金雪妹　　冯文明

[摘要] 目的 探討基于加速康复（ERAS）理念的集束化治疗护理措施在胰腺癌围术期的应用价值。 方法 回顾性分析2017年5月至2019年5月在本科接受胰腺癌根治手术的89例患者，其中45例患者接受基于ERAS理念的集束化治疗护理措施（观察组），其余44例患者接受常规护理措施（对照组）。分析两组患者肠功能恢复时间、并发症、排便时间、术后疼痛评分、进食半流质时间。 结果 观察组肠功能恢复时间、排便时间、进食半流质时间[（24.28±5.45）h、（30.14±6.85）h、（34.25±8.14）h]明显低于对照组[（31.21±6.47）h、（39.32±7.58）h、（43.35±9.21）h]，差异有统计学意义（P<0.05）。两组术后疼痛评分均随时间逐渐递减（r=-0.6970，P<0.0001）。观察组术后12 h、24 h、48 h疼痛评分[（5.54±1.01）分、（3.75±0.67）分、（3.14±0.54）分]均明显低于对照组[（6.02±1.13）分、（4.36±0.78）分、（3.54±0.62）分]，差异有统计学意义（P<0.05）。观察组尿潴留发生率（2.22%）明显低于对照组（18.18%），差异有统计学意义（P<0.05）。 结论 基于ERAS理念的集束化治疗护理措施能显著促进胰腺癌患者术后恢复，降低并发症发生率，降低术后疼痛。

[关键词] 胰腺癌;集束化护理;胰腺切除;术后疼痛;围术期

[中图分类号] R473.73          [文献标识码] B          [文章编号] 1673-9701（2021）09-0173-04

Application value of cluster nursing and treatment measures in the perioperative period of pancreatic cancer

JIN Xuemei   FENG Wenming

Department of Surgery， the First People′s Hospital of Huzhou University， Huzhou   313000， China

[Abstract] Objective To explore the application value of cluster treatment and nursing measures in the perioperative period of pancreatic cancer. Methods A total of 89 patients with pancreatic cancer who underwent radical surgery in our department from May 2017 to May 2019 were retrospectively analyzed. Among them， 45 patients received cluster therapy nursing measures based on eras concept（observation group）， and the remaining 44 patients received routine nursing measures（control group）. The recovery time of intestinal function， complications， defecation time， postoperative pain score and half fluid time were analyzed. Results The recovery time of intestinal function， defecation time and half fluid eating time of the observation group（[24.28±5.45] h， [30.14±6.85] h， [34.25±8.14] h） were significantly lower than those of the control group（[31.21±6.47] h， [39.32±7.58] h， [43.35±9.21] h）， the differences were statistically significant（P<0.05）. The postoperative pain scores of the two groups decreased gradually with time（r=-0.6970， P<0.0001）.The pain scores at 12 h， 24 h and 48 h after operation in the observation group（[5.54±1.01） points， [3.75±0.67] points， [3.14±0.54] points） were significantly lower than those in the control group（[6.02±1.13] points， [4.36±0.78] points， [3.54±0.62] points）， the differences were statistically significant（P<0.05）. The incidence of urinary retention（2.22%） in the observation group was significantly lower than that in the control group（18.18%）， the difference was statistically significant（P<0.05）. Conclusion Measures of cluster treatment and nursing can significantly promote postoperative recovery of the patients with pancreatic cancer， reduce the incidence rate of complications， and reduce postoperative pain.

[Key words] Pancreatic cancer; Cluster nursing; Pancreatectomy; Postoperative pain; Perioperative period

胰腺癌在全世界范圍内仍然是重大的公共卫生难题，发病率呈快速上升趋势[1]，据统计胰腺癌位居中国城市男性恶性肿瘤发病率的第8位，居北京市和上海市人群恶性肿瘤死亡率的第5位[2-3]。尽管在胰腺癌预防、诊断和治疗方面取得了长足进步，但胰腺癌5年生存率仍十分不理想[4]。目前对于胰腺癌，根治性手术仍是最有效的治疗手段[5]。但不管是胰十二指肠切除术、胰体尾切除或胰腺中段切除等手术均会给患者带来巨大的生理和心理创伤，且手术本身难度大、风险高、术后恢复慢[6-7]。本研究针对胰腺癌手术患者专门制定了一套完整的基于加速康复（Enhanced recovery after surgery，ERAS）理念的集束化治疗护理措施[8]，现报道如下。

1 资料与方法

1.1 一般资料

回顾性分析2017年5月至2019年5月在本科接受胰腺癌根治手术的89例患者，其中45例患者接受基于ERAS理念集束化治疗护理措施（观察组），其余44例患者接受常规护理措施（对照组）。……