Research on the development and application of a clustered diet and activity nursing program for perioperative cesarean section under the ERAS concept
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摘要:
目的 在加速康复外科(ERAS)理念下制定围手术期集束化饮食活动护理方案，评价采用此方案对剖宫产产妇的临床效果。 方法 选取蚌埠医科大学第一附属医院产科行择期剖宫产术的产妇为研究对象，2023年12月—2024年2月行择期剖宫产术产妇60例为对照组，采用常规饮食及活动指导；2024年3—5月行择期剖宫产术产妇60例为干预组，应用ERAS理念下集束化饮食活动护理方案。比较2组术前禁食水及术后进水时间；术前口渴、饥饿及补液率；术中及术后胃肠道反应、误吸发生率；术后拔尿管及首次下床、排气时间及腹胀发生率。 结果 干预组术前禁食、水时间短于对照组[(8.38±1.02)h vs. (11.96±2.16)h；(3.58±0.70)h vs. (8.76±1.08)h]，术前口渴饥饿发生率低于对照组，术后进水时间、术后拔尿管时间、首次下床时间均早于对照组，术后排气时间短于对照组，干预组腹胀发生率低于对照组，差异均有统计学意义(P < 0.05)。2组术后恶心呕吐发生率比较差异无统计学意义(P>0.05)，2组均未发生误吸。 结论 ERAS理念下剖宫产围手术期集束化饮食活动护理方案是一种安全、可行的护理模式，既可缩短术前禁食水、术后进水时间，减少产妇口渴及饥饿不适感，又能缩短产妇拔尿管时间、术后首次下床时间、排气时间，减少腹胀的发生，同时并不增加术中及术后恶心呕吐和误吸的发生率，可以促进术后早期康复。 Abstract:Objective To develop a perioperative clustered dietary activity nursing program under the ERAS concept and to evaluate the clinical effect of this program on women who have had caesarean sections. Methods Sixty women undergoing elective caesarean section from December 2023 to February 2024 were selected as the control group and were given regular diet and exercise advice; 60 women undergoing elective caesarean section from March 2024 to May 2024 were selected as the intervention group. The intervention group used a bundled nutritional care plan based on the ERAS concept. Comparison of preoperative fasting time and postoperative water intake time between two groups; preoperative thirst, hunger and fluid replacement rate; incidence of gastrointestinal reactions and aspiration during and after surgery; postoperative urinary catheter removal and time to first getting out of bed, time to flatulence and incidence of abdominal bloating. Results The preoperative fasting and water intake times were shorter in the intervention group than in the control group [(8.38±1.02) h vs. (11.96±2.16) h, (3.58±0.70) h vs. (8.76±1.08) h], the incidence of thirst and hunger before surgery was lower than that of the control group, the postoperative water intake time, postoperative urinary catheter removal and first time out of bed were earlier than those of the control group, and the postoperative exertion time was shorter than that of the control group, the incidence of abdominal distension was lower in the intervention group than in the control group, and the differences were statistically significant (P < 0.05); There was no statistically significant difference in the incidence of preoperative fasting time, preoperative fasting time, intraoperative and postoperative nausea, vomiting, and aspiration rates between the two groups (P>0.05). Conclusion Based on the concept of accelerated rehabilitation surgery, the bundled nutrition-activity care plan developed for caesarean section in the perioperative period is a safe, feasible and scientific care model. It can shorten the fasting time, the postoperative water intake time, reduce maternal thirst and hunger discomfort, shorten the time of urinary catheter removal, the first time of getting out of bed after surgery, and the time of gas expiration, reduce the occurrence of abdominal distention, and does not increase the incidence of gastrointestinal reactions and aspiration during and after surgery, thus promoting early postoperative recovery. -
