胸腹腔镜联合食管癌根治术围术期加速康复标准化护理流程的构建及初步应用

Construction and preliminary application of standardized nursing procedure for accelerated rehabilitation during perioperative period of thoracic laparoscopy combined with radical resection of esophageal cancer

目的探讨胸腹腔镜联合食管癌根治术围术期加速康复标准化护理流程的构建及初步应用效果。方法回顾性分析河南省人民医院2020-09—2021-04行胸腹腔镜联合食管癌根治术的80例食管癌患者的病例资料,以围术期加速康复标准化护理流程引入时间为分组依据。其中,2021-01—2021-04入院的40例围术期构建并实施加速康复标准化护理流程(观察组),选择2020-09—2020-12入院的40例围术期采用常规护理方案的患者为对照组。比较2组患者的一般资料。记录2组患者术后首次排气和排便时间、住院时间、第3天疼痛程度的NRS评分,以及干预后第7天的血红蛋白、白蛋白、前白蛋白营养指标。统计术后并发症、发生率。评价手术前后患者的焦虑(SAS)、抑郁(SDS)评分。结果2组患者的一般资料差异无统计学意义(P>0.05)。观察组患者术后首次排气时间、排便时间,住院时间均短于对照组,第3天的NRS评分低于对照组;干预后第7天的血红蛋白、白蛋白、前白蛋白营养指标高于对照组。干预后的焦虑、抑郁评分,以及并发症发生率均低于对照组。差异均有统计学意义(P<0.05)。结论胸腹腔镜联合食管癌根治术围术期构建并实施加速康复标准化护理流程,可优化术后临床指标,改善患者的营养状况和焦虑、抑郁不良情绪,并有利于降低术后并发症发生率。

Objective To explore the construction and preliminary application effect of standardized nursing procedure for accelerated rehabilitation during perioperative period of thoracic laparoscopy combined with radical resection of esophageal cancer.Methods The case data of 80 patients with esophageal cancer who underwent thoracic laparoscopy combined with radical resection of esophageal cancer in Henan Provincial People's Hospital from September 2020 to April 2021 were retrospectively analyzed.Based on the introduction time of standardized nursing procedures for accelerated rehabilitation during perioperative period,40 cases admitted from January 2021 to April 2021 were constructed and implemented during perioperative period(observation group).A total of 40 patients who were admitted to hospital from September 2020 to December 2020 and adopted routine nursing regimen during perioperative period were selected as the control group.The general data of the two groups were compared.The NRS scores of the first postoperative exhaust,defecation time,length of hospital stay,pain degree on day 3,and the nutritional indexes of hemoglobin,albumin and prealbumin on day 7 after intervention were recorded in the 2 groups.The incidence of postoperative complications was analyzed.The scores of anxiety(SAS)and depression(SDS)were evaluated before and after surgery.Results There was no significant difference in the general data between the two groups(P>0.05).The first postoperative exhaust time,defecation time and hospitalization time of observation group were shorter than those of control group,and the NRS score on day 3 was lower than that of control group.The nutritional indexes of hemoglobin,albumin and prealbumin on the 7th day after intervention were higher than those of the control group.The scores of anxiety,depression and complications after intervention were lower than those of the control group.The differences were statistically significant(P<0.05).Conclusion The establishment and implementation of standardized nursing procedures for accelerated rehabilitation during the perioperative period of thoracic laparoscopy combined with radical resection of esophageal cancer can optimize postoperative clinical indicators and improve the nutritional status,anxiety and depression of patients.And it is beneficial to reduce the incidence of postoperative complications.