照顾者对加速康复外科理念接受程度现状及影响因素分析

王碧轩; 屈清荣; 张宽新; 何卫芳; 高娅鑫

doi:10.16766/j.cnki.issn.1674-4152.002920

照顾者对加速康复外科理念接受程度现状及影响因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002920

郑州大学第一附属医院甲状腺外科，河南郑州 450052

基金项目:

河南省高等学校重点科研项目 20A320026

详细信息

通讯作者:
屈清荣，E-mail: 1718650462@qq.com

中图分类号: R473.6
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- 文章访问数: 312
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- 被引次数: 0
出版历程
- 收稿日期: 2022-02-01
- 网络出版日期: 2023-04-19

Caregivers' acceptance of enhanced recovery after surgery and its influencing factors

Department of Thyroid Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan 450052, China

摘要

摘要: 目的本研究从患者照顾者的自身角度出发，旨在了解照顾者对加速康复外科(ERAS)理念的接受程度并探讨其影响因素，为医务人员针对性进行干预提供参考。方法 2020年5—7月，采取便利抽样，通过自设调查问卷对郑州市某三级甲等医院165例患者的照顾者进行问卷调查，收集有效问卷160份，采用多元线性回归分析探讨影响因素。结果 160名照顾者加速康复外科理念接受程度总分、术前准备、术中处置、术后管理得分分别为(53.16±11.50)分、(17.73±4.42)分、(14.66±2.82)分、(20.77±4.92)分；多元线性逐步回归分析结果显示年龄、居住地、文化程度、人均月收入、手术史是照顾者对ERAS理念接受程度的主要影响因素(B值分别为-4.074、-2.058、2.289、2.922、-3.020，均P＜0.05)，其中年龄、居住地、手术史与接受程度呈负相关关系，文化程度和人均月收入与接受程度呈正相关关系。结论照顾者加速康复外科理念接受程度处于中等水平，但接受程度差异较大。医护人员应针对不同照顾者的特征进行加速康复外科理念教育，并采取针对性干预措施，提高照顾者对加速康复外科理念的接受程度，从而为患者选择最佳的治疗方案，促进患者术后康复。
- 加速康复外科 /
- 照顾者 /
- 接受程度 /
- 影响因素分析
Abstract: Objective To investigate the status of caregivers' acceptance of enhanced recovery after surgery (ERAS) and analyse the influencing factors from the perspective of patient caregivers themselves and to provide a reference for medical staff to carry out targeted intervention. Methods Data were collected from 165 patient caregivers in a tertiary first-class hospital, and a self-designed questionnaire was used to measure the acceptance of ERAS among them. Total 160 valid questionnaires were collected. Multiple linear regression was used to analyse the influencing factors. Results The total scores of acceptances of ERAS, preoperative preparation, intraoperative treatment and postoperative management of 160 caregivers were (53.16±11.50)points, (17.73±4.42) points, (14.66±2.82) points and (20.77±4.92) points, respectively. The results of multivariate linear stepwise regression analysis showed that age, habitat, culture level, average monthly income and operation history were the main influencing factors of caregivers' acceptance of ERAS concept (B values were -4.074, -2.058, 2.289, 2.922 and -3.020, respectively, all P < 0.05). Age, habitat and operation history were negatively correlated with the acceptance of ERAS, whereas culture level and average monthly incomes were positively correlated with it. Conclusion The acceptance of ERAS among caregivers is at mid-level, but a large difference is observed. The medical staff should be educated on the concept of ERAS according to the characteristics of different caregivers, and take targeted interventions to improve the acceptance of the concept of ERAS by caregivers, so as to select the best treatment scheme for patients and promote their postoperative recovery.
- Enhanced recovery after surgery /
- Caregivers /
- Acceptance /
- Influencing factors analysis

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表 1 照顾者对ERAS理念接受程度各维度得分最高及最低的条目(n=160)

