摘要
目的探讨加速康复外科(enhanced recovery after surgery,ERAS)理念在脊柱结核围手术期护理中的应用效果。方法采用前瞻性观察研究方法,按照就诊时间连续纳入2020年2月至2021年1月首都医科大学附属北京胸科医院收治的符合入组标准的159例脊柱结核患者作为研究对象,采用交替分组的方法分为观察组(79例,采用ERAS理念下的围手术期护理措施)和对照组(80例,采用常规围手术期护理措施)。比较两组患者术后首次进食时间、肛门排气时间、排便时间、首次下床时间、首次自解小便时间、尿管复插率、并发症发生率,以及疼痛数字评价量表(numerical rating scale,NRS)评分情况等。结果观察组术后首次进食时间、自解小便时间、肛门排气时间、排便时间、下床时间[分别为12(7,15)h、5(3,6)h、(18.47±5.78)h、(54.41±3.89)h、(11.35±4.23)d]均明显早于对照组[分别为47(42,52)h、7(5,7)h、(45.54±7.94)h、(65.37±5.96)h、(14.57±5.63)d],差异均有统计学意义(Z=10.899,P<0.01;Z=5.307,P<0.01;t=24.600,P<0.01;t=13.748,P<0.01;t=8.364,P<0.01);尿管复插率(3.8%,3/79)明显低于对照组(15.0%,12/80),差异有统计学意义(χ^(2)=5.838,P=0.016)。观察组术后并发症发生率(12.7%,10/79)明显低于对照组(36.3%,29/80),差异有统计学意义(χ^(2)=11.951,P=0.001)。观察组术前24h及术后2、24、72h的疼痛NRS评分[分别为(3.72±0.67)分、(3.70±0.88)分、(4.10±0.89)分、(3.32±0.84)分]均明显低于对照组[分别为(5.41±1.09)分、(4.51±0.73)分、(5.76±0.83)分、(4.24±0.73)分],差异均有统计学意义(t值分别为11.794、6.320、12.165、7.374,P值均<0.01)。结论脊柱结核围手术期进行ERAS理念下的护理干预,可加快患者术后早期康复,减少并发症和减轻疼痛。
Objective To explore the application effect of enhanced recovery after surgery(ERAS)in perioperative nursing for spinal tuberculosis.Methods A prospective observational study was conducted in consecutive 159 spinal tuberculosis patients hospitalized in the Department of orthopedics,Beijing Chest Hospital from February 2020 to January 2021,all the patients were alternatively divided into observation group(n=79,treated with ERAS in perioperative nursing)and control group(n=80,treated with standard nursing in perioperative period).The first time of taking food,anal exhaust,defecation,getting out of bed and self-urination,the rate of catheter re-insertion,the incidence of complications,and the scores of numerical rating scale(NRS)were compared between the two groups.Results The first time of taking food,self-urination,anal exhaust,defecation,getting out of bed in the observation group were significantly earlier than those in the control group(12(7,15)h vs.47(42,52)h,Z=10.899,P<0.01;5(3,6)h vs.7(5,7)h,Z=5.307,P<0.01;(18.47±5.78)h vs.(45.54±7.94)h,t=24.600,P<0.01;(54.41±3.89)h vs.(65.37±5.96)h,t=13.748,P<0.01;(11.35±4.23)d vs.(14.57±5.63)d,t=8.364,P<0.01,respectively).The rate of re-insertion of urinary catheter and the incidence of complications in the observation group were both significantly lower than those in the control group(3.8%(3/79)vs.15.0%(12/80),χ^(2)=5.838,P=0.016;12.7%(10/79)vs.36.3%(29/80),χ^(2)=11.951,P=0.001).The scores of NRS 24 hours before operation,2 hours,24 hours and 72 hours after operation were significantly lower than those in the control group((3.72±0.67)vs.(5.41±1.09),t=11.794;(3.70±0.88)vs.(4.51±0.73),t=6.320;(4.10±0.89)vs.(5.76±0.83),t=12.165;(3.32±0.84)vs.(4.24±0.73),t=7.374,respectively;all P<0.01).Conclusion The application of ERAS in perioperative nursing for spinal tuberculosis could promote the early recovery of patients after operation,reduce the postoperative complications and relieve the pain.
作者
王倩
张亚超
张磊
雷国华
WANG Qian;ZHANG Ya-chao;ZHANG Lei;LEI Guo-hua(Department of Orthopedics,Beijing Chest Hospital,Capital Medical University,Beijing 101149,China)
出处
《中国防痨杂志》
CAS
CSCD
2021年第5期463-467,共5页
Chinese Journal of Antituberculosis
关键词
结核
脊柱
围手术期医护
康复
疗效比较研究
Tuberculosis,spinal
Perioperative care
Rehabilitation
Comparative effectiveness research
