to April 2019 were selected as the subjects of the study.The patients were randomly divided into either a control group or an observation group with 40 cases each.Both groups were given routine nursing care,such as health education,psychological counseling,diet nursing,preoperative nursing and evaluation,condition nursing,medication nursing,intraoperative and postoperative routine nursing,and vital sign monitoring.The observation group was additionally given innovative nursing care based on the homogeneous medical concept.Changes in stress indicators,including heart rate(HR),mean arterial pressure(MAP),and blood glucose,were observed at one day before surgery(T0),10 min after pneumoperitoneum(T1),and 5 min after surgery(T2)in the two groups,and venous blood was collected to detect plasma noradrenaline(NE),adrenaline(E),and cortisol levels.RESULTS In the control group,HR,MAP,and blood glucose at T1 and T2 were all significantly higher than those at T0(P<0.05),but their levels at T2 were slightly lower those at T1 and still higher than those at T0(P<0.05).The change trends of HR,MAP,and blood glucose in the observation group were similar to those in the control group,but the differences were not statistically significant among different time points(P>0.05).HR,MAP,and blood glucose at T1 and T2 in the observation group were all significantly lower than those in the control group(P<0.05).Compared with those at T0,the concentrations of NE,E,and cortisol in the control group significantly increased at T1 and T2(P<0.05).In the observation group,the concentrations of NE,E,and cortisol increased at T1(P<0.05)and decreased at T2(P<0.05).Compared with the control group,the concentrations of NE,E,and cortisol at T1 and T2 were all decreased in the observation group(P<0.05).CONCLUSION Innovative nursing care based on the concept of homogenous medical treatment can significantly reduce the perioperative stress response of patients undergoing laparoscopic cholecystectomy,which is beneficial to promote the postoperative physical recovery of patients.