融入加速康复外科理念的临床护理路径在老年胃癌围手术期护理中的应用

Application of clinical nursing pathway based on enhanced recovery after surgery concept in perioperative nursing of gastric cancer in the elderly

目的探讨融入加速康复外科(ERAS)理念的临床护理路径在老年胃癌围手术期护理中的应用效果, 为临床护理方案的选择提供依据。方法选取2018年1月至2020年7月在合肥市第二人民医院行手术治疗的老年胃癌患者92例, 按照随机数字表法分为观察组与对照组, 每组46例, 对照组给予常规护理干预, 观察组给予融入ERAS理念的临床护理路径干预, 比较2组术后恢复情况、营养指标改善情况、术后并发症发生情况。结果观察组首次肠鸣音时间、首次排气时间、首次排便时间、首次下床活动时间、导尿管留置时间、术后住院时间分别为(18.43 ± 1.80) h 、(43.67 ± 8.79) h、(53.06 ± 5.18) h、(22.65 ± 4.95) h、(29.08 ± 2.69) h、(13.93 ± 2.19) d, 短于对照组的(22.96 ± 2.24) h、(47.98 ± 8.46) h、(57.97 ± 5.65) h、(31.30 ± 5.73) h、(35.40 ± 3.66) h、(15.48 ± 2.40) d, 差异有统计学意义(t值为2.40 ~ 10.69, 均P<0.05)。2组干预前营养指标比较差异无统计学意义(P>0.05);观察组干预后血清总蛋白、血清白蛋白和血红蛋白水平分别为(64.43 ± 6.22)、(35.43 ± 3.07)、(125.88 ± 4.75) g/L, 高于对照组的(55.97 ± 5.25)、(29.96 ± 2.64)、(120.05 ± 5.07) g/L, 差异有统计学意义(t = 7.05、9.16、5.69, 均P<0.05)。观察组术后总并发症发生率为4.35%(2/46), 低于对照组的19.57%(9/46), 差异有统计学意义(χ^(2) = 5.06, P<0.05)。结论融入ERAS理念的临床护理路径可有效保证老年胃癌患者术后康复过程中所需营养, 加快康复进程, 降低术后并发症发生率。

Objective To explore the application effect of clinical nursing pathway based on enhanced recovery after surgery(ERAS)concept in perioperative nursing of gastric cancer in the elderly,so as to provide basis for the selection of clinical nursing plan.Methods A total of 92 patients with gastric cancer who underwent surgical treatment in Hefei Second People′s Hospital from January 2018 to July 2020 were enrolled.They were divided into the observation group and the control group by random number table method,46 cases in each group.The control group was given routine nursing intervention,while the observation group was given clinical nursing pathway based on ERAS concept for intervention.The postoperative recovery,improvement of nutritional indexes,postoperative complications were compared between the two groups.Results The first bowel sound time,first exhaust time,first defecation time,leaving bed time,indwelling time of urinary catheter,and postoperative hospitalization time were(18.43±1.80)h,(43.67±8.79)h,(53.06±5.18)h,(22.65±4.95)h,(29.08±2.69)h,(13.93±2.19)d in the observation group,while(22.96±2.24)h,(47.98±8.46)h,(57.97±5.65)h,(31.30±5.73)h,(35.40±3.66)h,(15.48±2.40)d in the control group,there were significant differences between the two groups(t values were 2.40-10.69,all P<0.05).There was no significant difference in the nutritional indexes before intervention between the two groups(P>0.05).After intervention,the levels of serum total protein,serum albumin and hemoglobin were(64.43±6.22),(35.43±3.07),(125.88±4.75)g/L in the observation group,while(55.97±5.25),(29.96±2.64),(120.05±5.07)g/L in the control group,there were significant differences between the two groups(t=7.05,9.16,5.69,all P<0.05).The incidence of postoperative complications was 4.35%(2/46)in the observation group,19.57%(9/46)in the control group,there was significant difference between the two groups(χ^(2)=5.06,P<0.05).Conclusions The clinical nursing pathway based on ERAS concept can effectively ensure the nutrition needed by patients with gastric cancer during postoperative rehabilitation,accelerate rehabilitation process,and reduce the incidence of postoperative complications.