Influence of FTS concept based on Chinese medicine characteristics on comfort and postoperative recovery of patients undergoing laparoscopic cholecystectomy
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摘要:
目的 探究腹腔镜胆囊切除术患者实施中医特色快速康复外科(FTS)理念指导的护理效果及对患者舒适度、术后恢复的影响。 方法 选取2020年7月—2022年10月在台州市中西医结合医院接受腹腔镜胆囊切除术的180例患者为研究对象，按照随机数字表法分为对照组(90例)与观察组(90例)，分别采用快速康复外科护理与基于中医特色快速康复外科护理，比较2组临床相关指标、负性情绪及睡眠质量、日常生活能力与并发症发生情况。 结果 观察组首次下床活动时间、排气时间、排便时间、住院时间均短于对照组[(6.51±1.25)h vs. (7.86±1.92)h; (23.33±7.46)h vs.(27.22±8.55)h; (1.89±0.54)d vs.(2.91±0.92)d; (2.32±0.04)d vs.(2.87±0.25)d，均P＜0.05]。干预后，观察组焦虑自评量表评分、抑郁自评量表评分、匹兹堡睡眠质量指数均低于对照组(均P＜0.05)，日常生活能力评分高于对照组[(82.54±5.15)分vs. (78.45±5.26)分]。观察组并发症发生率为5.56%(5/90)，低于对照组[15.56%(14/90)，P＜0.05]。 结论 基于中医特色快速康复外科理念可有效促进腹腔镜胆囊切除术患者术后康复，缓解负性情绪，改善睡眠质量，提高日常生活能力，降低并发症发生风险，进而明显提升患者术后的舒适度。 Abstract:Objective To investigate the nursing effect of laparoscopic cholecystectomy patients guided by fast track surgery (FTS) concept with traditional chinese medicine (TCM) characteristics and its influence on patients ' comfort level and postoperative recovery. Methods A total of 180 patients who underwent laparoscopic cholecystectomy at Taizhou Integrated Traditional Chinese and Western Medicine Hospital from July 2020 to October 2022 were selected as the research subjects, and were divided into control group (90 cases) and observation group (90 cases) according to random number table method. Rapid rehabilitation surgical nursing and rapid rehabilitation surgical nursing based on the characteristics of TCM were respectively adopted. Clinical indicators, negative emotions, sleep quality, activities of daily living and complication rates were compared between the two groups. Results The time of first activity out of bed, exhaust time, defecation time and hospitalization time in the observation group were all shorter than those in the control group [(6.51?.25) h vs. (7.86?.92) h, (23.33?.46) h vs. (27.22?.55) h, (1.89?.54) d vs. (2.91?.92) d, (2.32?.04) d vs. (2.87?.25) d, all P < 0.05]. After the intervention, scores on the self-rating anxiety scale, the self-rating depression scale and Pittsburgh sleep quality index in the observation group were lower than those in the control group (all P < 0.05), and the score of daily living ability was higher than that in the control group [(82.54?.15) points vs. (78.45?.26) points]. The incidence of complications in the observation group was 5.56% (5/90), which was lower than 15.56% (14/90) in the control group (P < 0.05). Conclusion Based on the concept of TCM characteristics, it can effectively promote the postoperative rehabilitation of patients with laparoscopic cholecystectomy, relieve negative emotions, improve sleep quality, improve daily living ability, reduce the risk of complications, and significantly improve the comfort level of patients after surgery. -
表 1 2组腹腔镜胆囊切除术患者临床指标比较(x±s)
Table 1. Comparison of clinical indexes between the two groups of patients undergoing laparoscopic cholecystectomy (x±s)
组别 例数 首次下床活动时间(h) 首次排气时间(h) 首次排便时间(d) 住院时间(d) 对照组 90 7.86±1.92 27.22±8.55 2.91±0.92 2.87±0.25 观察组 90 6.51±1.25 23.33±7.46 1.89±0.54 2.32±0.04 t值 5.590 3.252 9.071 20.609 P值 ＜0.001 0.001 ＜0.001 ＜0.001 
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表 2 2组腹腔镜胆囊切除术患者负性情绪及睡眠质量比较(x±s，分)
Table 2. Comparison of negative emotions and sleep quality between the two groups of patients undergoing laparoscopic cholecystectomy (x±s, points)
组别 例数 SAS SDS PSQI 干预前 干预后 干预前 干预后 干预前 干预后 对照组 90 56.22±4.83 44.34±5.13a 59.72±6.12 48.16±8.11a 28.94±1.51 17.68±1.89a 观察组 90 55.54±5.38 40.35±7.41a 58.33±5.35 42.28±7.33a 29.26±1.68 13.92±1.77a t值 0.892 4.200 1.622 5.103 1.344 13.776 P值 0.373 ＜0.001 0.107 ＜0.001 0.181 ＜0.001 注：与干预前比较，aP＜0.05。
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表 3 2组腹腔镜胆囊切除术患者日常生活能力比较(x±s，分)
Table 3. Comparison of daily living ability between two groups of patients undergoing laparoscopic cholecystectomy (x±s, points)
组别 例数 干预前 干预后 t值 P值 对照组 90 60.33±4.37 78.45±5.26 193.148 ＜0.001 观察组 90 59.71±4.22 82.54±5.15 232.886 ＜0.001 t值 0.968 5.271 P值 0.334 ＜0.001
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表 4 2组腹腔镜胆囊切除术患者并发症比较[例(%)]
Table 4. Comparison of complications between two groups of patients undergoing laparoscopic cholecystectomy [cases (%)]
组别 例数 穿刺处皮下出血或感染 胆漏 压疮 总发生 对照组 90 9(10.00) 2(2.22) 3(3.33) 14(15.56) 观察组 90 3(3.33) 1(1.11) 1(1.11) 5(5.56) 注：2组并发症总发生率比较，χ2=4.739，P=0.029。
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