脊柱结核患者围手术期应用加速康复集束化护理临床路径表的价值

目的 探讨脊柱结核患者围手术期应用加速康复集束化护理临床路径表实施护理措施的效果。方法 搜集2018年1—6月浙江省中西医结合医院收治的符合入选标准的42例脊柱结核行手术治疗的患者作为对照组;2018年7—12月收治的符合要求的40例脊柱结核行手术治疗的患者作为观察组。对照组采用传统围手术期护理措施,观察组参照自行设计制定的脊柱结核快速康复集束化护理临床路径表实施护理措施。比较两组患者术后疼痛数字评价量表评分(NRS评分)及爆发痛发生情况,以及胃肠功能恢复时间、首次下床及进食时间、不良反应发生情况、满意度、住院费用等。结果 观察组术后24、48、72h疼痛NRS评分分别为(3.75±0.81)分、(3.48±0.93)分和(2.63±0.74)分,均明显低于对照组[分别为(4.26±1.06)分、(4.12±0.83)分和(3.26±0.83)分],差异均有统计学意义(t值分别为2.449、3.301、3.665,P值分别为0.017、0.001、0.000)。观察组发生爆发痛[1例(2.4%)]低于对照组[6例(14.3%)],差异有统计学意义(χ²=4.178,P=0.041)。观察组术后肛门排气时间、首次下床时间、首次进食时间分别为(23.65±7.76)h、(10.20±2.87)d、(19.58±10.43)h,均明显早于对照组[分别为(32.38±11.50)h、(13.90±1.45)d、(30.81±9.81)h],差异均有统计学意义(t值分别为4.008、7.444、5.024,P值均为0.000);恶心呕吐发生率(20.0%,8/40)明显低于对照组(64.3%,27/42),差异有统计学意义(χ²=16.424,P=0.000)。观察组术后满意率为100.0%(40/40),明显高于对照组的88.1%(37/42),差异有统计学意义(χ²=6.531,P=0.038);住院费用为(9.02±1.40)万元,明显低于对照组的(10.18±1.60)万元,差异有统计学意义(t=3.486,P=0.001)。结论 对脊柱结核患者实施集束化临床路径管理,能够促进患者的快速康复,降低住院费用、提高满意度,改善患者整体疗效,值得临床推广。

Value of clinical pathway table of enhanced recovery cluster nursing in patients with spinal tuberculosis during perioperative period

Objective To investigate the application effect of clinical pathway table of enhanced recovery cluster nursing in patients with spinal tuberculosis during perioperative period. Methods Forty-two patients who met the inclusion criteria and underwent surgery for spinal tuberculosis from Zhejiang Integrated Traditional and Western Medicine Hospital, between July 2018 and December 2018, were selected as the control group. Forty patients who met the inclusion criteria and underwent surgery for spinal tuberculosis from the same hospital between July 2018 and December 2018 were selected as the observation group. Patients in the control group were treated with traditional perioperative nursing measures, and those in the observation group were treated with clinical pathway table of enhanced recovery cluster nursing designed by ourselves. The postoperative Numerical Rating Scale (NRS score), occurrence of breakthrough pain, recovery time of gastrointestinal function, time of first getting out of bed and eating, occurrence of adverse reactions, satisfaction with hospitalization, cost of hospitalization and so on, were compared between the two groups. Results The NRS score of 24, 48 and 72 hours after operation were 3.75±0.81, 3.48±0.93 and 2.63±0.74, respectively in the observation group. All of them were significantly lower than those in the control group (4.26±1.06, 4.12±0.83 and 3.26±0.83, respectively). The differences were statistically significant (t=2.449, 3.301 and 3.665, respectively; P=0.017, 0.001 and 0.000, respectively). In the observation group, 1 patient (2.4%) experienced breakthrough pain, the rate was significantly lower than the control group (6 patients (14.3%)) (χ²=4.178, P=0.041). In the observation group, the times of first passing gas, getting out of bed and eating after operation were significantly earlier than those in the control group ((23.65±7.76) h vs. (32.38±11.50) h, t=4.008, P=0.000; (10.20±2.87) d vs. (13.90±1.45) d, t=7.444, P=0.000; (19.58±10.43) h vs. (30.81±9.81) h, t=5.024, P=0.000). The incidence rate of nausea and vomiting in the observation group (20.0%, 8/40) was significantly lower than that in the control group (64.3%, 27/42) (χ²=16.424, P=0.000). The postoperative satisfaction rate of the observation group was 100.0% (40/40), which was significantly higher than that of the control group (88.1%, 37/42) (χ²=6.531, P=0.038). The hospitalization expense in the observation group was RMB (90.2±14) thousand yuan, which was significantly lower than that in the control group (RMB (101.8±16) thousand yuan) (t=3.486, P=0.001). Conclusion The clinical pathway table of enhanced recovery cluster nursing for spinal tuberculosis patients could promote recovery of the patients, reduce the cost of hospitalization, improve satisfaction, and improve the overall efficacy, it is worthy of promotion in clinic.