基于循证的围术期护理在腹腔镜下结直肠癌根治术中的应用

目的 探讨基于循证的围术期护理在腹腔镜结直肠癌患者术后快速康复(enhanced recovery after surgery,ERAS)中的应用价值。 方法 选择2017年1月—2018年5月亳州市人民医院择期行腹腔镜结直肠癌根治术患者80例,按照数字表法随机分为循证护理组和常规护理组,各40例。常规护理组患者予以常规术前宣教、胃肠道准备、引流管观察、饮食护理、下床活动、疼痛护理等一般护理;循证护理组患者给予一般护理联合循证护理,即针对腹腔镜结直肠癌患者提出围术期可能出现的并发症,并优化护理方案。比较2组患者心理状态、术后并发症、术后切口愈合情况以及术后最早下床活动时间和平均住院时间。 结果 2组患者在护理前SAS以及SDS评分差异均无统计学意义;与护理干预前比较,2组患者SAS及SDS评分均明显降低,且循证护理组明显低于常规护理组。与常规护理组比较,循证护理组患者术后腹腔出血、腹腔感染、切口下出血以及切口感染发生率虽然有所降低,但差异无统计学意义;循证护理组切口愈合情况明显较好,最早下床活动时间(3.03±0.80) d]以及平均住院时间(7.13±1.07) d]较常规护理组的(5.08±0.97) d和(9.60±1.34) d明显缩短(t=-10.304,-9.157,均P<0.001)。 结论 基于循证的围术期护理可以降低腹腔镜结直肠癌患者术后腹腔出血、腹腔感染、切口下出血以及切口感染等并发症发生率,促进患者切口愈合,缩短卧床时间以及平均住院时间,促进患者术后康复。 

Application of evidence-based perioperative nursing in laparoscopic radical resection of colorectal cancer

Objective To investigate the application value of perioperative evidence-based nursing on enhanced recovery after surgery in patients undergoing laparoscopic surgeries for colorectal cancer. Methods Eighty patients undergoing selective radical resection of colorectal cancer under laparoscope were enrolled in this study from January 2017-May 2018 in Bozhou City People's Hospital. All of patients were randomly divided into evidence-based nursing group and control group, 40 patients in each group. Usual care was applied into patients in control group, and usual care combined with evidence-based nursing was applied into patients in evidence-based nursing group. The mental state and surgical incision healing after operation were evaluated in both two groups. The time to get out of bed after operation and postoperative complications as well as the mean hospitalization time were compared in two groups. Results There were no significances of SAS and SDS scores between control group and evidence-based nursing group. The mental state in both two groups were improved after nursing interventions; moreover, the mental state in evidence-based nursing group were superior to these in control group. Compared to control group, postoperative complications including abdominal hemorrhage, abdominal infection, subincision hemorrhage and incision infection were decreased in observation group, but they didn't achieve statistical threshold. Surgical incision healed better in evidence-based nursing group. Additionally, the time to get out of bed after operation and the mean hospitalization time in evidence-based nursing group were significantly shorter than these in control group(t=-10.304,-9.157, all P<0.001). Conclusion Perioperative evidence-based nursing can decrease incidences of abdominal hemorrhage, abdominal infection, subincision hemorrhage and incision infection, and improve surgical incision healing as well as enhanced recovery after surgery.