【作者】 陈锋；

【导师】 王功朝；

【作者基本信息】 山东大学 ， 护理学， 2017， 硕士

【摘要】 背景:加速康复外科(enhanced recovery after surgery,ERAS)或快速康复外科(fast-track surgery,FTS)的理念,最早是在20世纪初由丹麦外科教授Henrik Kehlet提出,其中心思想是在患者的术前、术中及术后采取一系列有循证医学依据的积极干预措施,将外科微创手术方式、麻醉、围手术期护理措施进行优化,以缓解手术创伤和应激反应,从而达到缩短患者术后住院时间、降低住院费用、提高患者满意度的效果。围术期护理是加速康复外科理念三个环节中不可或缺的一环,也是以患者为中心的具体体现。2015年9月开始,我院胸外科依据加速康复理念,学习邵逸夫医院胸外科的先进经验,对患者的围手术期护理采取了一系列的改进干预措施,包括术前宣教、疼痛宣教、术前术后呼吸功能训练、早期下床活动及术后疼痛药物规范应用及宣教,取得了较满意的效果。目的:探讨新型护理干预方法在肺癌患者围手术期加速康复外科(enhanced recovery after surgery,ERAS)中的应用效果。方法:回顾性分析山东省某三甲医院2014年7月至2016年6月份在胸外科接受肺叶切除的337例肺癌患者,其中168例肺癌患者围手术期护理方法为传统康复组分为A组,以2015年9月科室开始实施加速康复护理干预方法的169例肺癌患者分为加速康复组(B组)。回顾患者病例及科室统计资料获得患者一般资料、住院时间、住院费用、并发症发生率、疼痛评分、肠蠕动恢复时间及肺功能指标,护理满意度采用问卷调查。研究中所有数据均使用SPSS17.0软件进行处理分析。比较A组与B组病人的术后并发症的发生率、术后肠鸣音恢复时间、术后住院时间、住院费用、术后5天内疼痛评分、护理满意度差异。加速康复组患者入院后使用呼吸功能训练器进行呼吸功能训练,比较入院及术前肺功能指标中的最大通气量(MVV)、用力肺活量(FVC)、第一秒用力呼气量(FEV1)的差异。结果:(1)两组患者在术前一般资料、病理结果、术前基础疾病、病变累及部位、术后TNM分期等方面比较差异无统计学意义(P>0.05),具有可比性。(2)B组患者术后肺部感染、肺不张并发症发生率、术后住院时间、住院费用等均明显低于A组,差异具有统计学意义(P<0.05)。(3)两组的术后5天每日评估疼痛评分中,以患者描述的在过去24小时内最严重的疼痛数字评分进行标识,术后6小时、第1天疼痛评分(NRS)比较差异无统计学意义(P>0.05),B组患者术后第2天至第5天时的NRS评分均明显低于A组,差异具有统计学意义(P<0.05)。(4)B组患者术后肠蠕动恢复时间早于A组,差异具有统计学意义(P<0.05)。(5)B组患者的护理满意度评分明显高于A组,差异具有统计学意义(P<0.05)。(6)B组患者入院时肺功能指标与术前肺功能指标相比,最大通气量(MVV)、用力肺活量(FVC)、第1秒用力呼气量(FEV1)的指标明显提高,差异具有统计学意义(P<0.05)。结论:对于胸外科行肺叶切除术的患者,在围手术期应用加速康复外科理念指导的新型护理干预措施,可提高患者对手术的耐受力,减轻患者的疼痛,降低术后并发症的发生率,促进胃肠功能的早期恢复,降低住院费用,提高护理满意度,从而促进患者的快速康复。更多还原

【Abstract】 Background:The idea of enhanced recovery after surgery(ERAS)or fast-track surgery(FTS)was first proposed by Kehlet Henrik,a Danish surgeon.The central idea is to improve procedures of microinvasive operation,anesthesia and perioperative period nursing by taking a series of aggressive interventions which could minimize the surgical injury and relieve patients’ stress reaction so as to shorten the postoperative hospitalization,reduce the hospital costs and improve satisfaction of patients.Perioperative care is an integral part of the concept of ERAS,but also the embodiment of regarding the patient as the center.Starting from September 2015,based on ERAS theory and the advanced experiences from Sir Run Run Shaw Hospital thoracic surgery,the department of thoracic surgery in our hospital has carried a series of improvement measures including preoperative education,pain control,preoperative and postoperative work of breathing training and standard application of drug killer,which has obtained satisfactory results.Objective:Explore the effect of applying the new nursing intervention in perioperative period lung cancer patients based on enhanced recovery after surgery(ERAS).Methods:Retrospective analysis 337cases of patients with lung cancer from July 2014 to June 2016 in the department of thoracic surgery in a major hospital,including 168 cases of lung cancer patients adopted the traditional nursing methods(group A),169 patients with lung cancer patients adopted ERAS nursing treatment(group B).Respectively analysis patients general information,hospital stay,hospitalization expenses,postoperative complications,postoperative intestinal peristalsis recovery time and lung function indices.Questionnaire survey was used to review nursing satisfaction.SPSS 17.0 was adopted for data analyse.Comparing the incidence of postoperative complications,postoperative intestinal peristalsis recovery time,hospital stay,hospitalization expenses,one-week pain score and nursing satisfactionbetween group A and group B.Patients of group B used the device of respiratory function training to training their respiratory function,and then compare the differences of lung function including maximal voluntary ventilation(MVV),forced vital capacity(FVC)and forced expiratory volume in first second(FEV1)between pre-admission and pre-operation.Results:(1)Two groups of patients in the preoperative general information,pathological results,preoperative basic diseases,accumulation of the lesion part and TNM staging had no statistical significance(P>0.05).(2)Group B had statistically significant lower complication rate,shorten postoperative hospitalization and less hospital costs than group A(P<0.05).(3)One-week pain score was identified as the worst pain in the last 24 hours.The results showed that there was no statistical significance of the first day and the six hours after the operation pain score(NRS)between the two groups(P>0.05),the second to fifth day of the NRS scores of group B were significantly lower than that of group A(P<0.05).(4)Group B had a shorten intestinal peristalsis recovery time which was statistically significant(P<0.05).(5)Nursing satisfaction score in group B was obviously higher than that of group A which was statistically significant(P<0.05).(6)Group B had a significant better index in pulmonary function tests compared pre-operative with pre-admission which was statistically significant(P<0.05).Conclusion:For the patients of lung resection of thoracic surgery,the usage of new nursing intervention measures based on ERAS during postoperative period could promote patient’s tolerance of lung surgery,reduce the postoperative pain as well as the incidence of postoperative complications.Also,it could promote the early recovery of gastrointestinal function,reduce hospitalization expenses and improve nursing satisfaction,thus finally promote the recovery of the patients.更多还原