快速康复外科护理策略联合多模式镇痛在胃肠道恶性肿瘤围手术期管理中的应用

Application of Enhanced Recovery After Surgery Combined with Multi-Modal Analgesia in Perioperative Management of Gastrointestinal Malignant Tumors

目的观察快速康复外科(ERAS)护理策略联合多模式镇痛(MMA)在接受腹腔镜手术的胃肠道恶性肿瘤患者围手术期管理中的应用效果及安全性。方法回顾性分析2018年1月至2021年12月在郑州大学第一附属医院接受腹腔镜手术的120例胃肠道恶性肿瘤患者的临床资料,根据护理方式分为对照组(60例)和研究组(60例)。对照组患者接受常规围手术期护理,术后镇痛接受阿片类药物自控镇痛(PCIA)。研究组患者在围手术期接受ERAS护理策略进行护理干预,术前接受疼痛评估,术后在PCIA的基础上,接受盐酸罗哌卡因经超声引导下腹横肌平面神经阻滞,并在术后根据疼痛程度按需接受非阿片类药物(曲马多)进行辅助镇痛。对比两组患者的术后视觉模拟评分量表(VAS)评分、术后下床活动时间、首次进食时间、首次排气时间、术后并发症发生率、镇痛补救率、平均住院时长、出院前营养状态以及护理满意度。结果两组患者一般资料比较,差异无统计学意义(P>0.05)。研究组患者的术后6、12、24、48 h VAS评分低于对照组(P<0.05)。研究组患者术后下床活动时间、首次进食时间、首次排气时间、术后发热发生率、下肢静脉血栓发生率、恶心呕吐发生率、术后镇痛补救率、平均住院时长、出院前营养评分、护理满意度均优于对照组(P<0.05)。结论ERAS护理策略联合MMA有助于降低胃肠道恶性肿瘤患者腹腔镜术后的疼痛程度,促进患者术后恢复,降低并发症发生率,缩短住院时间,提升护理满意度。

Objective To study the effects and safety of enhanced recovery after surgery(ERAS)nursing strategies combined with multi-modal analgesia(MMA)in the perioperative management of patients with gastrointestinal malignancies undergoing laparoscopic surgery.Methods The clinical data of 120 patients with gastrointestinal malignant tumors who underwent laparoscopic surgery in the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2021 were retrospectively analyzed.They were divided into control group(60 cases)and study group(60 cases)according to the nursing methods.Patients in the control group received routine perioperative care and received opioid with patient-controlled intravenous analgesia(PCIA)for postoperative analgesia.Patients in the study group received perioperative ERAS care strategy for nursing intervention,preoperative pain assessment.The patients in the study group received ERAS nursing strategy for nursing intervention in the perioperative period,received pain assessment before operation,and received ropivacaine hydrochloride on the basis of PCIA after operation,and also received ultrasound-guided transversus abdominis plane nerve block,and received non-opioid(tramadol)for adjuvant analgesia as needed according to the degree of pain after surgery.The postoperative visual analogue scale(VAS)score,postoperative time to get out of bed,first eating time,first exhausting time,postoperative complication rate,analgesic rescue rate,average hospital stay,pre-discharge nutrition status and nursing care satisfaction were compared between the two groups.Results There was no statistical significance in general data between the two groups of patients(P>0.05).The VAS scores of the patients in the study group at 6,12,24,and 48 h after the operation were lower than those in the control group(P<0.05).The postoperative time of getting out of bed in the study group,the first eating time,the first exhausting time,the incidence of postoperative fever,the incidence of lower extremity venous thrombosis,the incidence of nausea and vomiting,the postoperative analgesic recovery rate,the average hospital stay,the nutritional score before discharge,and the nursing care satisfaction rate were better than those of the control group(P<0.05).Conclusion ERAS nursing strategy combined with MMA can help reduce the pain sensation after laparoscopic surgery in patients with gastrointestinal malignant tumors,Promote the postoperative recovery of patients,reduce the incidence of complications,shorten the length of hospital stay,and improve nursing satisfaction.