加速康复理念在腹腔镜肝癌切除患者护理中的应用

梁瑞; 刘娜娜; 李利; 王媚; 袁莎莎; 杨珊珊; 庞青

doi:10.16766/j.cnki.issn.1674-4152.002571

加速康复理念在腹腔镜肝癌切除患者护理中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002571

蚌埠医学院第一附属医院肝胆外科，安徽蚌埠 233004

基金项目:

国家自然科学基金青年基金项目 81600452

安徽省自然科学基金杰出青年项目 2008085J37

详细信息

通讯作者:
梁瑞, E-mail: yumo0407@163.com

中图分类号: R473.6 R735.7
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出版历程
- 收稿日期: 2021-09-27
- 网络出版日期: 2022-09-23

Application of accelerated rehabilitation concept in nursing of patients undergoing laparoscopic hepatocarcinoma resection

Department of Hepatobiliary Surgery, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的探讨融入加速康复理念的护理措施在腹腔镜下肝癌切除患者护理中的临床应用价值。方法选择2019年8月—2020年10月蚌埠医学院第一附属医院肝胆外科行腹腔镜下肝癌切除术的80例患者。采用随机数字表法进行分组：观察组40例，应用加速康复理念的护理措施；对照组40例，应用传统的护理措施。比较2组患者术后疼痛评分、围手术期指标、术后应激指标、护理满意度的差异。结果观察组患者术后24 h(t=5.300，P＜0.001)及术后48 h的疼痛评分(t=6.030，P＜0.001)均明显低于对照组，差异均有统计学意义；观察组患者术后排气时间[(2.68±1.01)d vs. (3.21±1.13)d]、术后排便时间[(3.56±1.02)d vs.(4.55±1.21)d]、腹腔引流管拔除时间[(3.39±1.05)d vs.(4.14±0.99)d]、住院时间[(7.53±1.74)d vs.(9.28±2.13)d]均优于对照组，差异均有统计学意义(均P＜0.05)，而2组手术时间、术中出血量、肝门阻断时间等差异无统计学意义(均P＞0.05)；观察组患者术后第1天和第4天的空腹血糖、C-反应蛋白指标优于对照组，差异均有统计学意义(均P＜0.05)；观察组患者的护理满意度显著高于对照组(90.00% vs. 70.00%)，差异有统计学意义(P＜0.05)。结论加速康复理念护理措施可以减少腹腔镜肝癌切除患者术后疼痛感、促进患者术后康复，降低术后应激反应，提高患者的护理满意度，具有良好的安全性与实用性。
- 加速康复理念 /
- 腹腔镜 /
- 肝癌 /
- 护理
Abstract: Objective To explore the clinical application value of accelerated rehabilitation concept in nursing of patients undergoing laparoscopic hepatocarcinoma resection. Methods The clinical data of 80 patients who underwent laparoscopic hepatocarcinoma resection at the Department of Hepatobiliary Surgery in First Affiliated Hospital of Bengbu Medical College from August 2019 to October 2020 were retrospectively analysed. Random table method was used for grouping. Forty cases were categorized into observation group, who received nursing measures with the concept of accelerated rehabilitation. Another 40 cases were categorized into control group, who received traditional nursing measures. The differences in postoperative pain score, perioperative index, postoperative stress index and nursing satisfaction index between the two groups were compared. Results The pain scores of patients in the observation group at 24 h (t=5.300, P < 0.01) and 48 h (t=6.030, P < 0.01) after operation were significantly lower than those of the control group and the differences were statistically significant. Meanwhile, the postoperative exhaust time [(2.68±1.01) d vs. (3.21±1.13) d], postoperative defecation time [(3.56±1.02) d vs. (4.55±1.21) d], abdominal drainage tube removal time [(3.39±1.05) d vs. (4.14±0.99) d], hospital stay [(7.53±1.74) d versus (9.28±2.13) d] and other perioperative indicators in the observation group were better than those in the control group, and the difference was statistically significant (all P < 0.05). By contrast, no statistical difference was found in the operation time, intraoperative blood loss and hepatic port occlusion time between the two groups (all P>0.05). The fasting blood glucose and C-reactive protein indices of the observation group were better than those of the control group on the 1st and 4th day after operation and the difference was statistically significant (all P < 0.05). The nursing satisfaction of the observation group was significantly higher than that of the control group (90.00% vs. 70.00%) and the difference was statistically significant (P < 0.05). Conclusion Accelerated rehabilitation concept in nursing measures could reduce postoperative pain in patients with laparoscopic hepatocarcinoma resection, promote postoperative recovery, reduce postoperative stress response and improve patients'satisfaction with medical care. These measures have good safety and clinical practicability.
- Accelerated rehabilitation concept /
- Laparoscopy /
- Hepatocarcinoma /
- Nursing

