护理团队主导的多元化管理对老年患者全身麻醉术后复苏情况的影响

应臻臻; 童珺霞; 童巧莉; 李月翠; 沈海萍

doi:10.16766/j.cnki.issn.1674-4152.003823

护理团队主导的多元化管理对老年患者全身麻醉术后复苏情况的影响

doi: 10.16766/j.cnki.issn.1674-4152.003823

1.
永康市第一人民医院手术室，浙江永康 321300
2.
永康市第一人民医院感染科
3.
浙江绿城心血管病医院手术室，浙江杭州 310000

基金项目:

浙江省医药卫生科技计划项目 2020PY065

详细信息

通讯作者:
应臻臻，E-mail：13750983676@163.com

中图分类号: R614.2 R473.6
计量
- 文章访问数: 19
- HTML全文浏览量: 12
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2024-06-13
- 网络出版日期: 2025-01-20

The impact of diversified management led by anesthesia nursing groups on the postoperative recovery of elderly patients undergoing general anesthesia

1.
Operating Room, the First People's Hospital of Yongkang, Yongkang, Zhejiang 321300, China

摘要

摘要: 目的分析麻醉护理团队主导的多元化管理在老年患者全身麻醉术后复苏期管理中的应用效果，为提高临床术后复苏质量提供参考。方法选取2023年1月—2024年1月在永康市第一人民医院手术室行全麻手术的130例老年患者作为研究对象，根据随机数字表法将其分为对照组(65例)和观察组(65例)。对照组应用常规护理，观察组在对照组基础上应用麻醉护理团队主导的多元化管理。比较2组患者苏醒情况、麻醉后恢复情况及并发症发生情况。结果观察组患者麻醉苏醒时间、拔除气管插管时间及出复苏室时间分别为(68.42±6.41)min、(72.38±7.04)min、(84.65±9.73)min，均短于对照组[(71.33±8.03)min、(76.16±8.51)min、(90.83±11.47)min]，且观察组RASS评分[(1.13±0.27)分]低于对照组[(2.18±0.45)分]，差异均有统计学意义(P<0.05)。术后24 h，观察组患者中文版40项术后恢复质量调查问卷(QoR-40)总分为(133.77±8.46)分，高于对照组[(120.34±9.79)分，P<0.05]。观察组术后躁动及低体温发生率分别为4.6%(3/65)、1.5%(1/65)，明显低于对照组[15.4%(10/65)、10.8%(7/65)，P<0.05]。结论麻醉护理团队主导的多元化管理能缩短老年患者全身麻醉术后苏醒时间，提高苏醒期复苏质量，减少术后并发症发生，提高护理工作效率。
- 全身麻醉 /
- 老年患者 /
- 麻醉护理团队 /
- 多元化管理 /
- 并发症
Abstract: Objective To analyze the application effect of diversified management led by anesthesia nursing groups in the management of postoperative recovery in elderly patients undergoing general anesthesia, and to provide reference for improving the quality of clinical postoperative recovery. Methods A total of 130 elderly patients who underwent general anesthesia surgery in the operating room of the First People's Hospital of Yongkang from January 2023 to January 2024 were selected as the study subjects. They were randomly divided into a control group and an observation group, with 65 cases in each group, using a random number table method. The control group received routine care, while the observation group received diversified management led by the anesthesia nursing group on the basis of the control group. The recovery, anesthesia recovery, and incidence of complications between two groups of patients were compared. Results The anesthesia recovery time, tracheal intubation removal time, and exit time of the observation group patients were (68.42±6.41) min, (72.38±7.04) min, and (84.65±9.73) min, respectively, which were shorter than the control group [(71.33±8.03) min, (76.16±8.51) min, and (90.83±11.47) min], and the RASS score of the observation group was (1.13±0.27) points, which was lower than that of the control group [(2.18±0.45) points, P<0.05]. 24 hours after surgery, the total score of the Chinese version of the quality of recovery-40 questionnaire (QoR-40) in the observation group was (133.77±8.46) points, which was higher than that of the control group [(120.34±8.46) points, P<0.05]; the incidence of postoperative agitation and hypothermia in the observation group was 4.6% (3/65) and 1.5% (1/65), respectively, which were lower than those of the control group [15.4% (10/65) and 10.8% (7/65), P<0.05]. Conclusion Diversified management led by anesthesia nursing groups can shorten the recovery time of elderly patients after general anesthesia surgery, improve the quality of recovery during the recovery period, reduce postoperative complications, and improve nursing work efficiency.
- General anesthesia /
- Elderly patients /
- Anesthesia nursing group /
- Diversified management /
- Complications

