加速康复外科理念在脊柱结核围手术期护理中的应用效果分析

目的: 分析探讨加速康复外科(ERAS)理念在脊柱结核围手术期护理应用中的效果。 方法: 收集青岛市胸科医院外科2017年7月至2020年6月收治的147例脊柱结核患者。其中,2017年7月至2018年12月收治的68例脊柱结核手术患者围手术期应用常规护理,作为对照组;2019年1月至2020年6月收治的79例脊柱结核手术患者在常规护理措施基础上融入了ERAS理念,作为ERAS组。比较两组患者的引流管拔除、最初下床进行功能锻炼、最初自主排尿的时间,术后72h疼痛(采用视觉模拟评分法)评分,住院天数,恶心呕吐、肺部感染、药物性肝损伤的发生率,以及患者满意度的差异。 结果: 与对照组相比,ERAS组患者引流管拔除时间[6.00(4.00,8.00)d和8.00(7.00,8.00)d;W=4321.000,P<0.001]、最初下床进行功能锻炼时间[2.00(2.00,4.00)d和5.50(4.25,6.00)d;W=3376.000,P<0.001]、首次在床上自主排尿时间[5.00(3.00,6.00)h和9.00(7.00,9.00)h;W=3369.000,P<0.001]、术后72h疼痛评分[3.00(2.00,4.00)分和5.00(5.00,6.00)分;W=4078.500,P<0.001]、住院总天数[19.00(18.00,21.00)d和22.00(19.00,27.00)d;W=4791.500,P<0.001]均有所下降,差异均有统计学意义。与对照组相比,ERAS组术后恶心呕吐发生率[7.6%(6/79)和19.1%(13/68);χ²=4.311,P=0.038]、肺部感染发生率[2.5%(2/79)和11.8%(8/68);χ²=4.914,P=0.027]、药物性肝损伤发生率[1.3%(1/79)和13.2%(9/68),χ²=8.258,P=0.004]均有所下降,差异均有统计学意义。ERAS组患者满意度高于对照组[96.2%(76/79)和85.3%(58/68),χ²=7.100,P=0.008],差异有统计学意义。 结论: ERAS理念应用于脊柱结核围手术期护理可以加速患者的康复,减少并发症的发生,提高患者的满意度。

Analysis of the effect of enhanced recovery after surgery in perioperative nursing of spinal tuberculosis

Objective: To analyze the effect of enhanced recovery after surgery (ERAS) concept in perioperative nursing of spinal tuberculosis. Methods: A total of 147 patients with spinal tuberculosis treated in the Department of Surgical of Qingdao Chest Hospital from July 2017 to June 2020 were collected. Of them, 68 cases treated from July 2017 to December 2018 received routine nursing during the perioperative period (control group); 79 cases from January 2019 to June 2020 who underwent surgery were treated with the ERAS concept on the basis of routine nursing measures (ERAS group). The time of drainage tube extraction, first getting out of bed for functional exercise and initial spontaneous urination, pain score 72 hours after operation (using visual analog scoring (VAS) method), the length of hospital stay, the incidence of nausea and vomiting, the incidence of lung infection and drug-induced liver damage, and the patient's satisfaction were observed and compared between the two groups. Results: Compared with the control group, the drainage tube removal time, the initial time to get out of bed for functional exercise, the initial spontaneous urination time, VAS score 72 h after operation and the length of hospital stay in the observation group were all significantly shorter than those in the control group (6.00(4.00,8.00) d vs. 8.00 (7.00,8.00) d, W=4321.000, P<0.001; 2.00 (2.00,4.00) d vs. 5.50 (4.25,6.00) d, W=3376.000, P<0.001; 5.00 (3.00, 6.00) h vs. 9.00 (7.00, 9.00) h, W=3369.000, P<0.001; 3.00 (2.00, 4.00) vs. 5.00 (5.00, 6.00), W=4078.500, P<0.001; 19.00 (18.00, 21.00) d vs. 22.00(19.00,27.00) d, W=4791.500,P<0.001, respectively). The incidences of postoperative nausea and vomiting and pulmonary infection, and drug-induced liver damage in the observation group were significantly lower than those in the control group (7.6% (6/79) vs. 19.1% (13/68), χ²=4.311,P=0.038; 2.5% (2/79) vs. 11.8% (8/68), χ²=4.914, P=0.027; and 1.3% (1/79) vs. 13.2% (9/68), χ²=8.258, P=0.004, respectively). The patient satisfaction in the observation group was significantly higher than that in the control group (96.2% (76/79) vs. 85.3% (58/68), χ²=7.100, P=0.008). Conclusion: The application of ERAS concept in perioperative nursing of spinal tuberculosis can speed up the recovery, reduce the occurrence of complications, and improve the satisfaction.