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表 1 2组肝癌患者临床资料比较

Table 1. Comparison of clinical data of liver cancer patients between the two groups

组别	例数	性别(例)		年龄 (x±s，岁)	BMI (x±s)	肿瘤大小 (x±s，cm)	Child分级(例)		手术方式(例)
组别	例数	男性	女性	年龄 (x±s，岁)	BMI (x±s)	肿瘤大小 (x±s，cm)	A级	B级	左半肝切除	右半肝切除	肝叶切除	肝段切除
观察组	40	26	14	55.10±9.30	24.34±3.01	4.13±0.68	25	15	4	4	26	6
对照组	40	21	19	56.33±9.30	25.22±3.45	4.37±0.56	30	10	6	4	28	2
统计量		1.289^a		0.592^b	1.216^b	1.723^b	1.455^a		2.474^a
P值		0.256		0.556	0.228	0.089	0.228		0.480
注：^a为χ²值，^b为t值。

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表 2 2组肝癌患者术后疼痛评分比较(x ±s，分)

Table 2. Comparison of postoperative pain scores between two groups of patients with liver cancer

组别	例数	术后24 h	术后48 h	术后72 h
观察组	40	3.58±1.59	2.80±0.83^a	2.35±1.06^ab
对照组	40	5.65±1.89	4.09±1.07^a	2.85±1.32^ab
t值		5.300	6.030	1.870
P值		＜0.001	＜0.001	0.070
注：与术后24 h比较, ^aP < 0.01;与术后48 h比较, ^bP < 0.05。

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表 3 2组肝癌患者围手术期指标比较(x ±s)

Table 3. Comparison of Perioperative indicators of hepatocellular carcinoma patients between two groups

组别	例数	手术时间(min)	术中出血(mL)	肝门阻断时间(min)	术后排气时间(d)	术后排便时间(d)	腹腔引流管拔除时间(d)	住院时间(d)
观察组	40	178.34±30.87	207.32±51.65	19.56±3.21	2.68±1.01	3.56±1.02	3.39±1.05	7.53±1.74
对照组	40	185.62±29.74	218.36±52.39	20.62±3.06	3.21±1.13	4.55±1.21	4.14±0.99	9.28±2.13
t值		1.074	0.949	1.512	2.212	3.956	3.287	4.024
P值		0.286	0.345	0.135	0.030	＜0.001	0.002	＜0.001

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表 4 2组肝癌患者术后应激指标比较(x ±s)

Table 4. Comparison of postoperative stress indexes of liver cancer patients between two groups

组别	例数	空腹血糖(nmol/L)			C-反应蛋白(mg/L)
组别	例数	术前	术后第1天	术后第4天	术前	术后第1天	术后第4天
观察组	40	5.08±0.53	6.73±1.39^a	6.05±0.65^ab	5.84±1.53	49.06±12.08^a	12.39±3.41^ab
对照组	40	5.24±0.61	7.83±1.23^a	6.82±0.78^ab	5.76±1.81	63.60±13.27^a	17.35±4.23^ab
t值		1.250	3.750	4.790	0.210	5.120	5.770
P值		0.210	＜0.001	＜0.001	0.830	＜0.001	＜0.001
注：与术前比较, ^aP < 0.01;与术后第1天比较, ^bP < 0.01。