HTML全文

表 1 2组老年患者一般资料比较(x±s)

Table 1. Comparison of general data between the two groups of elderly patients (x±s)

项目	对照组 (n=65)	观察组 (n=65)	统计量	P值
性别(例)			0.125^a	0.724
男性	37	35
女性	28	30
年龄(x±s，岁)	71.33±3.42	71.56±4.13	0.346^b	0.730
BMI(x±s)	23.91±3.58	24.02±3.71	0.172^b	0.864
ASA分级(例)			0.663^a	0.415
Ⅰ级	18	14
Ⅱ级	47	51
手术类型(例)			1.358^a	0.715
泌尿外科手术	32	30
骨科手术	11	16
胸科手术	15	14
其他	7	5
手术时间(x±s，min)	182.60±40.73	178.24±32.37	0.676^b	0.500
术中出血量(x±s，mL)	258.14±33.75	260.19±41.46	0.309^b	0.758
注：^a为χ²值，^b为t值。

下载: 导出CSV

表 2 2组老年患者苏醒情况比较(x±s)

Table 2. Comparison of awakening status between the two groups of elderly patients (x±s)

组别	例数	麻醉苏醒时间 (min)	拔除气管插管时间(min)	出复苏室时间(min)	RASS评分 (分)
对照组	65	71.33±8.03	76.16±8.51	90.83±11.47	2.18±0.45
观察组	65	68.42±6.41	72.38±7.04	84.65±9.73	1.13±0.27
t值		2.283	2.759	3.313	16.131
P值		0.024	0.007	< 0.001	< 0.001

下载: 导出CSV

表 3 2组老年患者术后恢复质量比较(x±s，分)

Table 3. Comparison of postoperative recovery quality between the two groups of elderly patients (x±s, points)

组别	例数	情绪状态		疼痛		躯体舒适度
组别	例数	术前1 d	术后24 h	术前1 d	术后24 h	术前1 d	术后24 h
对照组	65	34.98±5.70	26.52±3.47	26.88±3.42	22.11±3.00	42.77±4.16	38.19±4.12
观察组	65	35.12±5.22	30.11±4.19	27.01±3.88	23.85±2.69	42.38±5.20	40.22±3.56
统计量		0.146^a	5.320^b	0.203^a	3.481^b	0.472^a	3.006^b
P值		0.884	< 0.001	0.840	< 0.001	0.638	0.003

组别	例数	心理支持		身体独立性		总分
组别	例数	术前1 d	术后24 h	术前1 d	术后24 h	术前1 d	术后24 h
对照组	65	22.58±4.18	24.86±2.97	15.61±3.41	11.72±2.76	149.86±12.77	120.34±9.79
观察组	65	22.16±3.55	28.77±3.24	15.83±2.99	12.93±2.64	151.72±13.82	133.77±8.46
统计量		0.617^a	7.172^b	0.391^a	2.551^b	0.797^a	8.368^b
P值		0.538	< 0.001	0.696	0.012	0.427	< 0.001
注：^a为t值，^b为F值。

下载: 导出CSV

表 4 2组老年患者并发症发生情况比较[例(%)]

Table 4. Comparison of incidence of complications between the two groups of elderly patients [cases (%)]

组别	例数	躁动	低体温	呼吸抑制	低氧血症
对照组	65	10(15.4)	7(10.8)	6(9.2)	5(7.7)
观察组	65	3(4.6)	1(1.5)	3(4.6)	2(3.1)
χ²值		4.188	4.795	1.074	1.359
P值		0.041	0.029	0.300	0.244

