数字信息化的麻醉访视在ERAS腔镜手术中的应用

Application of VCR mode anesthesia preoperative visit in endoscopic surgery within an ERAS protocol

目的探讨录像带(VCR)情景再现模式结合麻醉访视公众号的数字信息化术前访视模式在改善ERAS腔镜手术患者围术期心理应激及提高患者围术期配合度及访视满意度方面的作用。方法选取2019年1~12月在我院行日间腔镜手术患者200例,年龄18~60岁,ASA分级Ⅰ或Ⅱ级,随机分为对照组(R组,n=100)和试验组(V组,n=100),R组患者常规术前访视;V组由麻醉医生利用现场VCR情景再现模式配合麻醉访视微信公众号进行术前访视。采用焦虑自评量表评估2组患者在访视前后其心理焦虑情况,采用改良标准5问题(rS5Q)评估2组患者麻醉苏醒拔管配合度,并于术后24 h填写麻醉访视满意度调查表。比较2组患者访视前(T 1)及入室后(T 2)2个时刻的平均动脉压(MAP)、心率(HR)。结果V组与R组T 1时的焦虑评分无统计学意义,V组T 2时的焦虑评分明显低于R组(P<0.05);V组麻醉苏醒拔管期的配合度明显高于R组(P<0.05);V组麻醉访视满意度明显高于R组(P<0.05);V组T 1、T 2时的MAP、HR均明显低于R组(P<0.05)。结论数字信息化术前访视能有效缓解ERAS腔镜患者的围术期焦虑及围术期心理应激反应,提高患者麻醉苏醒期配合度,缩短患者术后苏醒拔管时间。同时提高了患者诊疗满意度,为患者的舒适化医疗提供了帮助。

Objective To investigate how video cassette recorder(VCR)scene reproduction mode combined with the digital information preoperative visit mode of anesthesia visit official account can improve the perioperative psychological stress of enhanced recovery after surgery(ERAS)patients with endoscopic surgery,improve the perioperative patient compliance and the satisfaction degree of anesthesia preoperative visit.Methods A total of 200 patients,aged 18 to 60 years,ASAⅠorⅡ,undergoing day laparoscopic surgery in our hospital from January to December 2019,were randomly divided into the control group(group R,n=100)and the experimental group(group V,n=100).Patients in group R received routine preoperative visits.While for those in group V,preoperative visits were completed through the cooperation between the scene reproduction mode of on-site VCR and the anesthesia visit WeChat official account.The anxiety self-rating scale was used to assess the psychological anxiety of patients before and after the visit,and the modified standard 5 questions(rS5Q)were used to assess the degree of cooperation in the anesthesia recovery and extubation of the two groups.Meanwhile the anesthesia visit satisfaction survey was filled in 24 h after the operation.The mean arterial pressure(MAP)and heart rate(HR)of patients of the two groups at before the visit(T 1)and after entering the operating room(T 2)were compared with each other.Results The anxiety scores of group V and group R at T 1 were not statistically significant.The anxiety scores of group V at T 2 were significantly lower than those of group R(P<0.05);the degree of cooperation in the extubation period of group V was significantly higher than that of group R(P<0.05).The satisfaction degree of anesthesia visit in group V was significantly higher than that of group R(P<0.05).The levels of MAP and HR of group V at T 1 and T 2 were significantly lower than those in group R(P<0.05).Conclusion Digital information preoperative visit can effectively relieve the perioperative anxiety and perioperative psychological stress of ERAS patients undergoing endoscopy,improve the cooperation of patients during the anesthesia recovery period,and shorten the postoperative recovery and extubation time.At the same time,the satisfaction rate of patients in the process of diagnosis and treatment has been improved,and it contributes to provide comfortable medical treatments for patients.