加速康复理念的手术室护理在腹腔镜下胆囊结石患者中的应用研究

doi:10.3760/cma.j.cn441417-20241104-10033

摘要/Abstract

摘要：

目的　评估加速康复（ERAS）理念指导下的手术室护理在腹腔镜下胆囊切除手术患者中的应用效果。方法　选取2022年1月至2023年1月汉中市中心医院收治的100例腹腔镜下胆囊切除手术患者进行随机对照试验。将患者分为观察组和对照组，各50例。观察组：男、女各25例，年龄35～65（50.34±7.45）岁。对照组：男、女各25例，年龄34～66（49.87±7.58）岁。对照组接受常规护理，观察组在对照组基础上实施ERAS理念的手术室护理。比较两组不同时间点体温变化和疼痛状况［视觉模拟评分法（VAS）评分］、恢复指标（气管导管拔除、麻醉复苏室停留、首次下床活动、首次肛门排气、恢复进食、住院等时间）、社会功能［社会功能缺陷筛选量表（SDSS）评分］、心理应激状况［汉密尔顿焦虑量表（HAMA）评分、汉密尔顿抑郁量表（HAMD）评分］、生活质量［世界卫生组织生存质量量表（WHO-QOL）评分］的变化。采用χ2检验、t检验进行统计分析。结果　观察组麻醉1 h后、术后进入麻醉复苏室、离开麻醉复苏室体温均高于对照组［（36.23±0.18）℃比（35.21±0.23）℃、（36.40±0.31）℃比（35.57±0.54）℃、（36.62±0.18）℃比（36.12±0.14）℃］，差异均有统计学意义（均P<0.05）；观察组在术后6、12、24、72 h VAS评分均低于对照组［（7.76±1.56）分比（7.80±1.51）分、（4.48±0.71）分比（6.57±0.87）分、（3.71±0.61）分比（4.55±0.61）分、（2.86±0.82）分比（3.29±0.64）分］，差异均有统计学意义（均P<0.05）；观察组气管导管拔除、麻醉复苏室停留、首次下床活动、首次肛门排气、恢复进食、住院等时长均低于对照组［（55.48±7.93）min比（75.30±10.76）min、（115.37±16.48）min比（166.26±23.75）min、（14.68±2.13）h比（18.95±2.71）h、（23.28±3.33）h比（36.59±5.23）h、（18.50±2.64）h比（30.57±4.37）h、（5.31±0.75）d比（6.58±0.96）d］，差异均有统计学意义（均P<0.05）；干预后，观察组SDSS评分、HAMA和HAMD评分均低于对照组［（6.96±0.99）分比（11.17±0.09）分、（16.06±2.29）分比（22.05±3.15）分、（17.26±2.47）分比（20.89±2.98）分］，差异均有统计学意义（均P<0.05）；干预后，观察组WHO-QOL总分为［（81.18±6.36）分］，高于对照组［（71.80±6.15）分］，差异有统计学意义（P<0.05）。结论　ERAS理念指导下的手术室护理可有效减轻腹腔镜下胆囊切除手术患者术中体温波动和术后疼痛，缩短恢复时间，改善社会功能和心理应激状态，提高生活质量。

关键词: ERAS理念, , , 腹腔镜胆囊切除手术, , , 手术室护理, , , 心理应激

Abstract:

