快速康复外科理念在经鼻蝶入路垂体瘤切除患者护理中的应用

doi:10.3761/j.issn.1672-9234.2019.04.016

摘要/Abstract

摘要：

目的探讨快速康复外科在经鼻蝶入路垂体瘤切除患者围手术期护理中的应用效果。方法按照入院先后顺序将择期手术的经鼻蝶入路垂体瘤切除患者分为两组,2014年4月—2016年11月入住的105例患者为对照组,2016年12月—2018年8月入住的105例患者为试验组。对照组围手术期实施常规护理,试验组通过在围术期采用一系列有效的优化护理措施,减轻患者心理和生理的创伤应激反应,干预后比较两组患者术后首次下床活动时间、住院时间、住院总费用、焦虑情况、术后48 h疼痛例数及术后并发症的差异。结果试验组患者术后首次下床活动时间早于对照组,住院时间、住院总费用少于对照组,焦虑评分低于对照组,试验组患者术后48 h疼痛发生例数及并发症发生例数均少于对照组,差异均具有统计学意义（P＜0.05）。结论应用快速康复外科理念对经鼻蝶入路垂体瘤切除患者实施围手术期护理是安全有效的,可有效减轻患者术后48 h疼痛及焦虑程度,促使患者早日下床活动,减少住院时间、住院总费用及术后并发症的发生,促进患者早日康复。

关键词: 垂体肿瘤, 围手术期护理, 快速康复外科

Abstract:

Objective To explore the effects of enhanced recovery after surgery（ERAS） in patients during the perioperative period of pituitary tumor resection by transsphenoidal approach.Methods A total of 103 patients who were admitted from April 2014 to November 2016 were assigned to the control group. Another 105 patients admitted from December 2016 to August 2018 were assigned to the experimental group. Patients in the control group received routine care during perioperative period,while patients in the experimental group received ERAS. The outcomes compared between the two groups included the first time that patients are out of bed,length of stay in hospital,cost,anxiety,pain 48 hours after operation,and complications.Results The first time that patients were out of bed for activity in experimental group was earlier than that of the control group. The length of study in hospital and cost in the experimental group were less than that of the control group. The anxiety level in the experimental group was lower than that of the control group. The number of pain cases and complications in the experimental group were less than that of control group. All difference was statistically significant（P＜0.05）.Conclusion It is safe and effective to apply ERAS in patients undergoing pituitary adenoma resection by transsphenoidal approach. It can effectively alleviate the pain and anxiety level of the patients 48 hours after operation,make patients get out of bed early,reduce length of stay in hospital,total cost and the occurrence of postoperative complications,and promote the early recovery of the patients.

Key words: Pituitary Neoplasms, Perioperative Nursing, Enhanced recovery after surgery

叶琳,底瑞青,赵玉林,张文静,岳高杰. 快速康复外科理念在经鼻蝶入路垂体瘤切除患者护理中的应用[J]. 中华护理教育, 2019, 16(4): 301-305.

YE Lin,DI Rui-qing,ZHAO Yu-lin,ZHANG Wen-jing,YUE Gao-jie. Application of enhanced recovery after surgery in patients during the perioperative period of pituitary tumor resection by transsphenoidal approach[J]. Chinese Journal of Nursing Education, 2019, 16(4): 301-305.

