多学科合作快速康复外科理念在腹腔镜腹股沟疝修补术围手术期的应用

发布时间：2018-04-25 08:25

本文选题：疝 + 腹股沟　；参考：《中国普通外科杂志》2017年04期

【摘要】：目的:探讨以多学科团队(MDT)合作为基础的快速康复外科(ERAS)在腹腔镜腹股沟疝修补术围手术期应用的可行性及有效性。方法:将782例行择期腹腔镜腹股沟疝修补术的患者按入院顺序随机分为ERAS组(392例)和对照组(390例)。对照组接受常规治疗护理;ERAS组接受MDT合作ERAS理念的治疗护理,主要干预措施包括住院模式选择,医护一体化健康教育,饮食要求,胃肠道准备,尿潴留预防,术后早期活动,伤口疼痛预防,麻醉前给药,防止术中低温,围手术期补液管理,术后恶心、呕吐预防及1个月患者舒适度评价等。比较两组患者术后疼痛、恢复情况、并发症与应激反应发生率、术后舒适度等。结果:与对照组比较,ERAS组术后次日清晨NRS疼痛评分降低,恢复正常饮食时间、下床活动时间、住院时间均减少,术后满意率增加,血清肿、尿潴留、伤口感染等并发症与不适感、恶心反应的发生率降低,术后1个月中位腹股沟疼痛调查表评分降低(均P0.05)。结论:在腹腔镜腹股沟疝修补术患者围手术期中采用MDT合作ERAS理念可以减轻患者不适,加速康复,缩短住院时间,提高患者满意度及舒适度。
[Abstract]:Objective: To explore the feasibility and effectiveness of the application of the multidisciplinary team (MDT) based rapid rehabilitation surgery (ERAS) in the perioperative period of laparoscopic inguinal hernia repair. Methods: 782 patients undergoing selective laparoscopic inguinal hernia repair were randomly divided into group ERAS (392 cases) and control group (390 cases) according to the order of admission. Treatment and nursing care; group ERAS accepted the treatment and nursing of the concept of MDT cooperation ERAS. The main intervention measures include the choice of hospitalization mode, the integrated health education of medical care, the diet requirements, the preparation of the gastrointestinal tract, the prevention of urinary retention, the early postoperative activities, the prevention of pain in the wound, the pre anesthesia, the prevention of intraoperative hypothermia, the perioperative fluid management, postoperative nausea and vomiting. Prevention and comfort evaluation of patients for 1 months. Compare the postoperative pain, recovery, complication and stress response rate and postoperative comfort in the two groups. Results: compared with the control group, the pain score of NRS in the ERAS group was lower on the next morning after the operation, the normal diet time, the time of down bed activity, the hospitalization time were reduced, and the postoperative satisfaction rate increased. Serum swelling, urinary retention, wound infection and other complications and discomfort, the incidence of nausea reaction decreased and the 1 month middle groin pain questionnaire score decreased (all P0.05). Conclusion: the use of MDT cooperative ERAS in the perioperative period of laparoscopic inguinal hernia repair can reduce the discomfort of the patients, accelerate the recovery and shorten the time of hospitalization. Improve patient satisfaction and comfort.

【作者单位】：中南大学湘雅医院普通外科;中南大学湘雅医院护理部;中南大学肿瘤研究所;
【分类号】：R656.21

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