腹腔镜胆囊切除术后基于疼痛管理的康复护理效果评估

Evaluation of the effect of pain management-oriented rehabilitation nursing after laparoscopic cholecystectomy

目的探讨基于疼痛管理的康复护理对急性结石性胆囊炎患者腹腔镜胆囊切除术后疼痛控制、预后结局的影响。方法本研究为随机对照试验。选取2022年5月至2023年5月在安康市中医医院行腹腔镜胆囊切除术治疗的急性结石性胆囊炎患者113例,按照病床奇偶号将患者分为对照组(56例)和观察组(57例)。对照组男30例,女26例,年龄(59.38±4.02)岁,病程(5.12±1.24)h;观察组男35例,女22例,年龄(59.44±4.07)岁,病程(5.10±1.22)h。对照组患者接受常规护理,观察组患者接受基于疼痛管理的康复护理。比较两组患者手术恢复进程(肛门排气时间、进食流食时间、首次下床时间、住院时间)、术后不同时间点的疼痛控制[视觉模拟评分法(VAS)]、并发症发生率(切口感染、心律失常、粘连性肠梗阻、下肢血栓)及预后结局[生活质量综合评定问卷(GQOLI-74)]。统计学方法采用t检验、χ^(2)检验。结果观察组患者肛门排气时间、进食流食时间、首次下床时间及住院时间分别为(14.45±2.01)h、(9.74±1.27)h、(1.06±0.34)d、(7.80±1.03)d,均短于对照组的(18.64±2.17)h、(12.58±1.69)h、(2.37±0.76)d、(11.54±1.59)d,差异均有统计学意义(t=10.664、10.110、11.862、14.866,均P<0.001)。观察组患者在术后24 h、48 h、72 h疼痛评分分别为(6.03±0.97)分、(4.66±0.69)分、(3.13±0.63)分,均低于对照组的(7.24±1.26)分、(5.98±0.95)分、(4.55±1.02)分,差异均有统计学意义(t=5.726、8.439、8.921,均P<0.001)。观察组患者的并发症发生率[12.28%(7/57)比28.57%(16/56)],差异有统计学意义(χ^(2)=4.624,P=0.032)。观察组患者GQOLI-74的社会功能、躯体功能、物质生活、心理功能评分分别为(21.35±2.54)分、(22.24±2.40)分、(23.51±2.44)分、(22.12±2.77)分,均高于对照组的(17.41±2.26)分、(16.05±2.21)分、(18.35±2.46)分、(19.29±2.23)分,差异均有统计学意义(t=8.706、14.256、11.194、5.976,均P<0.001)。结论行腹腔镜胆囊切除术治疗的急性结石性胆囊炎患者应用基于疼痛管理的康复护理,能够有效控制疼痛,提高手术恢复进程及生活质量,降低并发症发生率。

Objective To explore the effects of pain management-oriented rehabilitation nursing on pain control and prognosis in patients undergoing laparoscopic cholecystectomy for acute cholelithiasis.Methods This study was a randomized controlled trial.A total of 113 patients undergoing laparoscopic cholecystectomy for acute cholelithiasis in Ankang Hospital of Traditional Chinese Medicine from May 2022 to May 2023 were selected and were randomly divided into a control group(56 cases)and an observation group(57 cases)based on their bed numbers.In the control group,there were 30 males and 26 females,aged(59.38±4.02)years,with a course of disease of(5.12±1.24)h.In the observation group,there were 35 males and 22 females,aged(59.44±4.07)years,with a course of disease of(5.10±1.22)h.The control group received standard care,while the observation group received pain management-oriented rehabilitation nursing.The postoperative recovery process(anal exhaust time,liquid feeding time,first ambulation time,and length of hospital stay),pain control at different postoperative time points[Visual Analogue Scale(VAS)],complication rate(incision infection,arrhythmia,adhesive intestinal obstruction,and lower limb thrombosis),and prognosis[Generic Quality of Life Inventory(GQOLI-74)]were compared between the two groups.Statistical methods used were t test andχ^(2) test.Results The anal exhaust time,liquid feeding time,first ambulation time,and length of hospital stay in the observation group were(14.45±2.01)h,(9.74±1.27)h,(1.06±0.34)d,and(7.80±1.03)d,which were shorter than those in the control group[(18.64±2.17)h,(12.58±1.69)h,(2.37±0.76)d,and(11.54±1.59)d],with statistically significant differences(t=10.664,10.110,11.862,and 14.866,all P<0.001).The pain scores of the observation group 24 h,48 h,and 72 h after surgery were(6.03±0.97),(4.66±0.69),and(3.13±0.63)points,which were lower than those of the control group[(7.24±1.26),(5.98±0.95),and(4.55±1.02)points],with statistically significant differences(t=5.726,8.439,and 8.921,all P<0.001).The complication rate of the observation group was lower than that of the control group[12.28%(7/57)vs.28.57%(16/56)],with a statistically significant difference(χ^(2)=4.624,P=0.032).The scores of social function,body function,material life,and psychological function of the GQOLI-74 in the observation group were(21.35±2.54),(22.24±2.40),(23.51±2.44),and(22.12±2.77)points,which were higher than those in the control group[(17.41±2.26),(16.05±2.21),(18.35±2.46),and(19.29±2.23)points],with statistically significant differences(t=8.706,14.256,11.194,and 5.976,all P<0.001).Conclusion The application of pain management-oriented rehabilitation nursing in patients undergoing laparoscopic cholecystectomy for acute cholelithiasis can effectively improve the pain control,enhance the postoperative recovery process and quality of life,and reduce the incidence of complications.