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Nursing Science

2168-5657

Scientific Research Publishing

10.12677/NS.2021.106128

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NS20210600000_96071422.pdf

医药卫生

快速康复外科护理模式优化高原肝包虫病人围手术期护理满意度的价值研究 The Value of Fast Track Surgery Nursing Model to Optimize Perioperative Nursing Satisfaction of High Altitude Hepatic Echinococcosis Patients

倪

雯汶

¹ ²

null

甘孜藏族自治州人民医院，四川甘孜

01 11 2021

10 06 800 804

2014

This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/

目的：对快速康复外科护理模式优化高原肝包虫病人围手术期的护理满意度进行调查研究。方法：选取我院2016年5月至2020年7月诊治的236例肝包虫患者，按不同护理方式参照随机数字表法将其分成对照组和FTS (快速康复外科，Fast Track Surgery)组，每组各118例，对照组采用术后常规围手术期护理措施，FTS组在此基础上融合快速康复外科护理模式，统计对比两组患者术后一般情况和护理满意度的差异。结果：FTS组患者的排气、排便时间显著早于对照组(P < 0.05)；FTS组患者术后当日睡眠时间显著高于对照组(P < 0.05)；FTS组患者的住院时间显著低于对照组(P < 0.05)；FTS组患者对护理态度和护理方式的评价显著高于对照组(P < 0.05)；FTS组患者术后心理状态的自我评估显著高于对照组(P < 0.05)。结论：快速康复外科护理模式融入肝包虫病人围手术期的护理能够显著改善患者术后的生活质量和心理状态，并且还能够大幅度提升患者的护理满意度，有巨大的推广价值。 Objective: To investigate and study the nursing satisfaction of patients with high altitude hepatic hydatid patients during the perioperative period to optimize the rapid rehabilitation surgical nursing model. Methods: A total of 236 cases of hepatic echinococcosis patients diagnosed and treated in our hospital from May 2016 to July 2020 were selected. According to different nursing methods, the patients were divided into the control group and the FTS (Fast Track Surgery) group according to the random number table method, with 118 patients in each group. The control group adopts postoperative routine perioperative nursing measures, and the FTS group integrates the Fast Track Surgery nursing model on this basis, and the differences in postoperative general conditions and nursing satisfaction between the two groups were statistically compared. Results: The time of exhaust and defecation in FTS group was significantly earlier than that in control group (P < 0.05); the sleep time of the patients in the FTS group on the postoperative day was significantly higher than that of the control group (P < 0.05); the hospitalization time of the patients in the FTS group was significantly lower than that of the control group (P < 0.05); the evaluation of nursing attitude and nursing style of FTS group was significantly higher than that of control group (P < 0.05); the self-evaluation of postoperative mental state of FTS group was significantly higher than that of control group (P < 0.05). Conclusion: The Fast Track Surgery nursing model integrated into the perioperative nursing of patients with hepatic echinococcosis can significantly improve the quality of life and psychological state of the patients after surgery, and can also greatly improve the patient’s nursing satisfaction, which has great promotion value.

快速康复外科，护理，肝包虫病，护理满意度, Fast Track Surgery Nursing Hepatic Echinococcosis Nursing Satisfaction

摘要

关键词

快速康复外科，护理，肝包虫病，护理满意度

The Value of Fast Track Surgery Nursing Model to Optimize Perioperative Nursing Satisfaction of High Altitude Hepatic Echinococcosis Patients<sup> </sup>

Wenwen Ni

Ganzi Tibetan Autonomous Prefecture People’s Hospital, Ganzi Sichuan

Received: Oct. 19^th, 2021; accepted: Dec. 17^th, 2021; published: Dec. 29^th, 2021

ABSTRACT

Objective: To investigate and study the nursing satisfaction of patients with high altitude hepatic hydatid patients during the perioperative period to optimize the rapid rehabilitation surgical nursing model. Methods: A total of 236 cases of hepatic echinococcosis patients diagnosed and treated in our hospital from May 2016 to July 2020 were selected. According to different nursing methods, the patients were divided into the control group and the FTS (Fast Track Surgery) group according to the random number table method, with 118 patients in each group. The control group adopts postoperative routine perioperative nursing measures, and the FTS group integrates the Fast Track Surgery nursing model on this basis, and the differences in postoperative general conditions and nursing satisfaction between the two groups were statistically compared. Results: The time of exhaust and defecation in FTS group was significantly earlier than that in control group (P < 0.05); the sleep time of the patients in the FTS group on the postoperative day was significantly higher than that of the control group (P < 0.05); the hospitalization time of the patients in the FTS group was significantly lower than that of the control group (P < 0.05); the evaluation of nursing attitude and nursing style of FTS group was significantly higher than that of control group (P < 0.05); the self-evaluation of postoperative mental state of FTS group was significantly higher than that of control group (P < 0.05). Conclusion: The Fast Track Surgery nursing model integrated into the perioperative nursing of patients with hepatic echinococcosis can significantly improve the quality of life and psychological state of the patients after surgery, and can also greatly improve the patient’s nursing satisfaction, which has great promotion value.