Objective　To evaluate the effect of operating room nursing guided by the enhanced recovery after surgery (ERAS) concept for patients undergoing laparoscopic cholecystectomy. Methods　one hundred patients who underwent laparoscopic cholecystectomy at Hanzhong Central Hospital from January 2022 to January 2023 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 50 cases in each group. There 25 males and 25 females in the observation group; they were 35-65 (50.34±7.45) years old. There 25 males and 25 females in the control group; they were 34-66 (49.87±7.58) years old. The control group took routine nursing; in addition, the observation group took operation nursing guided by the ERAS concept. The body temperatures and scores of Visual Analogue Scale (VAS) at different time points, recovery indicators (time to tracheal extubation, anesthesia recovery room stay, time for first off-bed activity, time for first anal exhaust, time for recovery to oral intake, and hospital stay), social function [Social Disability Screening Schedule (SDSS)], psychological stress [Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD), and quality of life [World Health Organization Quality of Life Scale (WHO-QOL)] were compared between the two groups. χ² and t tests were used for the statistical analysis. Results　The body temperatures 1 h after anesthesia and when they entered and left the anesthesia recovery room in the observation group were higher than those in the control group [(36.23±0.18) ℃ vs. (35.21±0.23) ℃, (36.40±0.31) ℃ vs. (35.57±0.54) ℃, (36.62±0.18) ℃ vs. (36.12±0.14) ℃], with statistical differences (all P<0.05). The scores of VAS 6, 12, 24, and 72 h after the operation in the observation group were lower than those in the control group ( 7.76±1.56 vs 7.80±1.51 ., 4.48±0.71 vs. 6.57±0.87, 3.71±0.61 vs. 4.55±0.61, and 2.86±0.82 vs. 4.55±0.61), with statistical differences (all P<0.05). The time to tracheal extubation, anesthesia recovery room stay, time for first off-bed activity, time for first anal exhaust, time for recovery to oral intake, and hospital stay in the observation group were shorter than those in the control group [(55.48±7.93) min vs. (75.30±10.76) min,(115.37±16.48) min vs. (166.26±23.75) min, (14.68±2.13) h vs. (18.95±2.71) h, (23.28±3.33) h vs. (36.59±5.23) h, (18.50±2.64) h vs. (30.57±4.37) h, and (5.31±0.75) d vs. (6.58±0.96) d], with statistical differences (all P<0.05). After the intervention, the scores of SDSS, HAMA, and HAMD in the observation group were lower than those in the control group (6.96±0.99 vs. 11.17±0.09, 16.06±2.29 vs. 22.05±3.15, and 17.26±2.47 vs. 20.89±2.98), with statistical differences (all P<0.05). After the intervention, the total score of WHO-QOL in the observation group was higher than that in the control group (81.18±6.36 vs. 71.80±6.15), with a statistical difference (P<0.05). Conclusion　ERAS-guided operating room nursing for patients undergoing laparoscopic cholecystectomy can reduce their perioperative temperature fluctuation and postoperative pain, shorten recovery time, and improve their social function, psychological stress, and quality of life.

Key words: ERAS concept, , Laparoscopic cholecystectomy, , Operating room nursing, , Psychological stress

孙蓓孙菲宛新建. 加速康复理念的手术室护理在腹腔镜下胆囊结石患者中的应用研究 [J]. 国际医药卫生导报, 2025, 31(10): 1742-1747.

Sun Bei, Sun Fei, Wan Xinjian.

Operation room nursing guided by enhanced recovery after surgery concept for patients taking laparoscopic cholecystectomy [J]. International Medicine and Health Guidance News, 2025, 31(10): 1742-1747.

参考文献

[1]烟晓丽,姚利,杨翔,等.基于加速康复外科理念的护理干预在腹腔镜胆囊切除术患者围手术期的应用效果[J].中国医药导报,2024,21(8):166-170. DOI:10.20047/j.issn1673-7210.2024.08.39.

[2]张兰.基于ERAS理念的手术室护理路径在行腹腔镜胆囊切除术患者中的应用[J].实用中西医结合临床,2023,23(18):117-119,128. DOI:10.13638/j.issn.1671-4040. 2023.18.034.

[3]徐雨晴,何巧芳,周萍.基于加速康复外科理念对游离皮瓣移植修复术的影响[J].河北医药,2023,45(16):2500-2502,2506. DOI:10.3969/j.issn.1002-7386.2023.16.024.

[4]万艳.手术室护理路径对行腹腔镜胆囊切除术患者的影响[J].实用中西医结合临床,2023,23(23):115-117,124. DOI:10.13638/j.issn.1671-4040.2023.23.033.

[5]中华消化杂志编辑委员会,中华医学会消化病学分会肝胆疾病协作组.中国慢性胆囊炎、胆囊结石内科诊疗共识意见(2018年)[J].临床肝胆病杂志,2019,35(6):1231-1236. DOI:10.3969/j.issn.1001-5256.2019.06.011.

[6]张笑雨,张璐,王松蛟.快速康复外科理念在肝移植手术护理中的应用效果[J/CD].全科口腔医学电子杂志,2020,7(25):126-128.https://xueshu.baidu.com/usercenter/paper/showpaperid 1a1302j0k0410js0703404n0xr778925&site xueshu_se

[7]田瑞东,宁纯民,刘海生.加速康复外科理念在腹腔镜结直肠癌围手术期中的应用效果观察[J].癌症进展,2019,17(15):1856-1859. DOI:10.11877/j.issn.1672-1535. 2019.17.15.33.

[8]钟小琳,王丽芳,钟招明.生物-心理-社会功能整体化护理在腹腔镜胆囊结石手术患者中的应用[J].齐鲁护理杂志,2023,29(8):41-43. DOI:10.3969/j.issn.1006-7256. 2023.08.013.

[9]黄招美,蔡艳菊,钟慧琼.基于PRECEDE模式的护理方案在腹腔镜胆囊结石取石术患者中的应用[J].齐鲁护理杂志,2021,27(20):101-104. DOI:10.3969/j.issn.1006-7256. 2021.20.041.