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表 5 2组肝癌患者护理满意度比较[例(%)]

Table 5. Comparison of nursing satisfaction between two groups of patients with liver cancer

组别	例数	非常满意	满意	基本满意	不满意	满意度
观察组	40	20(50.00)	10(25.00)	6(15.00)	4(10.00)	36(90.00)
对照组	40	10(25.00)	8(20.00)	10(25.00)	12(30.00)	28(70.00)
注：2组满意度比较，χ²=5.000，P=0.025。

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参考文献(26)

[1]	RINGE K I, HINRICHS J B. State of the art in the diagnostics of hepatocellular carcinoma and current treatment options[J]. Radiologe, 2021, 61(2): 213-226. doi: 10.1007/s00117-020-00798-9
[2]	LI L L, YE J J. Characterization of gut microbiota in patients with primary hepatocellular carcinoma received immune checkpoint inhibitors: A Chinese population-based study[J]. Medicine (Baltimore), 2020, 99(37): e21788. doi: 10.1097/MD.0000000000021788
[3]	ZHOU J, SUN H C, WANG Z, et al. Guidelines for the diagnosis and treatment of hepatocellular carcinoma (2019 Edition)[J]. Liver Cancer, 2020, 9(6): 682-720. doi: 10.1159/000509424
[4]	桂普国, 孙瑞平. 加速康复外科联合腹腔镜结直肠癌根治术对结直肠癌患者预后、免疫水平影响[J]. 医学临床研究, 2022, 39(1): 132-135. doi: 10.3969/j.issn.1671-7171.2022.01.038 GUI P G, SUN R P. Effect of accelerated rehabilitation surgery combined with laparoscopic radical resection of colorectal cancer on prognosis and immune level of patients with colorectal cancer[J]. Journal of Clinical Research, 2022, 39(1): 132-135. doi: 10.3969/j.issn.1671-7171.2022.01.038
[5]	KIM H J, CHO J Y, HAN H S, et al. Improved outcomes of major laparoscopic liver resection for hepatocellular carcinoma[J]. Surg Oncol, 2020, 35: 470-474. doi: 10.1016/j.suronc.2020.10.007
[6]	杨淑娟, 裘丹英, 贾勤, 等. 加速康复外科临床路径在结直肠癌围手术期护理中的应用[J]. 浙江临床医学, 2020, 22(7): 1063-1064. YANG S J, QIU D Y, JIA Q, et al. Application of clinical pathway of accelerated rehabilitation surgery in perioperative care of colorectal cancer[J]. Zhejiang Clinical Medical Journal, 2020, 22(7): 1063-1064.
[7]	杨义江. 加速康复理念在肝切除术围手术期护理中的应用研究[J]. 临床医学工程, 2019, 26(10): 1441-1442. doi: 10.3969/j.issn.1674-4659.2019.10.1441 YANG Y J. Study on the application of enhanced recovery after surgery during perioperative nursing of hepatectomy[J]. Clinical Medical & Engineering, 2019, 26(10): 1441-1442. doi: 10.3969/j.issn.1674-4659.2019.10.1441
[8]	杨晓瑜, 黄晓蕊, 杨晓纯. 加速康复理念对胸腔镜肺癌根治术患者护理的影响[J]. 甘肃医药, 2021, 40(5): 469-471. https://www.cnki.com.cn/Article/CJFDTOTAL-GSYY202105032.htm YANG X Y, HUANG X R, YANG X C. Influence of accelerated rehabilitation concept on nursing care of patients undergoing thoracoscopic lung cancer radical surgery[J]. Gansu Medical Journal, 2021, 40(5): 469-471. https://www.cnki.com.cn/Article/CJFDTOTAL-GSYY202105032.htm