参考文献 28

[1]	中国快速康复外科专家组. 中国加速康复外科围手术期管理专家共识(2016)[J]. 中华外科杂志, 2016,54(6):413-418.
[2]	Lassen K, Coollsen MM, Slim K , et al. Guidelines for perioperative care for pancreaticoduodenectomy:enhanced recovery after surgery(ERAS)society recommendations[J]. Clin Nutr, 2012,31(6):817-830. doi: 10.1016/j.clnu.2012.08.011
[3]	Rizalar S, Tapcu SY . Analysis of enhanced recovery after sur-gery applications in patients who received surgical intervention[J]. Open Access Library Journal, 2015,2(10):e2010.
[4]	吴莉萍, 龚茹洁 . 神经导航在经鼻蝶入路垂体瘤手术中的应用[J]. 护理研究, 2016,30(1C):1004-1006.
[5]	赖海燕, 韦字宁, 卢桂花 , 等. 临床护理路径在经鼻蝶入路垂体瘤切除术患者术后监护期的应用[J]. 中国临床护理, 2015,7(4):310-313. doi: 10.3969/j.issn.1674-3768.2015.04.013
[6]	易淑明, 郑晓妮 . 快速康复外科对胃肠道手术患者围术期的作用[J]. 中国老年学杂志, 2013,33(2):286-288.
[7]	周丹, 李丹妮, 周阿南 , 等. 呼吸训练对经鼻垂体瘤切除术患者术后呼吸舒适度及焦虑的影响[J]. 中国现代医学杂志, 2015,25(12):110-112.
[8]	郭红桃, 李倩 . 快速康复外科理念在椎管肿瘤病人围术期应用效果[J]. 内蒙古医科大学学报, 2013,35(S2):614-626.
[9]	王红霞, 王旭阳, 陈丽莉 , 等. 认知心理干预对垂体瘤患者心理障碍影响的研究[J]. 护士进修杂志, 2013,28(2):101-103.
[10]	马占英, 金奕, 徐娜 . 早期饮水对经鼻蝶入路垂体瘤切除术后患者安全性及口腔舒适度的影响[J]. 中国实用护理杂志, 2016,32(12):915-918.
[11]	赵欣, 马驰原, 王友伟 , 等. 快速康复外科在经鼻蝶入路垂体瘤切除术围术期护理中的应用[J]. 实用临床医药杂志, 2014,18(20):85-87,90.
[12]	韩杰, 杜晓霞 . 耳鼻咽喉头颈外科护理工作指南[M]. 北京: 人民卫生出版社, 2014: 109.
[13]	赵彬芳, 贺世明, 王元 , 等. 加速康复外科在脑胶质瘤患者围术期护理中的应用[J]. 中华现代护理杂志, 2018,24(12):1454-1457.
[14]	沃敏 . 快速康复外科理念及其在围手术期护理中的应用[J]. 上海医药, 2017,38(12):7-8.
[15]	马媛媛 . 缩短禁水时间对提高经鼻蝶入路垂体瘤切除术后患者舒适度的研究[J]. 护士进修杂志, 2014,29(23):2165-2166.
[16]	曾启秀 . 快速康复外科护理对胃癌患者术后康复及生活质量的影响[J]. 中国肿瘤临床与康复, 2014,21(5):607-609.
[17]	刘轶刚 . 纯内窥镜下单鼻孔经蝶入路垂体瘤切除术术后短期并发症[D]. 石河子:新疆医科大学, 2009.
[18]	郑红, 杨卫芳, 尹剑 . 经蝶垂体瘤切除术后并发症的观察及护理[J]. 护理与康复, 2012,11(5):429-430.
[19]	李兰 . 加速康复外科理念在鼻窦炎患者围手术期的应用[J]. 中国临床护理, 2018,10(2):167-169.
[20]	李乐之, 路潜 . 外科护理学[M]. 北京: 人民卫生出版社, 2012.
[21]	万艳慧, 马静, 高雪影 , 等. 临床护理路径在垂体瘤病人围术期护理中的应用[J]. 护理研究, 2017,31(1B):234-236.
[22]	杨梅, 余娜, 田聪林 . 多元化术前宣教模式对减轻患者术前心理压力及手术效果的影响分析[J]. 检验医学与临床, 2016,13(16):2348-2350.
[23]	American Society of Anesthesiologists Committee. Practice gui-delines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration:application to healthy patients undergoing elective procedures[J]. Anesthe-siology, 2017,126(3):376-393.
[24]	简红云, 管丽丽, 雷君 , 等. 加速康复护理在结直肠癌患者围手术期应用的效果[J]. 中国实用护理杂志, 2017,33(7):513-515.
[25]	姜红萍, 陈银, 陈燕 , 等. 基于快速康复外科理念的手术护理在经鼻蝶入路垂体瘤切除术中的应用[J]. 中西医结合护理(中英文), 2016,2(12):48-50,54.
[26]	王凌雁, 许森, 董珍丽 , 等 . 经蝶垂体瘤切除术后患者重度疼痛的危险因素[J]. 中国麻醉学杂志, 2013,33(2):252-253.
[27]	张琪英, 张菊英, 费建美 , 等. 空气湿度对经鼻蝶入路垂体瘤切除患者疼痛及舒适度的影响[J]. 护士进修杂志, 2014,29(23):2188-2189.
[28]	张萍, 华玮 . 鼻内镜手术患者术后疼痛护理研究进展[J]. 护理学杂志, 2015,30(4):101-104.