医护合作——快速康复模式在单孔腹腔镜上尿路重建围手术期的应用研究

doi:10.3877/cma.j.issn.1674-3253.2024.03.012

目的

探讨医护合作——快速康复模式在单孔腹腔镜上尿路重建围手术期的临床效果。

方法

选取2021年1月至2022年1月于南方医科大学第三附属医院行单孔腹腔镜上尿路重建术的50例患者作为研究对象，随机分为对照组和观察组，每组25例。对照组患者行围术期常规康复，观察组行围术期医护合作——快速康复模式。评价两组患者术后康复情况、并发症发生情况、对护理工作满意程度评价及术后生活质量。

结果

在康复指标方面，术后首次下床时间、肛门排气时间，观察组均早于对照组（P<0.05）；在住院时间、住院费用上，观察组优于对照组（P<0.05）；观察组术后并发症如泌尿系统感染、出血、吻合口瘘、吻合口狭窄的发生率与对照组相比差异无统计学意义（P>0.05）。观察组对护理工作的满意程度及出院后生活质量评分均高于对照组（P<0.05）。

结论

快速康复能有效缩短围术期单孔腹腔镜下上尿路重建手术患者的首次下床活动、肛门排气时间，因而减少住院时间和费用，增加患者对康复的信心，对护理工作的满意程度，进而提高患者术后生活质量，值得临床推广。

关键词: 快速康复外科（ERAS）, 单孔腹腔镜, 上尿路重建术, 医护合作, 围术期

Objective

To explore the clinical effect of the medical nursing cooperation of enhanced recovery model in the perioperative period of single port laparoscopic urinary tract reconstruction.

Methods

Fifty patients who underwent single port laparoscopic upper urinary tract reconstruction surgery at the Third Affiliated Hospital of Southern Medical University from January 2021 to January 2022 were selected as the study subjects. They were randomly divided into a control group and an observation group, with 25 cases in each group. The control group patients underwent routine rehabilitation during the perioperative period, while the observation group mainly underwent a perioperative medical nursing cooperation of enhanced recovery model. Evaluate the postoperative recovery, incidence of complications, satisfaction with nursing work, and postoperative quality of life of two groups of patients.

Results

In terms of rehabilitation indicators, the observation group had earlier first time out of bed and anal exhaust time after surgery than the control group (P<0.05); In terms of hospitalization time and expenses, the observation group was better than the control group (P<0.05); There was no statistically significant difference in the incidence of postoperative complications such as urinary tract infection, bleeding, anastomotic fistula, and anastomotic stenosis between the observation group and the control group (P>0.05). The satisfaction level of nursing work and the quality of life score after discharge in the observation group were higher than those in the control group (P<0.05).

Conclusions

Enhanced recovery after surgery can effectively shorten the first time out of bed activity and anal exhaust time of patients undergoing single port laparoscopic upper urinary tract reconstruction surgery during the perioperative period, thereby reducing hospitalization time and costs, increasing patients' confidence in rehabilitation, satisfaction with nursing work, and improving their postoperative quality of life, which is worthy of clinical promotion.

Key words: Enhanced recovery after surgery, Single-port laparoscopy, Upper urinary tract reconstruction, Medical nursing cooperation, Perioperative period

表1 两组单孔腹腔镜上尿路重建术后患者负面情绪评分（

±s）

组别	例数	SAS评分（分）	SDS评分（分）
观察组	25	3.07±0.28	3.13 ±0.24
对照组	25	7.72±0.78	7.34 ±0.88
t值		-27.713	-22.853
P值		<0.001	<0.001

表1 两组单孔腹腔镜上尿路重建术后患者负面情绪评分（

±s）

组别	例数	SAS评分（分）	SDS评分（分）
观察组	25	3.07±0.28	3.13 ±0.24
对照组	25	7.72±0.78	7.34 ±0.88
t值		-27.713	-22.853
P值		<0.001	<0.001

表2 两组单孔腹腔镜上尿路重建患者术后康复情况（

±s）

组别	例数	首次下床时间(h)	肛门排气时间(h)	住院时间(d)	住院费用(万)
观察组	25	18±4	24±3	09.4±1.0	3.80±0.30
对照组	25	23±6	34±5	13.2±1.2	4.02±0.19
t值		-3.347	-7.469	-12.104	-3.084
P值		0.002	<0.001	<0.001	0.004

表2 两组单孔腹腔镜上尿路重建患者术后康复情况（

±s）

组别	例数	首次下床时间(h)	肛门排气时间(h)	住院时间(d)	住院费用(万)
观察组	25	18±4	24±3	09.4±1.0	3.80±0.30
对照组	25	23±6	34±5	13.2±1.2	4.02±0.19
t值		-3.347	-7.469	-12.104	-3.084
P值		0.002	<0.001	<0.001	0.004

表3 两组单孔腹腔镜上尿路重建患者并发症发生情况(例）

组别	例数	泌尿系统感染	出血	吻合口瘘	吻合口狭窄	总数
观察组	25	0	0	0	0	0
对照组	25	1	0	0	0	1
χ²值						0.521
P值						0.500

表3 两组单孔腹腔镜上尿路重建患者并发症发生情况(例）

组别	例数	泌尿系统感染	出血	吻合口瘘	吻合口狭窄	总数
观察组	25	0	0	0	0	0
对照组	25	1	0	0	0	1
χ²值						0.521
P值						0.500

表4 两组单孔腹腔镜上尿路重建患者对护理工作满意度评价（例）

组别	例数	非常满意	满意	不满意
观察组	25	22	3	0
对照组	25	16	9	0
χ²值		3.947
P值		0.047

表4 两组单孔腹腔镜上尿路重建患者对护理工作满意度评价（例）

组别	例数	非常满意	满意	不满意
观察组	25	22	3	0
对照组	25	16	9	0
χ²值		3.947
P值		0.047

表5 两组单孔腹腔镜上尿路重建患者出院后生活质量评分（例）

组别	例数	90～100分	80～89分	60～79分	≤59分
观察组	25	20	5	0	0
对照组	25	14	9	2	0
χ²值		4.041
P值		0.044

表5 两组单孔腹腔镜上尿路重建患者出院后生活质量评分（例）

组别	例数	90～100分	80～89分	60～79分	≤59分
观察组	25	20	5	0	0
对照组	25	14	9	2	0
χ²值		4.041
P值		0.044

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Research on the application of the medical nursing cooperation of enhanced recovery model in the perioperative period of single-hole laparoscopic urinary tract reconstruction

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Research on the application of the medical nursing cooperation of enhanced recovery model in the perioperative period of single-hole laparoscopic urinary tract reconstruction