[9]	程楠. 加速康复理念(ERAS)在腹腔镜胰十二指肠切除术围手术期护理中的应用效果及并发症影响[J]. 中国医药指南, 2021, 19(16): 171-172. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202116078.htm CHENG N. Application effect of the ERAS in the perioperative nursing care of laparoscopic pancreaticoduodenectomy and the influence of complications[J]. Guide of China Medicine, 2021, 19(16): 171-172. https://www.cnki.com.cn/Article/CJFDTOTAL-YYXK202116078.htm
[10]	杨娇弟, 朱茜, 张思思, 等. 肾移植加速康复外科方案的构建与应用研究[J]. 中国基层医药, 2020, 27(20): 2515-2520. doi: 10.3760/cma.j.issn.1008-6706.2020.20.019 YANG J D, ZHU X, ZHANG S S, et al. Construction and application of accelerated rehabilitation surgery scheme for kidney transplantation[J]. Chinese Journal of Primary Medicine and Pharmacy, 2020, 27(20): 2515-2520. doi: 10.3760/cma.j.issn.1008-6706.2020.20.019
[11]	翟贺杰, 赵巧丽, 陈新星. 综合疼痛护理对骨科手术患者术后疼痛的影响[J]. 护理实践与研究, 2021, 18(22): 3408-3411. doi: 10.3969/j.issn.1672-9676.2021.22.022 ZHAI H J, ZHAO Q L, CHEN X X. Effect of comprehensive pain nursing on postoperative pain of orthopaedic patients[J]. Nursing Practice and Research, 2021, 18(22): 3408-3411. doi: 10.3969/j.issn.1672-9676.2021.22.022
[12]	陈茜, 胡露红, 张琳, 等. 基于加速康复理念的全程个案管理模式在乳腺癌手术患者中的应用[J]. 齐鲁护理杂志, 2020, 26(6): 19-23. doi: 10.3969/j.issn.1006-7256.2020.06.007 CHEN X, HU L H, ZHANG L, et al. Application of the whole-course case management model based on the concept of enhanced recovery after surgery in breast cancer patients[J]. Journal of Qilu Nursing, 2020, 26(6): 19-23. doi: 10.3969/j.issn.1006-7256.2020.06.007
[13]	ELHASSAN A, AHMED A, AWAD H, et al. The evolution of surgical enhanced recovery pathways: A review[J]. Curr Pain Headache Rep, 2018, 22(11): 74. doi: 10.1007/s11916-018-0727-z
[14]	唐志红, 王浈, 张艳琴, 等. 基于加速康复外科理念手术室护士实施禁食禁饮干预对连台手术患者空腹血糖、空腹胰岛素、胰岛素抵抗指数及不良反应的影响[J]. 中国当代医药, 2020, 27(34): 238-240. doi: 10.3969/j.issn.1674-4721.2020.34.069 TANG Z H, WANG Z, ZHANG Y Q, et al. Effect of fasting and drinking prohibition intervention on fasting blood glucose, fasting insulin, insulin resistance index and adverse reactions of operating room nurses based on the concept of accelerated rehabilitation surgery[J]. China Modern Medicine, 2020, 27(34): 238-240. doi: 10.3969/j.issn.1674-4721.2020.34.069
[15]	张杨西贝, 柏彬, 马杰, 等. 基于加速康复外科理念的术前护理干预模式在老年腰椎管狭窄症手术患者中的应用研究[J]. 中华全科医学, 2021, 19(12): 2146-2148, 2157. doi: 10.16766/j.cnki.issn.1674-4152.002257 ZHANG Y X B, BAI B, MA J, et al. Application of preoperative nursing intervention mode based on the concept of enhanced recovery after surgery in elderly patients with lumbar spinal stenosis[J]. Chinese Journal of General Practice, 2021, 19(12): 2146-2148, 2157. doi: 10.16766/j.cnki.issn.1674-4152.002257
[16]	白凤云, 程文刚, 王爱龙, 等. 加速康复外科理念在脑出血经侧裂岛叶显微镜下手术治疗中的应用研究[J]. 中国药物与临床, 2021, 21(22): 3736-3738. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202122037.htm BAI F Y, CHENG W G, WANG A L, et al. Research on the application of the concept of accelerated rehabilitation surgery in the microsurgical treatment of cerebral hemorrhage through the lateral fissure insular[J]. Chinese Remedies & Clinics, 2021, 21(22): 3736-3738. https://www.cnki.com.cn/Article/CJFDTOTAL-YWLC202122037.htm
