鲍海燕 张婷 赵康

[摘要] 目的 探討快速康复外科理念（FTS）联合临床护理路径在行腹腔镜胆囊切除术（LC）患者中的应用。 方法 回顾性分析2015年6月～2017年6月宁陕县医院接受LC治疗的胆囊疾病患者108例，按照护理方法不同分为两组，每组各54例。传统组围术期采用标准化临床护理路径进行干预，FTS组围术期采用FTS联合临床护理路径进行干预。观察两组患者术前负性情绪、术后疼痛、睡眠质量及恢复效果，比较两组患者术前及术后1、3 d的炎症应激水平及血糖水平，术后并发症及护理满意度情况。 结果 FTS组术前1 d的正性负性情绪量表（PANAS）评分、术后1 d的视觉模拟评分法（VAS）及电子版匹茨堡睡眠质量指数量表（ePSQI）评分均显著低于传统组，差异有统计学意义（P < 0.05）。FTS组术后首次肛门排气时间、肠鸣音恢复时间、首次进食时间、首次下床时间及住院时间显著短于传统组，差异有统计学意义（P < 0.05）。两组术后1、3 d的白细胞计数（WBC）、中性粒细胞百分数（GRA）、C反应蛋白（CRP）及血糖水平均显著高于术前1 d，差异有统计学意义（P < 0.05），术后1 d显著高于术后3 d，且FTS组术后不同时间点上述指标改善优于传统组，差异有统计学意义（P < 0.05）。FTS组并发症发生率低于传统组，差异有统计学意义（P < 0.05）。FTS组护理满意率高于传统组，差异有统计学意义（P < 0.05）。 结论 快速康复外科理念联合临床护理路径应用于LC围术期患者护理中，可有效改善患者心理及生理应激反应，促进其术后恢复及降低并发症率，患者护理满意度高。

[关键词] 快速康复外科理念；临床护理路径；腹腔镜胆囊切除术

[中图分类号] R473.6 [文献标识码] A [文章编号] 1673-7210（2018）08（a）-0176-05

[Abstract] Objective To explore the application of fast track surgery （FTS） concept combined with clinical nursing pathway in patients undergoing laparoscopic cholecystectomy （LC）. Methods From June 2015 to June 2017， in Hospital of Ningshan County， 108 patients with gallbladder disease treated with LC were selected， according to different nursing methods， they were divided into two groups， with 54 cases in each group. The convention group was given perioperative standardized clinical nursing pathway intervention， while FTS group was given perioperative FTS combined with clinical nursing pathway intervention. Preoperative negative emotions， postoperative pain， sleep quality and recovery in the two groups were observed， levels of inflammatory stress and blood glucose， postoperative complications and nursing satisfaction in two groups were compared. Results The positive and negative affect schedule （PANAS） score in FTS group at 1 d before operation， visual analogue scale （VAS） and electronic Pittsburgh sleep quality index （ePSQI） scores in FTS group at 1 d after operation were significantly lower than convention group， the differences were statistically significant （P < 0.05）. The postoperative initial anal exhaust time， recovery time of bowel sound， the time of taking food for the first time， initial ambulation time and hospitalization time in FTS group were significantly shorter than convention group， the differences were statistically significant （P < 0.05）. The white blood cell count （WBC）， percentage of neutrophils （GRA）， C reactive protein （CRP） and blood glucose levels in the two groups at 1， 3 d after operation were significantly higher than 1 d before operation， and 1 d after operation was significantly greater than 3 d after operation， the improvement of above-mentioned indexes in FTS group at different time points after operation were greater than convention group， the differences were statistically significant （P < 0.05）. The incidence rates of complications in FTS group was lower than convention group， the difference was statistically significant （P < 0.05）. The nursing satisfaction in FTS group was higher than convention group， the difference was statistically significant （P < 0.05）. Conclusion The application of FTS concept combined with clinical nursing pathway in the perioperative nursing for patients undergoing LC can effectively relieve the psychological and physiological stress response， promote the postoperative revcovery and reduce complications， the nursing satisfaction of patients is high.

[Key words] Fast track surgery concept； Clinical nursing pathway； Laparoscopic cholecystectomy

优化围术期临床护理路径是保障腹腔镜胆囊切除术（laparoscopic cholecystectomy，LC）手术成功的关键[1-2]。快速康复外科（fast track surgery，FTS）理念采用一系列有效措施降低手术患者创伤应激、并发症等，促进患者快速康复[3-4]。本研究将快速康复外科理念联合临床护理路径应用于宁陕县医院（以下简称“我院”） LC围术期患者，现报道如下：

1 资料与方法

1.1 一般资料

回顾性分析2015年6月～2017年6月我院行LC术治疗患者108例的临床资料。纳入标准：确诊为胆囊疾病，需行LC术者；年龄22～68岁。排除标准：抑郁、镇痛类药物史者；合并其他器质性疾病者；术前服用糖皮质激素类药物者；肝功能Child分级未达到A级者；腹膜炎者。我院于2016年7月开始实行FTS联合临床护理路径，将2015年6月～2016年6月54例患者作为传统组， 2016年7月～2017年6月54例患者作为FTS组。……