Table 1. Items with the highest and lowest scores in each dimension of caregivers' acceptance of ERAS concept (n=160)

维度	条目	得分(x±s, 分)
术前准备	术前充分宣教	4.32±0.58
	不常规放置胃管	3.20±1.26
术中处置	优化麻醉方式	4.20±0.59
	腹部手术不常规放置引流管	2.95±1.30
术后管理	术后48 h持续镇痛	4.16±0.64
	术后早期下床活动	2.84±1.34

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表 2 不同特征照顾者对ERAS理念接受程度的单因素分析(x±s，分)

Table 2. Univariate analysis of the acceptance of ERAS concept by caregivers with different characteristics(x±s, points)

项目	类别	人数	接受程度	统计量	P值	项目	类别	人数	接受程度	统计量	P值
年龄(岁)	18~29	35	62.32±7.36	15.412^a	＜0.001	婚姻状况	已婚	120	51.49±10.99	9.647^a	＜0.001
	30~49	54	56.12±9.00				未婚	28	62.72±7.46
	50~69	45	47.00±11.52				其他	12	46.43±13.16
	≥70	26	45.06±9.79			人均月收入(元)	＜1 000	48	48.27±10.68	12.503^a	＜0.001
性别	男性	72	54.67±12.92	-1.325^b	0.188		1 000~3 000	67	51.29±10.79
	女性	88	57.80±12.04				＞3 000	45	61.21±9.28
居住地	城镇	56	57.69±8.72	3.082^b	0.003	与患者关系	配偶	53	48.27±11.61	9.092^a	＜0.001
	农村	104	50.61±12.13				子女	48	58.67±8.24
文化程度	文盲	20	44.08±9.32	10.302^a	＜0.001		父母	26	45.12±9.76
	小学	39	47.96±12.50				兄弟姐妹	11	55.29±7.89
	初中	34	51.14±9.81				其他	22	61.00±10.31
	高中/中专/技校	37	56.52±7.18			患者手术史	是	18	56.73±9.85	1.092^b	0.278
	大专及以上	30	63.10±8.96				否	142	52.72±11.66
就业情况	无	20	42.85±10.67	3.829^a	0.002	手术史	是	43	54.95±10.93	2.628^b	0.010
	农民	30	50.26±12.60				否	117	48.33±11.81
	工人	29	53.28±10.27			就诊科室	骨科	40	56.24±12.21	2.410^a	0.095
	个体商人	24	54.27±9.87				胃肠外科	58	52.93±10.38
	医务/科教/公务员/行政	30	60.28±9.65				结直肠科	62	49.09±14.55
	退休	14	54.78±12.76
	其他	13	56.63±5.76
注：^a为F值，^b为t值。

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表 3 自变量赋值情况

Table 3. Assignment of independent variables

自变量	赋值方法
年龄(岁)	18~29=1，30~49=2，50~69=3，≥70=4
居住地	城镇=1，农村=2
文化程度	文盲=1，小学=2，初中=3，高中/中专/技校=4，大学及以上=5
就业情况	无(0，0，0，0，0，0)；农民(1，0，0，0，0，0)；工人(0，1，0，0，0，0)；个体商人(0，0，1，0，0，0)；医务科教类(0，0，0，1，0，0)；退休(0，0，0，0，1，0)；其他(0，0，0，0，0，1)
婚姻状况	已婚(0，0)；未婚(1，0)；其他(0，1)
人均月收入(元)	＜1 000=1, 1 000~3 000=2, ＞3 000=3
与患者关系	配偶(0，0，0，0)；父母(1，0，0，0)；子女(0，1，0，0)；兄弟姐妹(0，0，1，0)；其他(0，0，0，1)
手术史	是=1，否=2

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表 4 照顾者ERAS理念接受程度多元线性逐步回归分析结果

Table 4. Results of multiple linear stepwise regression analysis of caregivers' acceptance of ERAS concept

