吴婧 李坤旺 吴莺燕1

[摘要] 目的 观察临床护理路径对微创胃肠手术患者围手术期应激反应的影响。 方法 选择2012年6月～2013年12月于我科行腹腔镜胃肠手术治疗的50例患者，根据住院号的奇偶分为对照组和观察组，每组25例。对照组给予常规护理，观察组在此基础上采用临床护理路径，比较两组患者围手术期应激反应。 结果 对照组T2时心率（HR）、平均动脉压（MAP）、血糖、肾上腺素、去甲肾上腺素和皮质醇水平均较T1时明显增高，T3时明显降低；观察组各项指标变化趋势同对照组，但波动幅度明显减小，与对照组比较差异有统计学意义（P<0.05）。两组患者入院初SAS评分和生活质量量表得分比较，差异无统计学意义（P>0.05）；出院前观察组患者的SAS评分和生活质量量表得分低于对照组，差异有统计学意义（P<0.05）。 结论 在进行微创胃肠手术患者围手术期间采用临床护理路径方案，可降低负性情绪，提高生活质量，有利于患者安全平稳地度过手术期。

[关键词] 临床护理路径；腹腔镜；微创；胃肠手术；应激反应

[中图分类号] R473.5 [文献标识码] B [文章编号] 1673-9701（2015）22-0153-04

Effects of clinical nursing pathway on the stress response of patients with micro-invasive gastrointestinal surgery

WU Jing1 LI Kunwang2 WU Yingyan1

1.Department of Anus&Intestine Surgery， Lishui People's Hospital in Zhejiang Province， Lishui 323000， China； 2.Department of Anesthesiology， Lishui People's Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To observe the effects of clinical nursing pathway on the peri-operative stress response of patients with micro-invasive gastrointestinal surgery. Methods Fifty patients received laparoscopic gastrointestinal surgery from June 2012 to December 2013 in our department were divided into control group（25 cases） and observation group （25 cases） according to admission number. The control group received routine nursing while observation group received clinical nursing pathway based on routine nursing. The stress response was compared between two groups. Results In control group， the heart rate， mean arterial pressure， blood glucose， epinephrine， norepinephrine and cortisol levels at T2 were significantly higher than those at T1. All above indicators were significantly reduced at T3. The variation trend of all above indicators in observation group was the same as that in control group. The amplitude of variation of all above indicators in observation group was significantly smaller than that in control group（P<0.05）. There was no significant difference in SAS score or life quality score between those two groups at admission（P>0.05）. The SAS score and life quality score of observation group were significantly lower than those of control group before discharge（P<0.05）. Conclusion The implementation of clinical nursing pathway can relieve the peri-operative stress response and negative emotion of patients with micro-invasive gastrointestinal surgery and help patients improve life quality and undergo surgery safely.

[Key words] Clinical nursing pathway； Laparoscopy； Micro-invasive； Gastrointestinal surgery； Stress response

临床护理路径是目前广泛开展的护理方案之一，主要针对一些具有规范性的疾病治疗或手术操作而制定的流程化方案的护理干预模式[1]。临床护理路径中涵盖患者从入院到出院的主要流程和重要细节，通过临床护理路径患者也能大致了解自身的治疗、护理计划等，护患双方相互配合，共同促进护理质量提高[2]。微创胃肠手术主要是指腹腔镜下进行胃肠部手术操作，虽然已经在临床上广泛应用、疗效确切，但腹腔镜手术作为一种有创操作，给患者带来的应激反应往往在所难免，严重的应激反应甚至还可能会影响患者术后恢复[3]。为此，我院胃肠外科自2012年6月在微创胃肠手术患者中探索应用临床护理路径方案，发现该方案能有效地减轻患者围手术期的应激反应，现报道如下。……