加速康复外科理念在小儿胸腔镜肺切除术护理中的应用

Application of perioperative nursing with enhanced recovery after surgery concept in pediatric thoracoscopic pulmonary resection

目的:探讨加速康复外科理念在小儿胸腔镜肺切除术围手术期护理中应用的策略和价值。方法:将2017年7月至2017年12月在四川大学华西医院接受胸腔镜肺切除术的患儿纳入对照组,2018年1月至2018年8月在四川大学华西医院接受同样术式的患儿纳入试验组,每组62例。对照组采用胸腔镜手术传统护理措施,试验组采用加速康复外科理念指导下的护理措施,对比两组患儿在术后呕吐、腹胀、误吸、术后并发症、家属的焦虑评分以及住院满意度的差异。结果:两组术后均未出现呕吐、腹胀、误吸等情况,均一次手术痊愈出院,无严重术后并发症。出院及术后3个月于门诊复查X线片或CT示肺膨胀良好,患儿生长发育正常,未见特殊不适或胸廓畸形,亦未见原发疾病复发征象。试验组与对照组患儿家属的焦虑评分分别是3.48±0.85和5.30±1.76,差异有统计学意义(t=–3.474,P=0.001);住院满意度分别为98.39%和87.10%,差异有统计学意义(χ2=6.764,P<0.001)。结论:加速康复外科理念指导下围手术期的护理方法能够有效促进胸腔镜肺切除术患儿术后康复,显著提升患儿及家属的就医体验,降低家属的焦虑情绪,是对传统胸腔镜手术护理理念的重要创新与完善。

Objective: To investigate the protocol and value of application of perioperative nursing with enhanced recovery aft er surgery(ERA S) concept in pediatric thoracoscopic pulmonary resection. Methods: Nursing protocol with ERA S concept was developed for pediatric patients undergoing thoracoscopic pulmonary resection in 2018, and before that, traditional nursing measures were used in West China Hospital of Sichuan University. The results between Jan, 2018 to Aug, 2018(62 patients) were compared with those of a historical cohort of 62 patients from Jul, 2017 to Dec, 2017. The occurrence of postoperative vomiting, distension, aspiration, complications, parents’ anxiety score and satisfaction were compared. Results: There were no vomiting, abdominal distension and aspiration in patients of both groups postoperatively. Th e recovery was uneventful and no reoperation was needed. Chest X-ray or CT scan showed well expansion of the lungs 3 months aft er surgery. All patients thrive well without chest malformation, recurrence and other complaints. Th e anxiety score and satisfaction were 3.48±0.85 vs 5.30±1.76(t=-3.474, P=0.001) and 98.39% vs 87.10%(χ~2=6.764, P<0.001) in the ERAS group and the traditional group respectively. Conclusion: Th e perioperative nursing with ERA S concept, which can promote rehabilitation of pediatric patients undergoing thoracoscopic pulmonary resection, and alleviate the parents’ anxiety, is an important innovation and perfection of traditional thoracoscopic surgery nursing concepts.