变量	B	SE	β	t值	P值
年龄	-4.074	1.052	-0.355	-3.873	＜0.001
居住地	-2.058	0.941	-0.172	-2.187	0.031
文化程度	2.289	0.863	0.263	2.653	0.009
人均月收入	2.922	1.325	0.194	2.205	0.030
手术史	-3.020	0.812	-0.347	-3.719	＜0.001

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参考文献(24)

[1]	KEHLET H. Multimodal approach to control postoperative pathophysiology and rehabilitation[J]. Br J Anaesth, 1997, 78(5): 606-617. doi: 10.1093/bja/78.5.606
[2]	黎介寿. 加速康复外科的理念与意义[J]. 中国处方药, 2007(9): 54. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF200709039.htm LI J S. The concept and significance of enhanced recovery after surgery[J]. China Prescription Drug, 2007(9): 54. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCF200709039.htm
[3]	WILMORE D W, KEHLET H. Management of patients in fast track surgery[J]. BMJ, 2001, 322(7284): 473-476. doi: 10.1136/bmj.322.7284.473
[4]	LI Y, YAN C C, LI J, et al. A nurse-driven enhanced recovery after surgery (ERAS) nursing program for geriatric patients following lung surgery[J]. Thorac Cancer, 2020, 11(4): 1105-1113. doi: 10.1111/1759-7714.13372
[5]	PAL A R, MITRA S, AICH S, et al. Existing practice of perioperative management of colorectal surgeries in a regional cancer institute and compliance with ERAS guidelines[J]. Indian J Anaesth, 2019, 63(1): 26-30. doi: 10.4103/ija.IJA_382_18
[6]	SARTORI A, BOTTERI E, AGRESTA F, et al. Should enhanced recovery after surgery (ERAS) pathways be preferred over standard practice for patients undergoing abdominal wall reconstruction?A systematic review and meta-analysis[J]. Hernia, 2021, 25(2): 501-521. doi: 10.1007/s10029-020-02262-y
[7]	郭东昇, 刘宇博, 陈广祥, 等. 加速康复外科模式下全膝关节置换术中"鸡尾酒"复合液不同使用方案的疗效分析[J]. 中华全科医学, 2020, 18(5): 723-726, 838. doi: 10.16766/j.cnki.issn.1674-4152.001339 GUO D S, LIU Y B, CHEN G X, et al. Clinical effect analysis on different using methods of Cocktail compound liquid in total knee replacement under enhanced recovery after surgery mode[J]. Chinese Journal of General Practice, 2020, 18(5): 723-726, 838. doi: 10.16766/j.cnki.issn.1674-4152.001339
[8]	PHILP S, CARTER J, BARNETT C, et al. Patients' perspectives of Fast-Track Surgery and the role of the Fast-Track clinical nurse consultant in gynecological oncology[J]. Holist Nurs Pract, 2015, 29(3): 158-166. doi: 10.1097/HNP.0000000000000086
[9]	中华医学会外科学分会, 中华医学会麻醉学分会. 加速康复外科中国专家共识暨路径管理指南(2018)[J]. 中华麻醉学杂志, 2018, 38(1): 8-13. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201801001.htm Surgery Society of Chinese Medical Association, Society of Anesthesiology of Chinese Medical Association. Consensus on ERAS and guidelines for pathway management in China (2018)[J]. Chinese Journal of Anesthesilolgy, 2018, 38(1): 8-13. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK201801001.htm
[10]	LI L, CHEN J, LIU Z, et al. Enhanced recovery program versus traditional care after hepatectomy[J]. Medicine (Baltimore), 2017, 96(38): e8052. DOI: 10.1097/MD.0000000000008052.