[17]	黄晶晶, 刘翔, 张兆宏, 等. 加速康复外科理念在经胸前入路腔镜甲状腺外科领域中的临床应用[J]. 中国内镜杂志, 2021, 27(10): 7-11. doi: 10.12235/E20210055 HUANG J J, LIU X, ZHANG Z H, et al. Clinical application of the concept of enhanced recovery after surgery in transthoracic laparoscopic thyroid surgery[J]. China Journal of Endoscopy, 2021, 27(10): 7-11. doi: 10.12235/E20210055
[18]	GEMMA M, TOMA S, LIRA LUCE F, et al. Enhanced recovery program (ERP) in major laryngeal surgery: Building a protocol and testing its feasibility[J]. Acta Otorhinolaryngol Ital, 2017, 37(6): 475-478. doi: 10.14639/0392-100X-1091
[19]	陈宝英, 邵荣学, 蒋萍, 等. 序贯护理结合核心肌群锻炼缓解腰椎骨质疏松性骨折PKP术后疼痛的疗效观察[J]. 浙江临床医学, 2021, 23(1): 121-123. CHEN B Y, SHAO R X, JIANG P, et al. Observation on the effect of sequential nursing combined with core muscle group exercise in relieving pain after PKP of lumbar osteoporotic fracture[J]. Zhejiang Clinical Medical Journal, 2021, 23(1): 121-123.
[20]	陈天文, 温贺新, 刘牧林. 加速康复外科在老年腹腔镜胃癌根治术中的应用价值研究[J]. 中华普通外科学文献(电子版), 2021, 15(1): 47-51. doi: 10.3877/cma.j.issn.1674-0793.2021.01.010 CHEN T W, WEN H X, LIU M L. Application of enhanced recovery after surgery in perioperative period of laparoscopic radical gastrectomy for elderly patients[J]. Chinese Archives of General Surgery (Electronic Edition), 2021, 15(1): 47-51. doi: 10.3877/cma.j.issn.1674-0793.2021.01.010
[21]	RICHMAN M, BERMAN J M, ROSS E M. Regional anesthesia use in pediatric burn surgery: A descriptive retrospective series[J]. Cureus, 2021, 13(10): e19063. DOI: 10.7759/cureus.19063.
[22]	MARCHISIO A E, RIBEIRO T A, UMPIERRES C S A, et al. Accelerated rehabilitation versus conventional rehabilitation in total hip arthroplasty (ARTHA): A randomized double blinded clinical trial[J]. Rev Col Bras Cir, 2020, 47: e20202548. DOI: 10.159010100-6991e-20202548.
[23]	LI J, LUAN F, SONG J, et al. Clinical efficacy of controlled-release morphine tablets combined with celecoxib in pain management and the effects on WNK1 expression[J]. Clinics(Sao Paulo), 2021, 76: e1907. DOI: 10.6061/clinics/2021/e1907.
[24]	PAK D J, YONG R J, KAYE A D, et al. Chronification of Pain: Mechanisms, current understanding, and clinical implications[J]. Curr Pain Headache Rep, 2018, 22(2): 9. doi: 10.1007/s11916-018-0666-8
[25]	MILLER E S, APPLE C G, KANNAN K B, et al. Chronic stress induces persistent low-grade inflammation[J]. Am J Surg, 2019, 218(4): 677-683. doi: 10.1016/j.amjsurg.2019.07.006
[26]	FRIEND S F, NACHNANI R, POWELL S B, et al. C-Reactive Protein: Marker of risk for post-traumatic stress disorder and its potential for a mechanistic role in trauma response and recovery[J]. Eur J Neurosci, 2020. DOI: 10.1111/ejn.15031.