Clinical application effect of rapid rehabilitation surgical nursing technology in elderly patients undergoing ERCP
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摘要:
目的 探讨对于行经内镜逆行性胰胆管造影术(endoscopic retrograde cholangiopancreatography，ERCP)的老年患者应用快速康复外科护理的效果。 方法 选取2018年1月—2020年12月马鞍山市人民医院收治的110例老年胆总管结石患者(年龄≥60岁)，全部接受内镜下逆行胰胆管造影取石术。按照随机抽样分组，分为对照组和实验组，对照组55例接受常规性护理，实验组55例接受快速康复外科护理。比较2组手术成功率、手术时间、住院时间、手术并发症发生率、术后疼痛评分、临床护理服务满意率等指标的差异。 结果 实验组平均手术时间[(34.5±8.2)min]低于对照组[(39.5±10.5)min], 平均住院时间[(8.5±2.0)d]低于对照组[(9.9±2.5)d], 术后疼痛评分[(2.02±0.76)分]低于对照组[(2.56±0.78)分]，差异有统计学意义(均P＜0.05)。实验组手术成功率为96.4%, 高于对照组(90.9%)，手术并发症发生率为7.3%，低于对照组(16.4%)，但两者差异均无统计学意义(均P＞0.05)；实验组患者的临床护理服务满意率(94.5%)高于对照组(80.0%)，差异有统计学意义(P＜0.05)。 结论 快速康复外科护理可以保证老年患者ERCP术的成功率，降低术后疼痛评分，缩短手术时间及住院时间，全面提升临床护理服务满意率及护理管理质量。 -
关键词:
- 快速康复外科护理 /
- 胆总管结石 /
- 经内镜逆行性胰胆管造影术
Abstract:Objective To investigate the effect of rapid rehabilitation surgical nursing on elderly patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). Methods A total of 110 elderly patients (aged ≥ 60 years) with common bile duct stones who were admitted and underwent ERCP at Maanshan People's Hospital from January 2018 to December 2020 were included in this study. The patients were randomly divided into the control and experimental groups. A total of 55 cases in the control group received routine nursing, and 55 cases in the experimental group received rapid rehabilitation surgical nursing. The differences of clinical indicators such as operation success rate, operation time, hospital stay, incidence of operation complications, postoperative pain score and satisfaction rate of clinical nursing service in both groups were compared. Results The operation time[(34.5±8.2) min], hospitalisation time[(8.5±2.0) days] and postoperative pain score [(2.02±0.76) points] in the experiment group were significantly shorter than those in the control group[(39.5±10.5) min, (9.9±2.5) days and (2.56±0.78) points, respectively, all P < 0.05]. The experiment group had higher surgical success rate and lower operative complications than the control group (96.4% vs. 90.9%, 7.3% vs. 16.4%, respectively, all P > 0.05). The satisfaction rate of clinical nursing service in the experimental group (94.5%) was higher than that in the control group (80.0%), and the difference was statistically significant (P < 0.05). Conclusion Rapid rehabilitation surgical nursing can ensure the success rate of ERCP in elderly patients, reduce postoperative pain score, shorten operation time and hospital stay, and comprehensively improve the satisfaction rate of clinical nursing service and the quality of nursing management. -
表 1 2组患者手术成功率、并发症、手术时间、住院时间比较
Table 1. Comparison of surgical success rate, surgical complications, surgical time and hospitalization time between the two groups
组别 例数 手术成功[例(%)] 并发症[例(%)] 手术时间(x±s，min) 住院时间(x±s，d) 对照组 55 50(90.9) 9(16.4) 39.5±10.5 9.9±2.5 实验组 55 53(96.4) 4(7.3) 34.5±8.2 8.5±2.0 统计值 0.610a 2.161a 2.783b 3.243b P值 0.435 0.142 0.006 0.002 注：a为χ2值；b为t值。 
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表 2 2组患者术前及术后24 h VRS疼痛评分比较(x±s，分)
Table 2. Comparison of VRS pain scores before and 24 hours after operation between the two groups (x±s, score)
组别 例数 VRS疼痛评分 t值 P值 术前 术后24 h 对照组 55 1.65±0.64 2.56±0.78 10.351 ＜0.001 实验组 55 1.55±0.57 2.02±0.76 1.247 0.093 t值 0.865 3.677 P值 0.389 ＜0.001
