快速康复外科护理模式对老年腹腔镜胆囊切除术患者手术应激和术后恢复的影响

Effect of rapid rehabilitation surgical nursing mode on surgical stress and postoperative recovery in elderly patients undergoing laparoscopic cholecystectomy

目的研究快速康复外科护理模式对老年腹腔镜胆囊切除术患者手术应激和术后恢复的影响。方法将2018年12月至2020年2月于泉州市中医院行腹腔镜胆囊切除术的78例老年患者作为研究对象,使用随机数字表法分为对照组(行常规围术期护理模式,n=39)与研究组(行快速康复外科护理模式,n=39),对两组生理应激指标、心理应激指标、术后恢复情况以及并发症发生情况进行比较。结果术后1 d,研究组肾上腺素水平、皮质醇水平均上升,但研究组低于对照组,差异有统计学意义(P<0.05);术后1 d,研究组汉密顿焦虑量表(HAMA)评分低于对照组,差异有统计学意义(P<0.05);研究组术后恢复时间(下床活动时间、肛门排气时间、饮食恢复正常时间、住院时间)均短于对照组,差异有统计学意义(P<0.05);研究组并发症(感染、切口疼痛、出血、胆漏)总发生率为5.13%,低于对照组的20.51%,差异有统计学意义(P<0.05)。结论将快速康复外科护理模式应用于老年腹腔镜胆囊切除术患者中可取得理想的效果,该护理模式有助于减轻患者的应激反应,缩短患者的康复时间,减少并发症的发生。

Objective To study the effect of rapid rehabilitation surgical nursing mode on surgical stress and postoperative recovery in elderly patients undergoing laparoscopic cholecystectomy.Methods A total of 78 elderly patients who underwent laparoscopic cholecystectomy in Quanzhou Hospital of Traditional Chinese Medicine from December 2018 to February 2020 were divided into the control group(39 patients received the mode of conventional perioperative nursing)and the study group(39 patients received the mode of rapid rehabilitation surgical nursing)according to the random number table method.The physiological stress indicators,psychological stress indicators,postoperative recovery and complications were compared between the two groups.Results At 1 d after surgery,the adrenal hormone level and cortisol level of the study group increased,but were lower than those of the control group,with statistically significant differences(P<0.05).At 1 d after surgery,the Hamilton Anxiety Scale(HAMA)score of the study group was lower than that of the control group,with statistically significant difference(P<0.05).The recovery time(time of getting out of bed,time of anal discharge,time of returning to normal diet,and length of stay)of the study group was shorter than that of the control group,with statistically significant difference(P<0.05).The total incidence of complications(infection,incisional pain,bleeding,and bile leakage)of the study group was 5.13%,which was lower than that of the control group(20.51%),with statistically significant difference(P<0.05).Conclusion The application of the rapid rehabilitation surgical nursing mode to elderly patients undergoing laparoscopic cholecystectomy can achieve ideal results.This nursing mode can help relieve the stress response of patients,shorten their recovery time and reduce the incidence of complications.