ERAS理念指导下的细节护理在结肠肿瘤手术中的应用价值

Application value of detail nursing based on the the guidance of ERAS idea in colorectal tumor surgery

目的探讨快速康复外科(enhanced recovery after surgery,ERAS)理念指导下的手术室细节护理在结肠肿瘤手术中的临床应用价值。方法选取结肠肿瘤手术患者85例,随机分为观察组(n=40)和对照组(n=45)。对照组给予常规护理模式,而观察组则在ERAS理念指导下给予细节护理,比较2组患者术后VAS评分、围手术期应激状态、术后恢复情况、术后并发症和不良反应、患者满意度调查情况。结果观察组在术后1、3 d的VAS评分较对照组明显降低,差异有统计学意义(P<0.05);而术后7 d 2组患者VAS评分比较差异无统计学意义(P>0.05);观察组患者术后1~7 d C-反应蛋白及胰岛素抵抗指数显著低于对照组,差异均有统计学意义(P<0.05);观察组首次离床时间、首次排气时间、首次排便时间、首次进流食时间和出院时间均早于传统组,差异有统计学意义(P<0.05)。并且观察组患者术后腹胀、呕吐、肺部感染、切口感染的发生明显少于传统组(P<0.05);观察组与传统组患者术后并发症发生情况,如腹腔内感染、吻合口狭窄、腹腔内出血等差异无统计学意义(P>0.05);观察组患者的各项满意度(安全感和服务质量)均明显优于对照组,差异有统计学意义(P<0.05)。结论对于结肠肿瘤手术,在ERAS理念指导下应用细节护理,有利于患者术后加速康复,缩短住院时间,安全有效,同时未增加并发症的发生风险,且患者满意度高,建议临床推广。

Objective To investigate the Application value of detail nursing based on the the guidance of enhanced recovery after surgery(ERAS)idea in colorectal tumor surgery,and to explore the application value and safety of detailed nursing in operation room and fast track surgery(FTS)at perioperative period in patients with colon cancer.Methods A total of 85 patients with colon cancer who were admitted and treated by surgery in our hospital from August 2017 to August 2018 were randomly divided into control group(n=45)and observation group(n=45).The patients in control group were treated by traditional nursing mode,however,the patients in observation group were treated by operation room detail nursing based on the ERAS idea.The postoperative VAS score,perioperative stress state,postoperative recovery status,postoperative complications and adverse reactions as well as the satisfaction degree of patienttts were observed and compared between the two grousp.Results The VAS scores at d and 3d after operation in observation group were significantly lower than those in control group(P<0.05),however,there were no significant differences in VAS scores at 7d after operation between the two groups(P>0.05).The levels of C-reactive protein and insulin resistance index at 1~7 days after operation in observation group were significantly lower than those in control group(P<0.05).The first time to leave the bed,the first time to exhaust,the first time to defecate,the first time to enter the fluid and the time of discharging from hospital in observation group were significantly earlier than those in control group(P<0.05).Moreover the incidence rates of postoperative abdominal distension,vomiting,pulmonary infection and incision infection in observation group were significantly lower than those in control group(P<0.05).There were no significant differences in the incidence rates of postoperative complications including intra-abdominal bleeding,intra-abdominal infection and anastomotic stenosis between the two groups(P>0.05).In addition the satisfaction degree(security and service quality)of patients in observation group was superior to that in control group(P<0.05).Conclusion The application of detail nursing based on the the guidance of ERAS idea in colorectal tumor surgery is conducive to the accelerated postoperative recovery of patients,which can shorten the length of hospital stay,witheffectiveness and safety,without increasing the risk ofcomplications,with higher satisfactory degree ofpatients,therefor,it is worthy of clinical promotion.