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表 3 2组患者临床护理服务满意率比较[例(%)]
Table 3. Comparison of satisfaction rate of clinical nursing service between two groups [cases (%)]
组别 例数 满意 基本满意 不满意 总体满意 对照组 55 32(58.2) 12(21.8) 11(20.0) 44(80.0) 实验组 55 43(78.2) 9(16.3) 3(5.5) 52(94.5) 注：2组总体满意率比较，χ2=5.191, P=0.023。
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[1] AL-MUSAWI J, NAVARATNE L, MARTINEZ-ISLA A. Laparoscopic common bile duct exploration versus endoscopic retrograde cholangiopancreatography for choledocholithiasis found at time of laparoscopic cholecystectomy[J]. AM J Surg, 2019, 217(1): 188-189. doi: 10.1016/j.amjsurg.2018.02.007 [2] 曹娇娇, 邹晓平, 韩光曙. 内镜治疗80岁以上高龄胆总管结石患者的价值[J]. 中华消化内镜杂志, 2020, 37(5): 331-335. doi: 10.3760/cma.j.cn321463-20191012-00417CAO J J, ZOU X P, HAN G S. The value of endoscopy in the treatment of choledocholithiasis in elderly patients over 80 years old[J]. Chinese Journal of Digestive Endoscopy, 2020, 37(5): 331-335. doi: 10.3760/cma.j.cn321463-20191012-00417 [3] 韩广弢, 李皓桓. 快速康复外科理念对全膝关节置换者生理与心理康复的影响[J]. 中国组织工程研究, 2019, 23(36): 5760-5765. doi: 10.3969/j.issn.2095-4344.1991HAN G M, LI H H. Effect of rapid rehabilitation surgery concept on physiological and psychological rehabilitation of total knee arthroplasty patients[J]. Chinese Journal of Tissue Engineering Research, 2019, 23(36): 5760-5765. doi: 10.3969/j.issn.2095-4344.1991 [4] 赵爽, 刘欣伟, 刘松波, 等. 快速康复外科理念在髋关节镜围术期中应用研究[J]. 创伤与急危重病医学, 2019, 7(6): 344-346. https://www.cnki.com.cn/Article/CJFDTOTAL-CSJB201906005.htmZHAO S, LIU X W, LIU S B, et al. Application of rapid rehabilitation surgery concept in perioperative period of hip arthroscopy[J]. Trauma and Critical Care Medicine, 2019, 7(6): 344-346. https://www.cnki.com.cn/Article/CJFDTOTAL-CSJB201906005.htm [5] 严露, 顾则娟. 基于快速康复外科理念护理干预对冠心病冠状动脉搭桥术患者应激发应及康复效果的影响[J]. 医学临床研究, 2019, 36(12): 2487-2489. doi: 10.3969/j.issn.1671-7171.2019.12.072YAN L, GU Z J. Effect of nursing intervention based on the concept of rapid rehabilitation surgery on stress stimulation and rehabilitation effect of patients undergoing coronary artery bypass grafting[J]. Journal of Clinical Research, 2019, 36(12): 2487-2489. doi: 10.3969/j.issn.1671-7171.2019.12.072 [6] 张春节. 快速康复外科护理对胆结石手术患者术后恢复的影响[J]. 航空航天医学杂志, 2020, 31(1): 102-103. doi: 10.3969/j.issn.2095-1434.2020.01.052ZHANG C J. Effect of rapid rehabilitation surgical nursing on postoperative recovery of patients undergoing gallstone surgery[J]. Journal of Aerospace Medicine, 2020, 31(1): 102-103. doi: 10.3969/j.issn.2095-1434.2020.01.052 [7] 闫丹丹, 许岩, 顾珊菱, 等. 快速康复护理应用于前交叉韧带重建术后的效果观察[J]. 长春中医药大学学报, 2020, 36(6): 1279-1281. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX202006054.htmYAN D D, XU Y, GU S L, et al. Observation on the effect of rapid rehabilitation nursing after anterior cruciate ligament reconstruction[J]. Journal of Changchun University of Traditional Chinese Medicine, 2020, 36(6): 1279-1281. https://www.cnki.com.cn/Article/CJFDTOTAL-CZXX202006054.htm [8] 陈娟丽, 胡玉琴, 周燕, 等. 基于加速康复外科理念的围麻醉期体位护理模式在胸腔镜手术患者中的应用[J]. 中华现代护理杂志, 2020, 26(35): 4977-4980. doi: 10.3760/cma.j.cn115682-20200321-02030CHEN J L, HU Y Q, ZHOU Y, et al. Application of perianesthesia posture nursing mode based on the concept of accelerated rehabilitation surgery in patients undergoing thoracoscopic surgery[J]. Modern Nursing, 2020, 26(35): 4977-4980. doi: 10.3760/cma.j.cn115682-20200321-02030 [9] 李妹红, 史龙华, 向薇熹. 