下载: 导出CSV

参考文献(19)

[1]	刘欢, 李文霞, 王辰雁, 等. 全身麻醉患者术后麻醉恢复室雾化吸入戊乙奎醚对肺部并发症发生率的影响[J]. 中国临床医生杂志, 2024, 52(6): 721-725. doi: 10.3969/j.issn.2095-8552.2024.06.023 LIU H, LI W X, WANG C Y, et al. Effect of atomized inhalation of penehyclidine on the incidence of pulmonary complications in general anesthesia patients[J]. Chinese Journal of Clinicians, 2024, 52(6): 721-725. doi: 10.3969/j.issn.2095-8552.2024.06.023
[2]	DAUS C S, STEIN K J, BAECHT L M. Redefining competencies for nurse anesthesia education: integrating emotional intelligence assessment and training into a nurse anesthesia DNP program[J]. AANA J, 2024, 92(1): 27-34.
[3]	刘宁, 单单单, 张静. 多学科团队协作路径化管理模式对麻醉科手术患者转运质量、护理质量及身心应激的影响[J]. 国际护理学杂志, 2023, 42(3): 545-549. doi: 10.3760/cma.j.cn221370-20210618-00135 LIU N, SHAN D D, ZHANG J. Effects of multidisciplinary team collaborative routing management Model on transport quality, nursing quality and physical and mental stress of anesthesiology patients[J]. International Journal of Nursing, 2023, 42(3): 545-549. doi: 10.3760/cma.j.cn221370-20210618-00135
[4]	赵静波, 张兰兰, 何佳益, 等. 多学科协作模式在预防老年全身麻醉围术期低体温发生率的分析[J]. 浙江临床医学, 2023, 25(6): 914-915. ZHAO J B, ZHANG L L, HE J Y, et al. Analysis of the incidence of perioperative hypothermia in the elderly under general anesthesia using a multidisciplinary collaborative model[J]. Zhejiang Clinical Medical Journal, 2023, 25(6): 914-915.
[5]	LEMOS C S, POVEDA V B. Role of perioperative nursing in anesthesia: a national overview[J]. Rev Esc Enferm USP, 2022, 4: 56: e20210465. DOI: 10.1590/1980-220X-REEUSP-2021-0465.
[6]	何建萍. 多元化健康教育结合全程情绪管理对健康初产妇阴道分娩的影响[J]. 中国妇幼保健, 2022, 37(17): 3264-3267. HE J P. Effect of diversified health education combined with whole emotional management on vaginal delivery of healthy primipara[J]. China Maternal and Child Health Care, 2022, 37(17): 3264-3267.
[7]	朱明明, 刘芳, 王冉. 躁动镇静评分在重症患者中应用的研究进展[J]. 中华护理杂志, 2018, 53(2): 247-250. ZHU M M, LIU F, WANG R. Research progress of the application of restlessness sedation score in severe patients[J]. Chinese Journal of Nursing, 2018, 53(2): 247-250.
[8]	马燕, 李仲然, 马开喜, 等. 右美托咪定复合罗哌卡因腹横肌平面阻滞对老年患者结直肠癌根治术后早期恢复质量的影响[J]. 临床麻醉学杂志, 2020, 36(2): 148-151. MA Y, LI Z R, MA K X, et al. Effect of dexmedetomidine combined with ropivacaine transversal plane block on early recovery quality of elderly patients with colorectal cancer after radical surgery[J]. Journal of Clinical Anesthesiology, 2020, 36(2): 148-151.
[9]	苏亮, 徐丽莹. 多元化管理对老年患者全身麻醉术后认知功能的影响: 评《现代麻醉护理实践新思维》[J]. 中国实验方剂学杂志, 2023, 29(5): 282. SU L, XU L Y. Effect of diversified management on cognitive function of elderly patients after general anesthesia: review of New Thinking of Modern Anesthesia Nursing Practice[J]. Chinese Journal of Experimental Formulae, 2023, 29(5): 282.
