基于追踪方法学的加速康复外科理念在全腔镜下食管癌切除围手术期的应用

Application of the concept of fast-track surgery based on the tracking methodology in the perioperative period of laparoscopic total esophagectomy for esophageal cancer

目的 探讨基于追踪方法学的加速康复外科理念(ERAS)在全腔镜下食管癌切除围手术期中的应用价值。方法 选取2021年1月至2023年10月于安阳市肿瘤医院行全腔镜下食管癌切除术的146例患者纳入研究,按照随机数表法分为对照组和研究组各73例。对照组患者给予常规护理干预,研究组患者在对照组基础上给予基于追踪方法学的ERAS护理,两组患者均干预至出院。比较两组患者的康复指标,术后24 h、48 h、72 h、96 h的疼痛情况[视觉模拟量表(VAS)评分]以及并发症发生率和患者对护理的满意度。结果 研究组患者的首次下床活动时间、进食时间、排气时间及住院时间分别为(13.21±3.52) h、(20.10±2.08) h、(16.32±2.47) h、(7.12±1.02) d,明显短于对照组的(20.96±4.12) h、(27.63±3.11) h、(21.47±3.59) h、(11.29±1.53) d,差异均有统计学意义(P<0.05);研究组患者术后48 h、72 h、96 h的VAS评分分别为(4.12±0.32)分、(3.21±0.31)分、(2.75±0.30)分,明显低于对照组的(4.69±0.35)分、(4.09±0.34)分、(3.67±0.33)分,差异均有统计学意义(P<0.05);研究组患者的并发症发生率1.37%,明显低于对照组的10.96%,总护理满意度为97.26%,明显高于对照组的86.30%,差异均有统计学意义(P<0.05)。结论 基于追踪方法学的ERAS可减轻全腔镜下食管癌切除术患者术后疼痛感,降低并发症发生风险,促进病情康复,提升患者满意度。

Objective To explore the application value of the Enhanced Recovery After Surgery(ERAS)concept based on the tracking methodology in the perioperative period of laparoscopic total esophagectomy for esophageal cancer.Methods A total of 146 patients who underwent laparoscopic total esophagectomy at Anyang Cancer Hospital from January 2021 to October 2023 were selected for the study and divided into a control group(n=73)and a study group(n=73),according to the random number table method.Patients in the control group were given conventional nursing intervention,while those in the study group were given ERAS concept nursing based on the tracking methodology on the basis of the treatment in the control group.Both groups of patients were intervened until discharge.The recovery indicators of the two groups of patients,the pain situation(Visual Analogue Scale,VAS)at 24 h,48 h,72 h,and 96 h after surgery,as well as the complication rate and patients’satisfaction with nursing were compared.Results The time of first getting out of bed,the time of eating,the time of exhausting,and the duration of hospital stay in the study group were(13.21±3.52)h,(20.10±2.08)h,(16.32±2.47)h,and(7.12±1.02)d,respectively,which were significantly shorter than(20.96±4.12)h,(27.63±3.11)h,(21.47±3.59)h,and(11.29±1.53)d in the control group(all P<0.05).The VAS scores of patients in the study group at 48 h,72 h,and 96 h after surgery were(4.12±0.32)points,(3.21±0.31)points,and(2.75±0.30)points,respectively,which were significantly lower than(4.69±0.35)points,(4.09±0.34)points,and(3.67±0.33)points in the control group(all P<0.05).The complication rate in the study group was 1.37%,which was significantly lower than 10.96%in the control group(P<0.05).The overall satisfaction rate with nursing in the study group was 97.26%,which was significantly higher than 86.30%in the control group(P<0.05).Conclusion ERAS concept nursing based on tracking methodology can alleviate postoperative pain,reduce the risk of complications,promote rehabilitation and improve patient satisfaction in patients with total endoscopic resection of esophageal cancer.