Keywords:Fast Track Surgery, Nursing, Hepatic Echinococcosis, Nursing Satisfaction

This work is licensed under the Creative Commons Attribution International License (CC BY 4.0).

http://creativecommons.org/licenses/by/4.0/

1. 前言

棘球蚴病(包虫病)是一种严重的人畜共患寄生虫病，由动物和人类中的棘球绦虫幼虫引起 [ 1 ]，它主要发生在人类或其他中间宿主的内脏器官中，肝脏和肺是最常见的靶器官 [ 2 ]。根据虫卵的类型、分类、大小、位置、并发症以及可用的医疗设备，肝包虫的治疗有多种方式，包括抗感染药物治疗、手术治疗、非手术干预等 [ 3 ]。临床上首选手术治疗 [ 4 ]，但是由于在长期的膨胀生长过程中，肝包虫形成的虫卵压迫肝组织、周围肝内血管和胆管，手术后可能会出现反复胆瘘、梗阻性黄疸、残腔感染，甚至肝门胆管狭窄等术后并发症，是医护人员在临床实践中面临的重大挑战 [ 5 ]。快速康复外科护理模式(Fast Track Surgery, FTS)是一种新的护理概念，通过减少直接手术损伤、手术应激反应和手术相关并发症，从而达到促进患者快速康复、缩短住院时间以及降低住院费用的目的 [ 6 ] [ 7 ]。FTS的最终目标是实现“无痛、无风险手术”，这一点已经引起了全世界的关注 [ 8 ] [ 9 ]。它主要包括术前、术中和术后采用的一系列循证医学证实的围手术期优化护理措施：术前，心理安慰和身体肌肉训练可能会降低患者对术前心理和手术压力的反应 [ 10 ] [ 11 ]；术中，优化麻醉和手术(微创手术)，可以减轻疼痛并缩短恢复时间；术后，营养支持和疼痛管理有利于改善器官功能障碍，早期康复锻炼可以预防手术相关并发症。目前，FTS概念已广泛应用于恶性肿瘤手术和腹腔镜手术(尤其是结直肠手术)，但在肝包虫病人围手术期的护理应用经验相对较少，因此，本研究将在我院2016年5月至2020年7月收治的236例肝包虫患者纳入研究，对FST优化肝包虫病人围手术期护理满意度进行调查评估，现报告如下。

2. 资料与方法 2.1. 一般资料

选取我院2016年5月至2020年7月诊治的236例肝包虫患者，按不同护理方式参照随机数字表法将其分成对照组和FTS组，每组各118例，纳入标准：经B超检查和CT摄片诊断为肝包虫病，并第一次行手术；无心血管及呼吸系统手术禁忌症，无重度器质性疾病手术风险；术前未行介入治疗或穿刺术及其他治疗方法；智力正常，意识清醒并愿意合作；自愿参与并签署知情同意书。排除标准：合并有其他脏器包虫病及有其他腹部手术史患者；急诊手术患者；服用止痛药物者或有影响疼痛的基础疾病患者。对照组118例，其中男52例，女66例，平均年龄(53.55 ± 8.14)岁，内囊摘除结合外囊完整剥离手术48例，半肝切除术32例，肝部分切除术38例；FTS组118例，男51例，女67例，平均年龄(54.20 ± 9.06)岁，内囊摘除结合外囊完整剥离手术46例，半肝切除术33例，肝部分切除术39例。两组患者性别、年龄以及手术方式对比P > 0.05，可进行分组比较，该研究经我院伦理委员会审批通过。

2.2. 方法

对照组采用术后常规围手术期护理措施，FTS组在此基础上融合快速康复外科护理模式，具体措施如下：

术前进行心理干预和饮食干预。护理人员与患者积极沟通，加强患者对快速康复理念的理解，同时让患者充分了解手术过程和手术后可能出现的不良反应，缓解患者紧张、焦虑和恐惧的心情。饮食方面先进行营养风险筛查，如果存在营养风险则先给予营养干预，待营养状况改善后再进入手术流程，术前6 h禁固体食物，可以饮用糖水，术前2 h饮用葡萄糖溶液400 ml后禁饮。

术中护理。术中不放置胃管，尿管在麻醉后放置，术后1 d尽早拔除。术中注意保暖，采取铺保温毯、调节手术室温度以及给输入液体加温等措施。尽量减少手术时间，并且注意手术动作轻柔，减少对膈肌的刺激。

术后镇痛、饮食及身体锻炼干预。术后护送患者回房，麻醉清醒后护理人员密切观察患者病情变化和疼痛情况，叮嘱患者不需要强忍疼痛，采取适当止痛措施如安置镇痛泵以减轻患者疼痛。术后6 h听诊腹部，有肠鸣音即可进流食，观察患者进食后情况，如无不适则从术后第1天起逐渐由流质饮食恢复到半流质饮食，3天内即可恢复到正常饮食，在此过程中需要频繁对患者进行饮食指导。术后叮嘱患者卧床休息，6 h后指导患者床上活动四肢，协助患者翻身，并对其四肢进行按摩以促进血液循环，术后1天鼓励患者在护理人员的协助下下床活动。