快速康复外科理念在乳腺癌改良根治术围术期的应用效果[J]. 临床医学工程, 2020, 27(10): 1407-1408. doi: 10.3969/j.issn.1674-4659.2020.10.1407LI M H, SHI L H, XIANG W X. Perioperative application effect of rapid rehabilitation surgery concept in modified radical mastectomy[J]. Clinical Medical Engineering, 2020, 27(10): 1407-1408. doi: 10.3969/j.issn.1674-4659.2020.10.1407 [10] 童兴, 汪兵, 齐亮, 等. 退行性骨关节病诊疗创新倒悬牵引养生床设计与应用研究[J]. 中国医学装备, 2020, 17(7): 45-48. doi: 10.3969/J.ISSN.1672-8270.2020.07.011TONG X, WANG B, QI L, et al. Innovative diagnosis and treatment of degenerative osteoarthropathy Design and application of upside-down traction health bed[J]. China Medical Equipment, 2020, 17(7): 45-48. doi: 10.3969/J.ISSN.1672-8270.2020.07.011 [11] 牛洪艳, 倪静玉, 张玲, 等. 护理满意度量表在临床住院病人中应用的信效度研究[J]. 护理研究, 2016, 30(3): 287-290. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201603010.htmNIU H Y, NI J Y, ZHANG L, et al. Study on reliability and validity of nursing satisfaction scale in clinical inpatients[J]. Nursing Research, 2016, 30(527): 287-290. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201603010.htm [12] 肖玉巧, 陈艳, 汤华, 等. 基于快速康复理念的集束化护理管理在胆石症患者ERCP术后引入和干预的效果观察[J]. 世界最新医学信息文摘, 2018, 18(89): 214, 216. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201889174.htmXIAO Y Q, CHEN Y, TANG H, et al. Observation on the effect of introduction and intervention of cluster nursing management based on the concept of rapid rehabilitation in cholelithiasis patients after ERCP[J]. Digest World Latest Med Inf, 2018, 18 (89): 214-216. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201889174.htm [13] 王伟艺, 涂彦渊, 袁祖荣, 等. 胆总管结石合并胆囊结石老年患者腹腔镜与传统手术治疗比较[J]. 老年医学与保健, 2017, 23(1): 19-22. doi: 10.3969/j.issn.1008-8296.2017.01.007WANG W Y, TU Y Y, YUAN Z R, et al. Comparison of laparoscopic and traditional surgical treatment for elderly patients with choledocholithiasis complicated with cholecystolithiasis[J]. Geriatrics and Health Care, 2017, 23 (1): 19-22. doi: 10.3969/j.issn.1008-8296.2017.01.007 [14] 石卉, 万军, 徐世平, 等. 老年胆系感染患者临床特征分析及死亡风险评估[J]. 中华内科杂志, 2019, 58(6): 415-418. doi: 10.3760/cma.j.issn.0578-1426.2019.06.003SHI H, WAN J, XU S P, et al. Clinical characteristics analysis and death risk assessment of elderly patients with biliary infection[J]. Chinese Journal of Internal Medicine, 2019, 58 (6): 415-418. doi: 10.3760/cma.j.issn.0578-1426.2019.06.003 [15] 赖敏, 彭远清. ERCP治疗胆总管结石围手术期护理分析[J]. 现代医药卫生, 2019, 35(11): 1727-1729. doi: 10.3969/j.issn.1009-5519.2019.11.046LAI M, PENG Y Q. Perioperative nursing analysis of ERCP in treating choledocholithiasis[J]. Modern Medicine and Health, 2019, 35(11): 1727-1729. doi: 10.3969/j.issn.1009-5519.2019.11.046 [16] 周海斌, 杨建锋, 张啸, 等. 浙江省ERCP人群特点及疾病趋势的初步研究[J]. 中华消化内镜杂志, 2019, 36(6): 402-406. doi: 10.3760/cma.j.issn.1007-5232.2019.06.004ZHOU H B, YANG J F, ZHANG X, et al. Preliminary study on population characteristics and disease trends of ERCP in Zhejiang Province[J]. Chinese Journal of Digestive Endoscopy, 2019, 36(6): 402-406. doi: 10.3760/cma.j.issn.1007-5232.2019.06.004 [17] 高慧云. 快速康复护理对胃癌患者术后康复及生活质量的影响[J]. 护理管理杂志, 2017, 17(2): 129-131. doi: 10.3969/j.issn.1671-315X.2017.02.019GAO H Y. Effect of rapid rehabilitation nursing on postoperative rehabilitation and quality of life of patients with gastric cancer[J]. Journal of Nursing Management, 2017, 17(2): 129-131. doi: 10.3969/j.issn.1671-315X.2017.02.019 -
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