腹腔镜下胰十二指肠切除术后胃排空延迟危险因素分析及护理对策

Analysis of risk factors of delayed gastric emptying after laparoscopic pancreaticoduodenectomy and nursing strategy

目的探讨腹腔镜下胰十二指肠切除术(LPD)后胃排空延迟的相关危险因素,总结预防和治疗的护理措施,为临床护理工作提供参考依据。方法回顾性收集2018年4月—2019年12月医院胆胰外科163例LPD患者的一般资料、实验室指标、手术基本资料、术后一般资料。按是否术后发生胃排空延迟对所有患者进行分组,分析影响其发生的危险因素。结果LPD术后胃排空延迟的影响因素包括糖尿病史(P=0.017)、体质量下降程度(P<0.001)、术后第3天与术后第1天白蛋白下降值(P=0.006)、术后下床活动时间(P=0.010)、术后并发胰瘘(P=0.005)、术后出血(P<0.001)及腹腔感染(P=0.031)。胃排空延迟组术后住院时间显著长于非胃排空延迟组(30.00±18.40 d vs.21.00±7.90 d,P=0.016)。结论LPD术后胃排空延迟延长患者的住院时间,影响患者术后恢复,其围术期影响因素较多。需加强危险因素评估,提供针对性护理,以减少LPD术后胃排空延迟的发生。

Objectives To investigate the risk factors of delayed gastric emptying(DGE)af⁃ter laparoscopic pancreaticoduodenectomy(LPD),and summarize the nursing measures of pre⁃vention and treatment for DGE,so as to provide reference basis for clinical nursing work in the fu⁃ture.Methods Between April 2018 and December 2019,clinicopathological data of 163 patients underwent LPD were retrospectively collected,including general information,laboratory data,operative data and postoperative outcomes.All patients were divided into 2 groups according to whether delayed gastric emptying occurred after operation,then risk factors of delayed gastric emptying following LPD were analyzed.Results The results shown that the diabetes(P=0.017),degree of weight loss(P<0.001),decrease of albumin on the 3rd and 1st day after opera⁃tion(P=0.006),off bed time after surgery(P=0.010),postoperative pancreatic fistula(P=0.005),postoperative bleeding(P<0.001),and intra-abdominal abscess(P=0.031)were associ⁃ated with the delayed gastric emptying after LPD.The postoperative hospital stay in the gastric emptying delayed group was significantly longer than that in the non-gastric emptying delayed group(30.00±18.40 vs.21.00±7.90 days,P=0.016).Conclusion Delayed gastric emptying after LPD prolongs the hospitalization time and affects the postoperative recovery of the patients.Due to many factors affect the occurrence of delayed gastric emptying,it is necessary to strength⁃en the assessment of risk factors and provide targeted nursing to reduce the occurrence of delayed gastric emptying after LPD.