2.3. 观察指标及判定标准

术后一般情况主要包括术后首次排气、排便时间、术后当日睡眠时间以及住院时间的观察记录。护理满意度评估，分组收集患者不记名打分的本院统一的满意度调查表，统计其中与护理相关的栏目护理态度、护理方式和心理状态评分后进行比较，根据满意度的不同打分，满分为10分。

2.4. 统计学处理

所有数据分析均在SPSS 22.0软件上进行。计量资料以平均值 ± 标准差( x ¯ ± s)表示，t检验进行比较，P < 0.05被认为差异具有统计学意义。

3. 结果 3.1. 两组患者术后一般情况对比

FTS组和对照组相比，排气、排便时间显著提前，术后当日睡眠时间显著增加，住院时间显著缩短，P < 0.05，有统计学差异，见表1。

Table 1 Comparison of postoperative general conditions between the two groups ( x ¯ ± s

组别(n)	排气时间(d)	排便时间(d)	术后当日睡眠时间(h)	住院时间(d)
对照组(n = 118)	3.72 ± 1.29	5.01 ± 2.25	5.69 ± 3.55	9.13 ± 3.42
FTS组(n = 118)	2.20 ± 1.01	3.82 ± 1.29	7.01 ± 2.17	6.45 ± 2.58
t	3.3664	5.0026	4.2665	8.1221
P	0.0001	0.0004	0.0000	0.0000

表1. 两组患者术后一般情况对比( x ¯ ± s)

3.2. 两组患者护理满意度对比

FTS组和对照组相比，对护理态度和护理方式的评价显著提高，患者自身心理状态更好，P < 0.05，组间差异显著，见表2。

Table 2 Comparison of nursing satisfaction between the two groups ( x ¯ ± s

组别(n)	护理态度	护理方式	心理状态
对照组(n = 118)	8.55 ± 1.44	7.85 ± 1.65	7.92 ± 2.58
FTS组(n = 118)	9.15 ± 1.32	9.05 ± 1.47	8.56 ± 1.72
t	3.2654	4.2223	4.2352
P	0.0005	0.0000	0.0000

表2. 两组患者护理满意度对比( x ¯ ± s)

4. 讨论

南美洲、东欧、中东、东非、俄罗斯和中国等牧区是肝包虫病的高度流行地区 [ 12 ]，一般来说，肝包虫病在早期无症状表现，据报道其无症状率可达33.88% [ 13 ]，它发作的症状表现为不明显的细微疼痛，其死亡率约为2%~4%。中国是世界包虫病发病率最高的国家之一，主要流行地区为中国西部农村、半农业和半牧区，尤其是新疆维吾尔自治区、青海省、甘肃省、宁夏自治区、西藏自治区、内蒙古自治区和四川省西部等高原地区，它不仅降低了牧民和农民的收入，对他们的健康和生活质量也造成了严重影响 [ 14 ]。尤其值得注意的是，如果肝包虫病得不到治疗或者治疗不足，其诊断后15年内死亡率高达90%，与肝癌死亡率相似。虽然随着医疗的进步，近年来肝包虫患者的手术方式有了多种方案选择，因手术难度的增加术后存在并发症的可能，给患者的生活带来长期不便及较大的心理负担 [ 15 ]。由于肝包虫病人术后临床情况较为复杂，涉及的风险较高，因此早有人呼吁医护人员应根据患者的临床特点，采取个体化、综合性的治疗和护理措施 [ 5 ]。快速康复外科护理模式目前已被许多外科手术证实可以显著缩短住院时间及降低住院费用、减少术后疼痛、降低并发症发生频率及提高患者的护理满意度，其有效性和安全性被证明是可靠的 [ 11 ] [ 16 ]，但其在肝包虫病人围手术期的应用和价值研究还相当缺乏。

本次评估快速康复外科护理模式在高原肝包虫病人围手术期护理应用中的价值，对比术后一般情况发现，FTS组患者的排气、排便时间显著早于对照组(P < 0.05)，患者术后当日睡眠时间显著高于对照组(P < 0.05)，住院时间显著低于对照组(P < 0.05)。对比两组患者的护理满意度发现，FTS组患者对护理态度和护理方式的评价显著高于对照组(P < 0.05)，并且术后心理状态的自我评估显著高于对照组(P < 0.05)。

综上，本研究证实以人本理念为核心的快速康复外科护理模式在肝包虫病人围手术期的应用能够大幅度提高患者术后的生活质量和心理状态，并且还进一步提升了患者对护理态度和护理方式的满意度。未来，肝包虫病人快速康复外科护理模式的围手术期策略还需要在更完善的统一标准下抽取更多高质量的大样本进行循证分析，以便进行更安全有效的多学科合作以及广泛推广到其他更多的外科手术。

文章引用

倪雯汶. 快速康复外科护理模式优化高原肝包虫病人围手术期护理满意度的价值研究 The Value of Fast Track Surgery Nursing Model to Optimize Perioperative Nursing Satisfaction of High Altitude Hepatic Echinococcosis Patients[J]. 护理学, 2021, 10(06): 800-804. https://doi.org/10.12677/NS.2021.106128

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