加速康复护理在腹腔镜子宫全切术患者中的应用研究

孔海燕; 陈丽芬; 周英姿; 滕智敏; 余淑炬; 胡玮; 张徐

doi:10.16766/j.cnki.issn.1674-4152.002213

加速康复护理在腹腔镜子宫全切术患者中的应用研究

doi: 10.16766/j.cnki.issn.1674-4152.002213

温州医科大学附属第一医院妇科，浙江温州 325000

基金项目:

浙江省自然科学基金项目 LQ21H160044

详细信息

通讯作者:
陈丽芬，E-mail：nsdgnsds@163.com

中图分类号: R473.71 R713.42
计量
- 文章访问数: 186
- HTML全文浏览量: 91
- PDF下载量: 3
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-23
- 网络出版日期: 2022-02-15

Application effect of fast rehabilitation nursing on patients after laparoscopic hysterectomy

Department of Gynecology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨加速康复护理在腹腔镜子宫全切术患者中的应用效果，为提高护理质量提供依据。方法选取2020年7—12月温州医科大学附属第一医院收治的220例行腹腔镜子宫全切手术的患者，按照随机数字表法分为对照组和观察组，每组110例。对照组给予常规护理干预，观察组则给予加速康复护理，包括术前减轻患者的焦虑、抑郁情绪，缩短禁食禁水时间；术中限制性输液；术后早期进食、早期拔管、早期运动锻炼、疼痛管理等护理措施。比较2组患者心理状态、疼痛评分、术后恢复情况、并发症发生率。结果护理后(术前1 d), 观察组SAS和SDS评分显著低于对照组(均P＜0.05)。观察组术后不同时间的NRS评分均显著低于对照组，差异有统计学意义(均P＜0.05)。观察组首次排气时间、首次下床活动时间、术后住院时间分别为(16.73±1.65)h、(12.78±1.43)h和(3.71±0.42)d，均显著低于对照组[(20.61±2.38)h、(21.06±2.45)h和(5.03±0.65)d], 差异有统计学意义(均P＜0.05)。观察组并发症发生率为5.45%，显著低于对照组的29.09%(P＜0.05)。结论加速康复护理应用于腹腔镜子宫全切术患者临床效果理想，值得推广。
- 加速康复护理 /
- 腹腔镜子宫全切术 /
- 护理
Abstract: Objective To study the application effect of fast rehabilitation nursing on patients after laparoscopic hysterectomy and to provide a basis for improving the quality of nursing. Methods A total of 220 patients who underwent laparoscopic hysterectomy from July to December 2020 were randomly divided into the control group and observation group, with 110 cases in each group. The control group was given routine nursing intervention, whilst the observation group was given fast rehabilitation nursing, including reducing the anxiety and depression of patients, shortening the time of fasting and water deprivation before operation, limited intraoperative infusion, early postoperative feeding, early extubation, early exercise, pain management and other nursing measures. The psychological status, pain score, postoperative recovery and complication rate of both groups were compared. Results After nursing (one day before the operation), the SAS and SDS scores of the observation group were significantly lower than those of the control group (all P < 0.05). The NRS scores of the observation group at different time points after operation were significantly lower than those of the control group (all P < 0.05). The first exhaust time, the first ambulation time and the postoperative hospital stay of the observation group were (16.73±1.65) h, (12.78±1.43) h and (3.71±0.42) days, which were significantly lower than those of the control group [(20.61±2.38) h, (21.06±2.45) h and (5.03±0.65) days], respectively (all P < 0.05). The incidence of complications in the observation group was 5.45%, which was significantly lower than that (29.09%) in the control group (P < 0.05). Conclusion The clinical effect of fast rehabilitation nursing in patients after laparoscopic hysterectomy is good, which is worthy of clinical promotion.
- Fast rehabilitation nursing /
- Laparoscopic hysterectomy /
- Nursing

HTML全文

表 1 2组腹腔镜子宫全切术患者SAS和SDS评分比较(x±s, 分)

组别	例数	SAS		SDS
组别	例数	入院时	术前1 d	入院时	术前1 d
对照组	110	53.84±4.36	50.27±4.03^a	56.61±5.58	53.14±4.82^a
观察组	110	53.81±4.39	46.56±3.14^a	56.57±5.54	48.35±4.17^a
t值		0.051	7.616	0.053	7.882
P值		0.959	＜0.001	0.958	＜0.001
注：与入院时比较，^aP＜0.05。

下载: 导出CSV

表 2 2组腹腔镜子宫全切术患者术后NRS疼痛评分比较(x±s, 分)

组别	例数	术后第1天	术后第2天	术后第3天
对照组	110	3.06±0.96	2.33±0.72^a	1.38±0.47^ab
观察组	110	2.09±0.65	1.24±0.53^a	0.43±0.18^ab
t值		8.775	12.787	19.797
P值		＜0.001	＜0.001	＜0.001
注：与术后第1天比较，^aP < 0.05；与术后第2天比较，^bP < 0.05。

