ERAS理念下的围术期系统化管理对颅内脑膜瘤患者术后恢复情况及近期预后的影响

Effect of perioperative systematic management under the concept of ERAS on postoperative recovery and short-term prognosis of patients with intracranial meningioma

目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念下的围术期系统化管理对颅内脑膜瘤患者术后恢复情况及近期预后的影响。方法收集颅内脑膜瘤患者113例的临床资料进行回顾性队列研究,根据护理方案分为对照组56例和观察组57例。对照组采取常规护理,观察组采取常规护理+ERAS理念下的围术期系统化管理。统计2组术后恢复情况(监护室停留时间、住院时间、首次下床活动时间、首次排便时间)、近期预后、并发症发生情况、护理满意度,比较护理前后的创伤后应激障碍量表(post-traum atic stressdisorder self-rating scale,PTSD-SS)、医学应对方式问卷(medical coping style questionnaires,MCMQ)。结果观察组监护室停留时间、住院时间、首次下床活动时间、首次排便时间均短于对照组(P<0.05);观察组干预后PTSD-SS量表5个维度评分均低于对照组(P<0.05);观察组干预后回避、屈服评分均低于对照组,面对评分均高于对照组(P<0.05);术后1个月、2个月、3个月观察组KPS评分高于对照组(P<0.05);观察组并发症发生率低于对照组,护理满意度高于对照组(P<0.05)。结论ERAS理念下的围术期系统化管理应用于颅内脑膜瘤患者,可促进术后恢复,减轻创伤后应激障碍,改善患者应对方式及预后,在降低并发症发生率、提高患者护理满意度方面具有积极作用。

Objective To investigate the impact of perioperative systematic management under the concept of enhanced recovery after surgery(ERAS)on postoperative recovery and short-term prognosis of patients with intracranial meningioma.Methods The clinical data of 113 patients with intracranial meningioma treated in our hospital were collected for a retrospective cohort study.According to different nursing programs,they were divided into the control group(n=56)and the observation group(n=57).The control group was treated with routine nursing and the observation group was supplementd with perioperative systemic management under the concept of ERAS.The postoperative recovery(duration of ICU stay,length of hospitalization,the first time of off-bed activity,time of first defecation),recent prognosis,incidence of complications and nursing satisfaction in the two groups were calculated.Post-traumatic stress disorder self-rating scale(PTSD-SS)and medical coping style questionnaires(MCMQ)before and after nursing were compared.Results The duration of ICU stay,length of hospitalization,the first time of off-bed activity and first defecation time were shorter than those in the control group(P<0.05).The scores of the five dimensions of the PTSD-SS scale in the observation group after intervention were lower than those of the control group(P<0.05).The avoidance and yield scores of the observation group after intervention were lower than those of the control group,and the face score was higher than that of the control group(P<0.05).At 1 month,2 months,and 3 months after operation,the KPS score of the observation group was higher than that of the control group(P<0.05).The incidence of complication in the observation group was lower than that of the control group,while the nursing satisfaction was higher than that of the control group(P<0.05).Conclusion Perioperative systemic management under the concept of ERAS can be applied to patients with intracranial meningioma,which can promote postoperative recovery,reduce post-traumatic stress disorder,improve patients′coping style and prognosis,and play a positive role in reducing the incidence of complications and improving nursing satisfaction of the patients.