基于加速康复外科理念缩短接台手术术前禁饮食时间的应用研究

Application of enhanced recovery after surgery-based multidisciplinary cooperation model in reducing preoperative fasting time of reception surgery

目的探讨基于加速康复外科(ERAS)理念的多学科协作模式对缩短接台手术术前禁饮食时间的应用效果,为接台手术术前禁饮食方案选择提供依据。方法回顾性分析青岛市市立医院2017年1月至2019年2月共计384例接台手术患者的临床信息,以实施传统术前禁饮食方案的患者作为对照组(156例);实施ERAS理念下多学科协作模式护理的患者作为试验组(228例),试验组按照ERAS指南制订围手术期禁饮食流程,并按照流程对试验组患者进行围手术期饮食管理。观察并比较2组患者术前实际禁饮食时间、术前饥饿程度、口渴发生率、胰岛素抵抗指数、临时停台率的差异。结果试验组术前禁饮食时间(4.01±1.55)h,短于对照组的(10.12±1.57)h,差异有统计学意义(t值为-1.65,P<0.01);试验组术前口渴、饥饿发生率分别为13.2%(30/228)、11.8%(27/228),低于对照组的89.7%(140/156)、87.2%(136/156),差异有统计学意义(χ^(2)值为220.20、215.20,P<0.01);试验组术后1、3 d胰岛素抵抗指数分别为1.85±0.43、1.52±0.61,低于对照组的1.99±0.51、1.67±0.49,差异有统计学意义(t值为-2.90、-2.56,P<0.05);试验组的临时停台率为1.75%(4/228),少于对照组的7.69%(12/156),差异有统计学意义(χ^(2)值为8.19,P<0.01)。结论应用ERAS理念的多学科协作模式可有效缩短接台手术患者术前禁饮食时间,降低胰岛素抵抗水平,减少术前饥饿、口渴的发生率。

Objective To explore the effect of enhanced recovery after surgery(ERAS)-based multidisciplinary collaboration model on shortening the time of forbidden eating before receiving surgery,provide the basis for the selection of the preoperative diet prohibition scheme.Methods From January 2017 to February 2019,a total of 384 patients who received the operation in Qingdao Municipal Hospital were analyzed retrospectively.The patients who under the traditional preoperative diet prohibition scheme were taken as the control group(156 cases)while those who under the multidisciplinary cooperation mode nursing under the concept of eras were taken as the experimental group(228 cases).The experimental group formulated the perioperative diet prohibition process according to the guidelines of eras,and the experimental group carried out the perioperative diet management for the patients according to the procedure.The difference between the two groups in the time of fasting,hunger,thirst incidence,insulin resistance,temporary stop will be observed and compared.Results The time of fasting was(4.01±1.55)h in the experimental group and(10.12±1.57)h in the control group,there was significant difference between the two groups(t value was-1.65,P<0.01).The incidences of thirst,hunger were 13.2%(30/228),11.8%(27/228)in the experimental group and 89.7%(140/156),87.2%(136/156)in the control group,there were significant differences between the two groups(χ^(2) values were 220.20,215.20,P<0.01).The levels of insulin resistance on the first and third day after operation were 1.85±0.43,1.52±0.61 in the experimental group and 1.99±0.51,1.67±0.49 in the control group,the differences were statistically significant(t values were-2.90,-2.56,P<0.05).The temporary stop rate was 1.75%(4/228)in the experimental group and 7.69%(12/156)in the control group,the difference was statistically significant(χ^(2) value was 8.19,P<0.01).Conclusions The ERAS-based multidisciplinary collaboration model can effectively shorten the preoperative fasting time,reduce the level of insulin resistance,reduce the incidence of hunger and thirst,and improve the rate of temporary stop and adjustment.