[10]闫小娟.个性化全面优质护理对胆囊结石择期手术患者术前焦虑、VAS评分及生活质量的影响[J].国际护理学杂志,2019,38(2):251-253. DOI:10.3760/cma.j.issn.1673-4351. 2019.02.035.

[11]苏晓丽.多维度健康教育在改善腹腔镜胆囊结石手术患者自护能力及生活质量中的应用[J].国际护理学杂志,2021,40(13):2373-2376. DOI:10.3760/cma.j.cn221370- 20191008-00680.

[12]赵芝鑫,郑少坤,陈晓东,等.十二指肠镜下鼻胆管引流在胆囊结石合并胆总管结石腹腔镜术中的应用[J].海南医学,2022,33(3):335-338. DOI:10.3969/j.issn.1003-6350.2022.03.017.

[13]罗刚,江帆,黄子锋,等.腹腔镜下胆囊切除术联合经腹顺行导丝引导逆行胰胆管造影术取石治疗胆囊结石合并细径胆总管结石的疗效分析[J].临床外科杂志,2021,29(5):466-469. DOI:10.3969/j.issn.1005-6483.2021.05.020.

[14]李红梅,崔利萍,司莹.营养心理双轮驱动的ERAS护理对肝胆外科患者的干预效果[J].国际医药卫生导报,2024,30(20):3481-3486. DOI:10.3760/cma.j.issn.1007-1245. 2024.20.027.

[15]侯潇峰,宋展,刘驰,等.同期腹腔镜胆囊切除术联合内镜下逆行胰胆管造影治疗胆囊结石合并胆总管结石临床分析[J].中华实用诊断与治疗杂志,2021,35(2):156-158. DOI:10.13507/j.issn.1674-3474.2021.02.012.

[16]方剑,开喆,陈祝明.腹腔镜下胆囊切除术与小切口胆囊切除术治疗胆囊结石的疗效观察及其对免疫功能的影响[J].河北医学,2020,26(7):1062-1066. DOI:10.3969/j.issn. 1006-6233.2020.07.002.

[17]张忠伟,唐贺超,周柏萱,等.腹腔镜下经胆囊管汇入处微切开治疗青中年胆囊结石并胆管结石[J].肝胆胰外科杂志,2023,35(2):110-112,129. DOI:10.11952/j.issn.1007-1954.2023.02.009.

[18]王磊,刘康伟,段玉灵,等.老年胆囊结石并胆总管结石病人经内镜下逆行胰胆管造影术后序贯腹腔镜胆囊切除术治疗手术时机的研究[J].临床外科杂志,2021,29(6):559-561. DOI:10.3969/j.issn.1005-6483.2021.06.017.

[19]田维新,车建平.腹腔镜下胆囊切除术对胆囊结石患者免疫功能及炎性因子水平的影响[J].山西医药杂志,2021,50(20):2925-2927. DOI:10.3969/j.issn.0253-9926. 2021.20.024.

[20]寇光荣.胆囊结石患者手术室腹腔镜治疗中应用循证护理的效果[J].国际医药卫生导报,2020,26(18):2808-2809. DOI:10.3760/cma.j.issn.1007-1245.2020.18.043.

[21]过一清,韦凯扬,廖嘉忠,等.腹腔镜下胆囊切除术联合钬激光治疗胆囊结石合并胆总管结石的疗效观察[J].现代消化及介入诊疗,2020,25(11):1490-1492. DOI:10.3969/j.issn.1672-2159.2020.11.016.

[22]刘小飞,张大伟,罗宏宇,等.腹腔镜胆囊切除术联合内镜下逆行胰胆管造影和十二指肠乳头括约肌切开术治疗胆囊结石合并肝外胆管结石患者疗效研究[J].实用肝脏病杂志,2021,24(5):753-756. DOI:10.3969/j.issn.1672-5069. 2021.05.037.

[23]汪兆姑.胆囊结石伴胆囊炎腹腔镜术后ERAS护理模式的应用效果[J].中国医药导报,2023,20(12):165-168,180. DOI:10.20047/j.issn1673-7210.2023.12.37.

[24]何香凌.加速康复外科(ERAS)对胆囊结石伴慢性胆囊炎患者行腹腔镜胆囊切除临床路径的影响[J].中国社区医师,2020,36(30):134-135. DOI:10.3969/j.issn.1007- 614x. 2020.30.065.

[25]叶赛,赵杰,李威威,等.加速康复外科对胆囊结石并胆总管结石患者康复、炎症和应激的影响[J].中华实验外科杂志,2023,40(9):1831-1834. DOI:10.3760/cma.j.cn421213- 20230207-01033.