[10]	朱莉, 马灵驭, 王甜. 体位管理联合亲情式语音唤醒服务对全麻手术患者术中压力性损伤和苏醒质量的影响[J]. 中国医药导报, 2023, 20(31): 193-196. ZHU L, MA L Y, WANG T. Impact of posture management combined with family friendly voice wake-up service on intraoperative stress injury and recovery quality in patients undergoing general anesthesia surgery[J]. China Medical Herald, 2023, 20(31): 193-196.
[11]	黄双盈, 钱蓉. 手术室人文关怀联合体温管理对肝癌患者术后心理状态、免疫功能及预后的影响[J]. 河北医药, 2023, 45(23): 3660-3663. HUANG S Y, QIAN R. Effect of humanistic care combined with temperature management in operating room on psychological state, immune function and prognosis of patients with liver cancer after surgery[J]. Journal of Hebei Medicine, 2023, 45(23): 3660-3663.
[12]	田小威, 马静, 黄俊城. 前馈控制联合音乐干预对全身麻醉恢复期患者躁动、护理不良事件及苏醒质量的影响[J]. 护理实践与研究, 2022, 19(6): 926-929. TIAN X W, MA J, HUANG J C. Effects of feedforward control combined with music intervention on agitation, nursing adverse events and quality of recovery in patients recovering from general anesthesia[J]. Nursing Practice and Research, 2022, 19(6): 926-929.
[13]	朱欣艳, 张屈云, 史冬妮, 等. 麻醉护理团队主导的多学科疼痛管理在肝移植患者围手术期中的应用效果[J]. 中华现代护理杂志, 2022, 28(32): 4462-4466. ZHU X Y, ZHANG Q Y, SHI D N, et al. Application of multidisciplinary pain management led by anesthesia nursing team in perioperative period of liver transplantation patients[J]. Chinese Journal of Modern Nursing, 2022, 28(32): 4462-4466.
[14]	HUANG Y, SUN L, GUO J, et al. Exploration and application of the peri-anesthesia nursing management mode of the five-sphere integrated plan[J]. Am J Health Behav, 2023, 47(3): 489-497.
[15]	冯睿. 麻醉护理一体化管理模式联合预见性护理对老年人复苏期护理的临床影响研究[D]. 呼和浩特: 内蒙古医科大学, 2020. FENG R. Study on the clinical impact of anesthesia nursing integrated management model combined with proactive nursing on elderly resuscitation nursing[D]. Hohhot: Inner Mongolia Medical University, 2020.
[16]	黄符香, 高长胜, 张爽, 等. 老年全麻术后患者麻醉复苏期发生低氧血症的影响因素[J]. 中国老年学杂志, 2022, 42(21): 5232-5235. HUANG F X, GAO C S, ZHANG S, et al. The influencing factors of hypoxemia during anesthesia recovery period in elderly patients undergoing general anesthesia[J]. Chinese Journal of Gerontology, 2022, 42(21): 5232-5235.
[17]	李思源, 魏时靖, 孙莉, 等. 全身麻醉术后恶心呕吐危险因素及现有止吐药物效果的回顾性研究分析[J]. 中国临床医生杂志, 2023, 51(2): 228-232. LI S Y, WEI S J, SUN L, et al. Retrospective study on the risk factors of nausea and vomiting after general anesthesia and the effect of existing antiemetic drugs[J]. Chinese Journal For Clinicians, 2023, 51(2): 228-232.
[18]	MCPHERSON C, MILLER S P, El-DIB M, et al. The influence of pain, agitation, and their management on the immature brain[J]. Pediatr Res, 2020, 88(2): 168-175.
[19]	XIAO R, ZHAO X, QI Q, et al. Effect of language arousal nursing combined with thermal insulation nursing on MAP, SPO₂, NRS and adverse reactions in elderly patients undergoing spinal fracture surgery under general anesthesia[J]. Altern Ther Health Med, 2023, 29(8): 764-769.