Key words:
- Accelerated rehabilitation /
- Bundled care /
- Cesarean section /
- Perioperative period
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表 1 2组产妇一般资料比较
Table 1. Comparison of general information between two groups of parturients
项目 对照组(n=60) 干预组(n=60) 统计量 P值 年龄(x±s, 岁) 28.65±2.47 29.07±2.19 0.979a 0.330 BMI(x±s) 20.46±1.63 19.77±2.68 1.710a 0.090 糖尿病[例(%)] 无 53(88.33) 51(85.00) 0.288b 0.591 有 7(11.67) 9(15.00) 孕周[例(%)] 0.455b 0.500 早产 14(23.33) 11(18.33) 足月产 46(76.67) 49(81.67) 剖宫产[例(%)] 初次 19(31.67) 22(36.67) 0.333b 0.564 再次 41(68.33) 38(63.33) 注：a为t值，b为χ2值。 
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表 2 ERAS理念下剖宫产围手术期集束化饮食活动护理方案制定及应用
Table 2. Development and application of bundled dietary activity nursing plan for cesarean section perioperative period under ERAS concept
项目 ERAS理念下剖宫产围手术期集束化饮食活动护理 常规护理 术前 饮食 1.剖宫产产妇术前晚餐宜吃易消化饮食，睡前1 h可加餐。
2.术前口服10%GS或无果肉的果汁或无颗粒碳水化合物饮料(100~200 mL)。口服时间根据手术台次不同制定，第1台手术者于术日晨4:00—6:00口服；第2台手术者于术日晨6:00—8:00口服；下午手术者于10:00前口服，且在术日晨6:00前加食清淡早餐(牛奶、面条、面包)。
备注: 1.妊娠糖尿病患者，可饮用清水。2.易消化的饮食: 米粥、面条、鸡蛋、鱼肉、嫩豆腐、蔬菜等。3.睡前加餐选择藕粉、麦片、芝麻糊等。择期剖宫产孕妇术前晚餐宜吃易消化饮食，术前禁食10~12 h，禁饮6 h。 活动 建立术后早期活动健康告知书，介绍术后活动的意义、活动方法及记录等内容；术前指导内容同常规护理，对术后活动进行回示，了解掌握情况并针对性指导。 术前指导患者进行踝泵、深呼吸、股四头肌及抬臀运动，并按摩下肢，以促进血液循环。 术后 饮食 评估剖宫产手术后产妇基本情况，如无恶心、呕吐等症状，嘱产妇做吞咽动作，术后2 h给予20~30 mL温开水，无胃肠道不适可少量多次进食(50 mL-100 mL-200 mL)，排气后给予半流质，少量多餐。 术后6 h饮水，进流质饮食(免糖、免产气物质除外)；排气后给予高蛋白、丰富维生素、易消化的饮食。 活动 1.在常规护理基础上，剖宫产术后使用免压沙袋，避免产妇不适；尽早嚼口香糖，增加活动。
2.术后6~24 h拔出尿管，拔除尿管时取半坐卧位，嘱产妇1~2 h内喝300 mL温开水，并协助尽早下床；(0:00—14:00回病房)术后6~12 h即拔除尿管；(14:00—24:00回病房)次日晨6:00即拔除尿管。
3.多模式镇痛模式，术后疼痛评分 < 3分，缓解产妇疼痛，促进其活动。术后去枕平卧位且伤口压沙袋6 h；术后6 h翻身；术后应尽早主动、被动地运动；术后第1天拔尿管后下床；根据恢复状况逐步下床活动。
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表 3 2组产妇术前禁食水时间及术后进水时间比较(x±s, h)
Table 3. Comparison of preoperative fasting, water restriction, and postoperative water intake times between the two groups of parturients
组别 例数 术前禁食时间 术前禁水时间 术后进水时间 对照组 60 11.96±2.16 8.76±1.08 7.81±1.10 干预组 60 8.38±1.02 3.58±0.70 3.95±1.08 t值 11.589 31.192 19.400 P值 ＜0.001 ＜0.001 ＜0.001
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表 4 2组产妇术前口渴、饥饿及静脉补液率比较[例(%)]
Table 4. Comparison of preoperative thirst, hunger, and intravenous fluid replacement rates between two groups of parturients[cases(%)]
组别 例数 口渴、饥饿 静脉补液 对照组 60 8(13.33) 5(8.33) 干预组 60 2(3.33) 2(3.33) χ2值 3.927 0.607 P值 0.048 0.436
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表 5 2组产妇术后拔尿管、首次下床及排气时间、腹胀发生率比较
Table 5. Comparison of postoperative catheter removal, first time out of bed and exhaust time, and incidence of abdominal distension between two groups of parturients
组别 例数 拔尿管时间(x±s，h) 首次下床时间(x±s，h) 排气时间(x±s，d) 腹胀[例(%)] 对照组 60 20.62±4.12 25.81±3.11 1.23±0.50 15(25.00) 干预组 60 9.07±2.06 11.38±1.77 1.06±0.25 6(10.00) 统计量 19.400a 31.215a 2.308a 4.675b P值 ＜0.001 ＜0.001 0.023 0.031 注：a为t值，b为χ2值。
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