下载: 导出CSV

表 3 2组腹腔镜子宫全切术患者术后恢复情况比较(x±s)

组别	例数	首次排气时间(h)	首次下床活动时间(h)	术后住院时间(d)
对照组	110	20.61±2.38	21.06±2.45	5.03±0.65
观察组	110	16.73±1.65	12.78±1.43	3.71±0.42
t值		14.052	30.613	18.889
P值		＜0.001	＜0.001	＜0.001

下载: 导出CSV

参考文献(15)

[1]	曾秀琼, 谢秋娴. 腹腔镜与开腹全子宫切除术的临床效果比较[J]. 临床医学工程, 2018, 25(2): 135-136. doi: 10.3969/j.issn.1674-4659.2018.02.0135
[2]	刘丽, 林征, 戎明梅, 等. 加速康复外科理念护理的女性生殖系统疾病患者出院准备度的现状调查及影响因素分析[J]. 中国计划生育和妇产科, 2020, 12(3): 36-40. doi: 10.3969/j.issn.1674-4020.2020.03.10
[3]	周春莲, 杨燕青, 汪小丹. 超声引导下腹横肌平面阻滞对于妇科腹腔镜手术患者预防性镇痛的效果[J]. 中国内镜杂志, 2018, 24(3): 75-79. doi: 10.3969/j.issn.1007-1989.2018.03.016
[4]	刘颖. 优质护理服务对改善妇科腹腔镜手术患者焦虑、抑郁情绪及术后疼痛的影响[J]. 川北医学院学报, 2018, 33(2): 294-296. doi: 10.3969/j.issn.1005-3697.2018.02.042
[5]	曹爽, 李月华. 癌痛规范化干预对癌痛患者疼痛程度及心理状况的影响研究[J]. 现代中西医结合杂志, 2019, 28(15): 1685-1688. doi: 10.3969/j.issn.1008-8849.2019.15.025
[6]	田作荣. 认知行为干预对腹腔镜子宫切除术后患者早期认知障碍风险的影响[J]. 腹腔镜外科杂志, 2018, 23(4): 255, 259. https://www.cnki.com.cn/Article/CJFDTOTAL-FQJW201804006.htm
[7]	吕强, 苏文杰, 李美亭, 等. 腹腔镜子宫切除术患者术前不同焦虑水平对帕瑞昔布镇痛效果的影响[J]. 实用医院临床杂志, 2018, 15(5): 51-53. doi: 10.3969/j.issn.1672-6170.2018.05.015
[8]	周宏霞, 刘建民. 加速康复外科护理理念在经皮肾镜取石术患者中的临床护理应用效果分析[J]. 中华全科医学, 2017, 15(12): 2145-2147. https://www.cnki.com.cn/Article/CJFDTOTAL-SYQY201712045.htm
[9]	欧阳振波, 王存孝. 加速康复外科在妇科的应用进展[J]. 现代妇产科进展, 2017, 26(5): 390-392. https://www.cnki.com.cn/Article/CJFDTOTAL-XDFC201705021.htm
[10]	PISARSKA M, MAŁCZAK P, MAJOR P, et al. Enhanced recovery after surgery protocol in oesophageal cancer surgery: Systematic review and meta-analysis[J]. PLoS One, 2017, 12(3): e0174382. doi: 10.1371/journal.pone.0174382
[11]	SANDBERG E M, TWIJNSTRA A R H, DRIESSEN S R C, et al. Total laparoscopic hysterectomy versus vaginal hysterectomy: A systematic review and meta-analysis[J]. J Minim Invasive Gynecol, 2017, 24(2): 206-217. doi: 10.1016/j.jmig.2016.10.020
[12]	CHRISTIANSEN U J, KRUSE A, OLESEN P G, et al. Outpatient vs inpatient total laparoscopic hysterectomy: A randomized controlled trial[J]. Obstet Gynecol Surv, 2020, 75(2): 94-95. doi: 10.1097/OGX.0000000000000769
[13]	卢宗君, 吴海葵, 吴先群. 快速康复护理在腹腔镜下患侧输卵管开窗妊娠病灶清除术治疗异位妊娠患者中的应用[J]. 临床与病理杂志, 2019, 39(11): 2501-2506. doi: 10.3978/j.issn.2095-6959.2019.11.026
[14]	王君, 周义文, 冯琼. 快速康复护理在子宫颈癌围术期护理中的临床应用[J]. 中国医药导报, 2018, 15(2): 147-150. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY201802037.htm
[15]	陈洁. 加速康复外科理念在腹腔镜全子宫切除手术患者术后康复指标, 并发症及满意度的应用[J]. 实用妇科内分泌电子杂志, 2019, 6(19): 24-25, 193. https://www.cnki.com.cn/Article/CJFDTOTAL-FKDZ201919016.htm