加速康复理念在腹腔镜肝癌切除患者护理中的应用

  目的  探讨融入加速康复理念的护理措施在腹腔镜下肝癌切除患者护理中的临床应用价值。  方法  选择2019年8月—2020年10月蚌埠医学院第一附属医院肝胆外科行腹腔镜下肝癌切除术的80例患者。采用随机数字表法进行分组:观察组40例，应用加速康复理念的护理措施；对照组40例，应用传统的护理措施。比较2组患者术后疼痛评分、围手术期指标、术后应激指标、护理满意度的差异。  结果  观察组患者术后24 h(t=5.300，P＜0.001)及术后48 h的疼痛评分(t=6.030，P＜0.001)均明显低于对照组，差异均有统计学意义；观察组患者术后排气时间(2.68±1.01)d vs. (3.21±1.13)d]、术后排便时间(3.56±1.02)d vs.(4.55±1.21)d]、腹腔引流管拔除时间(3.39±1.05)d vs.(4.14±0.99)d]、住院时间(7.53±1.74)d vs.(9.28±2.13)d]均优于对照组，差异均有统计学意义(均P＜0.05)，而2组手术时间、术中出血量、肝门阻断时间等差异无统计学意义(均P＞0.05)；观察组患者术后第1天和第4天的空腹血糖、C-反应蛋白指标优于对照组，差异均有统计学意义(均P＜0.05)；观察组患者的护理满意度显著高于对照组(90.00% vs. 70.00%)，差异有统计学意义(P＜0.05)。  结论  加速康复理念护理措施可以减少腹腔镜肝癌切除患者术后疼痛感、促进患者术后康复，降低术后应激反应，提高患者的护理满意度，具有良好的安全性与实用性。 

Application of accelerated rehabilitation concept in nursing of patients undergoing laparoscopic hepatocarcinoma resection

  Objective  To explore the clinical application value of accelerated rehabilitation concept in nursing of patients undergoing laparoscopic hepatocarcinoma resection.  Methods  The clinical data of 80 patients who underwent laparoscopic hepatocarcinoma resection at the Department of Hepatobiliary Surgery in First Affiliated Hospital of Bengbu Medical College from August 2019 to October 2020 were retrospectively analysed. Random table method was used for grouping. Forty cases were categorized into observation group, who received nursing measures with the concept of accelerated rehabilitation. Another 40 cases were categorized into control group, who received traditional nursing measures. The differences in postoperative pain score, perioperative index, postoperative stress index and nursing satisfaction index between the two groups were compared.  Results  The pain scores of patients in the observation group at 24 h (t=5.300, P < 0.01) and 48 h (t=6.030, P < 0.01) after operation were significantly lower than those of the control group and the differences were statistically significant. Meanwhile, the postoperative exhaust time (2.68±1.01) d vs. (3.21±1.13) d], postoperative defecation time (3.56±1.02) d vs. (4.55±1.21) d], abdominal drainage tube removal time (3.39±1.05) d vs. (4.14±0.99) d], hospital stay (7.53±1.74) d versus (9.28±2.13) d] and other perioperative indicators in the observation group were better than those in the control group, and the difference was statistically significant (all P < 0.05). By contrast, no statistical difference was found in the operation time, intraoperative blood loss and hepatic port occlusion time between the two groups (all P>0.05). The fasting blood glucose and C-reactive protein indices of the observation group were better than those of the control group on the 1st and 4th day after operation and the difference was statistically significant (all P < 0.05). The nursing satisfaction of the observation group was significantly higher than that of the control group (90.00% vs. 70.00%) and the difference was statistically significant (P < 0.05).  Conclusion  Accelerated rehabilitation concept in nursing measures could reduce postoperative pain in patients with laparoscopic hepatocarcinoma resection, promote postoperative recovery, reduce postoperative stress response and improve patients'satisfaction with medical care. These measures have good safety and clinical practicability.