loading目 录
第一章 前言 ..................................................................................................................................... 3 第二章 文献综述 ............................................................................................................................. 4 第三章 研究对象和方法 ................................................................................................................. 7 第四章 结果 ................................................................................................................................... 11 第五章 讨论 ................................................................................................................................... 14 第六章 结论 ................................................................................................................................... 17 参考文献......................................................................................................................................... 17 致谢 ................................................................................................................................................ 18 附录 ................................................................................................................................................ 19
围术期护理干预对精准肝切除患者加速康复的效果研究
中文摘要
目的：制定基于加速康复（ERAS）理念的标准化、系统化围术期护理干预方案，分析其对精准肝切除患者加速康复的效果，为肝切除加速康复护理提供参考。
方法：选取某院在2016年6月~2017年6月收治实施精准肝切除患者为研究对象，纳入研究90例。采用随机对照设计研究，患者平均分为干预组（加速康复组）和对照组（常规护理组），两组患者采取相同的手术治疗方法，对照组患者给予常规护理措施。制定加速康复围术期护理方案，干预组患者给予加速康复围术期护理干预。记录并比较护理前后患者肝功能指标、镇痛、排气时间、住院时间、生活质量等。
结果：术前患者肝功能、疾病等指标具有可比性。术后加速康复组患者全麻恢复时间显著短于常规护理组（P < 0.05），加速康复组患者镇痛使用次数显著少于常规恢复组，差异明显（P < 0.05）。术后第三天和术后第七天，加速康复组患者谷丙转氨酶（ALT）、总胆红素（TBIL）同时间指标值均显著低于常规护理组，谷氨酰转肽酶（GGT）指标同时间恢复情况显著优于常规护理组，肝功能康复情况显著优于常规护理组（P < 0.05）。加速康复组患者首次进食时间、肠鸣音恢复时间、首次排便时间、住院时间等显著短于常规护理组（P < 0.05）。加速康复组患者首次进食时间（6.2±2.9）d、肠鸣音恢复时间（45±11）h、首次排便时间（2.1±0.7）d、住院时间（5.6±2.3）d等显著短于常规护理组首次进食时间（10.5±3.7）、肠鸣音恢复时间（56±14）h、首次排便时间（3.2±1.5）d、住院时间（8.2±3.1）（P < 0.05），加速康复组患者术后VAS评分同时间显著低于常规护理组（P < 0.05）。患者术后常见并发症包括腹腔出血、感染、胆漏等，加速康复组有3例出现并发症，并发症发生率（6.6 %）显著低于常规护理组（22.0 %），同时间加速康复组患者躯体功能、心理功能、物质功能、社会功能和QOL总分均显著高于常规护理组（P < 0.05）。 结论：给予精准肝切除患者加速康复围术期护理干预能够促进患者胃肠功能恢复，有助于提高患者生活质量，减轻术后疼痛，促进肝功能的恢复，同时能够缩短住院时间，加速康复围术期护理干预具有推广使用价值。
关键词：精准肝切除；加速康复；围术期护理；肝功能；生活质量
Effect of perioperative nursing intervention on accelerated rehabilitation of patients with precise
hepatectomy
英文摘要
Objective: To establish a rapid ( ERAS ) based on the rehabilitation nursing intervention program was standardized and systematic in concept , analysis of precise liver resection in patients with accelerated rehabilitation effect , to provide reference for accelerated rehabilitation nursing of hepatic resection .
Method：90 patients with Precise hepatectomy in hospital from June 2016 ~ June 2017 were selected. Patients were randomly divided into ointervention group (accelerated rehabilitation group) and the control group (routine nursing group) according to randomized controlled design study , two groups patients were gicen same surgical treatment . Patients in the control group were given routine nursing measures . The perioperative nursing plan of accelerated rehabilitation was established, and the intervention group was given perioperative nursing intervention of accelerated protest . The indexes of liver function, analgesia, exhaust time, length of stay and quality of life were measured before and after nursing were recordedand compared .
Result：Preoperative liver function , disease and other indicators were comparable . The recovery time of general anesthesia in the accelerated rehabilitation group was significantly shorter than that in the routine nursing group ( P < 0.05 ) , and the number of analgesic use in the accelerated
rehabilitation group was significantly less than that in the routine recovery group ( P < 0.05 ) . After third days and seventh days after operation , accelerate the rehabilitation group of patients with ALT , TBIL with time index values were significantly lower than that of the conventional nursing group , GGT index and the recovery time was significantly better than the conventional nursing group , recovery of liver function was significantly better than the routine nursing group ( P < 0.05 ) . The first eating time, recovery time of bowel sound , the first defecation time , hospitalization time in accelerated rehabilitation group patients was significantly shorter than the conventional nursing group ( P < 0.05) . Accelerate the rehabilitation group were eating for the first time ( 6.2±2.9 ) d, the recovery time of bowel sound ( 45±11 ) h, the first defecation time ( 2.1±0.7 ) d, hospitalization time ( 5.6±2.3 ) d was significantly shorter than the conventional nursing group for the first time, eating time (10.5±3.7 ), recovery time of bowel sounds ( 56±14 ) h, the first defecation time ( 3.2±1.5 ) d, hospitalization time ( 8.2±3.1 ) ( P < 0.05), the VAS scores of the patients in the accelerated rehabilitation group were significantly lower than those in the routine care group ( P < 0.05 ) , Postoperative complications included abdominal bleeding, infection , bile leakage and so on. There were 3 cases of complications in the accelerated rehabilitation group , the incidence of complications in the accelerated rehabilitation group ( 6.6 % ) was significantly lower than that in the routine nursing group ( 22 % ) . At the same time, the body function, psychological function, material function, social function and total score of QOL in the accelerated rehabilitation group were significantly higher than those in the routine nursing group ( P < 0.05 ). Conclusion：Precise liver resection in patients with accelerated rehabilitation perioperative nursing intervention can promote the recovery of gastrointestinal function, help to improve the quality of life of patients, reduce postoperative pain, promote the recovery of liver function, and can shorten the hospitalization time. Perioperative nursing intervention of accelerated rehabilitation has its value of popularization and application.
Keywords：Precise hepatectomy , accelerated rehabilitation , perioperative care , liver function , quality of life
中英文符号对比
英文缩写 ERAS ALT TBIL ASA GGT VAS 第一章 前言
肝脏是人体重要脏器官，结构复杂，具有多种功能，直接参与能量代谢。在普外科中肝脏疾病类型较多，并且中国是世界上肝癌发病率和死亡率最高的国家，肝肿瘤疾病严重威胁人们生命安全。随着医学的进步，现阶段对于肝肿瘤治疗方法已经有很多，但是手术治疗方法仍然是重要治疗方法之一。传统肝切除手术依靠解剖，近些年发展，肝脏管道系统复杂，
英文全称 Postoperative rapid rehabilitation Glutamic pyruvic transaminase total bilirubin American Society of Anesthesiologists Glutamyl peptidase Visual analogue scale 中文名称 加速康复 谷丙转氨酶 总胆红素 美国麻醉医师协会 谷氨酰转肽酶 视觉模拟评分法