郑莉　刘连新　孙丹　王玲

[摘要] 目的 探討早期快速康复护理对原发性肝癌切除术患者术后康复及生活质量的影响。 方法 选取哈尔滨医科大学附属第一医院2014年5月～2016年5月收治的90例原发性肝癌切除术患者，按照就诊时间顺序分为对照组（2014年5月～2015年5月）与观察组（2015年6月～2016年5月），每组各45例，对照组给予常规护理，观察组给予早期快速康复护理，比较两组患者术后胃肠功能恢复情况、首次下床活动时间、术后疼痛评分、术后并发症、手术前后肝功能指标及生活质量。 结果 观察组肠鸣音恢复时间、排气时间、排便时间、首次下床活动时间均较对照组短，差异有统计学意义（P < 0.05）。观察组术后恶心呕吐、腹痛腹胀、咽喉不适发生率及疼痛评分均较对照组低，差异有统计学意义（P < 0.05）。两组术后血清白蛋白水平较术前降低，谷丙转氨酶、谷草转氨酶水平较术前升高，差异有统计学意义（P < 0.05）。观察组术后血清白蛋白水平较对照组升高，谷丙转氨酶、谷草转氨酶水平较对照组降低，差异有统计学意义（P < 0.05）。观察组躯体功能、角色功能、情感功能、认知功能及社会功能评分均较对照组高，差异有统计学意义（P < 0.05）。 结论 早期快速康复护理相比于常规护理可有效促进患者术后康复，改善肝功能指标，降低并发症发生率，提高生活质量。

[关键词] 早期快速康复护理；原发性肝癌切除术；术后康复；生活质量

[中图分类号] R473.6 [文献标识码] A [文章编号] 1673-7210（2016）12（a）-0158-04

Influence of early rapid rehabilitation nursing on postoperative rehabilitation and quality life in patients with primary liver cancer resection

ZHENG Li LIU Lianxin SUN Dan WANG Ling

Department of Liver Surgery， the First Clinical Hospital Affiliated to Harbin Medical University， Heilongjiang Province， Harbin 150001， China

[Abstract] Objective To explore influence of early rapid rehabilitation nursing on postoperative rehabilitation and quality life in patients with primary liver cancer resection. Methods 90 cases with primary liver cancer resection treated in the First Clinical Hospital Affiliated to Haerbin Medical University from May 2014 to May 2016 were selected. All the patients were divided into control group （from May 2014 to May 2015） and observation group （from June 2015 to May 2016） according to time sequence of seeing doctor， 45 cases in each group. Routine nursing care was used in control group， and early rapid rehabilitation care was applied in observation group. Postoperative gastrointestinal function recovery， bed activity time， postoperative pain score， postoperative complications and liver function indicators before and after operation and the quality of life between two groups were compared. Results The bowel sounds recovery time， evacuation time， defecation time， bed activity time in observation group were shorter than those in control group， with statistically significant differences （P < 0.05）. The incidence rate of postoperative nausea and vomiting， abdominal pain， abdominal distention， throat discomfort， pain scores in observation group were lower than those in control group， with statistically significant differences （P < 0.05）. The serum albumin levels in two groups after operation were lower than before operation， ALT and AST levels in two groups after operation were higher than before operation， with statistically significant differences （P < 0.05）. The serum albumin level in observation group after operation was higher than that in control group， ALT and AST levels in observation group after operation were lower than those in control group， with statistically significant differences （P < 0.05）. The physical function， role function， emotional function， cognitive function and social function scores in observation group were higher than those in control group， with statistically significant differences （P < 0.05）. Conclusion The early rapid rehabilitation nursing care can effectively promote the patients postoperative rehabilitation， improve liver function index， reduce the incidence of complications， improve the quality of life when compared with the conventional care.

[Key words] Early rapid rehabilitation nursing； Primary liver cancer resection； Postoperative rehabilitation； Quality of life

原发性肝癌作为临床上一类发病率及病死率均较高的恶性肿瘤，以手术作为治疗该病的首选方法，但有研究报道指出，部分原发性肝癌患者在术后易出现胃肠功能障碍、疼痛等情况，为患者带来了不适感，也有部分患者因过度担心治疗效果及镇痛药物的副作用，产生焦虑、抑郁等不良情绪，甚至影响预后[1-2]。因此，对原发性肝癌切除术患者实施护理期间不仅需满足患者基本需求，还需注意其术后康复。本研究主要观察早期快速康复护理应用于原发性肝癌切除术中的效果及对胃肠功能康复的影响。

1 资料与方法

1.1 一般资料

选取哈尔滨医科大学附属第一医院2014年5月～2016年5月收治的90例原发性肝癌切除术患者，全部患者均符合原发性肝癌诊疗规范，术前未接受过介入及其他治疗方法，肝功能Child-Pugh A级或术前接受保肝治疗可见肝功能达到A级；……