[11]	张现伟, 贾英萍, 张飞, 等. 加速康复外科在小儿结肠病变围手术治疗中的应用[J]. 中华全科医学, 2020, 18(3): 358-361, 475. doi: 10.16766/j.cnki.issn.1674-4152.001246 ZHANG X W, JIA Y P, ZHANG F, et al. Application of enhanced recovery after surgery in the perioperative period of pediatric colonic lesions[J]. Chinese Journal of General Practice, 2020, 18(3): 358-361, 475. doi: 10.16766/j.cnki.issn.1674-4152.001246
[12]	罗先武. 快速康复外科在三级甲等医院腹部外科中的应用现状、实施障碍与对策研究[D]. 武汉: 武汉大学, 2018. LUO X W. Research on the application status, implementation obstacles and countermeasures of fast track surgery in abdominal surgery in tertiary hospitals[D]. Wuhan: Wuhan University, 2018.
[13]	李幼生. 加速康复外科: 现状及今后需要关注的问题[J]. 中华医学杂志, 2017, 97(4): 244-247. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201017032.htm LI Y S. Enhanced recovery after surgery: current status and future concerns[J]. National Medical Journal of China, 2017, 97(4): 244-247. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201017032.htm
[14]	王家良. 临床流行病学: 临床科研设计、测量与评价[M]. 上海: 上海科学技术出版社, 2014: 56-338. WANG J L. Clinical epidemiology: clinical research design, measurement and evaluation[M]. Shanghai: Shanghai Science and Technology Press, 2014: 56-338.
[15]	努尔古丽·买提哈提, 史凌云, 李雪, 等. 骨科护士对加速康复外科人工关节置换术患者护理的知信行分析研究[J]. 新疆医科大学学报, 2019, 42(5): 697-701. https://www.cnki.com.cn/Article/CJFDTOTAL-XJYY201905028.htm NUERGULI MAITIHATI, SHI L Y, LI X, et al. Investigation and analysis on knowledge attitude and practice about enhanced recovery after surgery applied in nursing patients with total joint arthroplasty[J]. Journal of Xinjiang Medical University, 2019, 42(5): 697-701. https://www.cnki.com.cn/Article/CJFDTOTAL-XJYY201905028.htm
[16]	KISIELEWSKI M, RUBINKIEWICZ M, PEDZIWIATR M, et al. Are we ready for the ERAS protocol in colorectal surgery?[J]. Wideochir Inne Tech Maloinwazyjne, 2017, 12(1): 7-12.
[17]	DESIDERIO J, TRASTULLI S, D' ANDREA V, et al. Enhanced recovery after surgery for gastric cancer (ERAS-GC): optimizing patient outcome[J]. Transl Gastroenterol Hepatol, 2020, 5(1): 11.
[18]	杨璐霄, 何亮, 张加鑫, 等. 腹腔镜辅助胃癌根治术不留置胃管临床研究[J]. 中国实用外科杂志, 2020, 40(4): 461-464. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202004027.htm YANG L X, HE L, ZHANG J X, et al. Application of gastric-free tube in laparoscopic radical gastrectomy[J]. Chinese Journal of Practical Surgery, 2020, 40(4): 461-464. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWK202004027.htm
[19]	GRANT M C, HANNA A, BENSON A, et al. Dedicated operating room teams and clinical outcomes in an enhanced recovery after surgery pathway for colorectal surgery[J]. J Am Coll Surg, 2018, 226(3): 267-276.
[20]	陈苗, 冯立, 邢智. 加速康复外科在结直肠肿瘤中的应用进展[J]. 世界最新医学信息文摘, 2019, 19(31): 34-35, 45. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201931017.htm CHEN M, FENG L, XING Z. Application progress of enhanced recovery after surgery in colorectal cancer[J]. World Update Medical Information Digest, 2019, 19(31): 34-35, 45. https://www.cnki.com.cn/Article/CJFDTOTAL-WMIA201931017.htm
[21]	宋美璇, 李显蓉. 基于集束化护理的加速康复外科在老年结直肠癌病人中应用的研究进展[J]. 护理研究, 2019, 33(17): 2979-2982. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201917014.htm SONG M X, LI X R. Research progress on application of enhanced recovery after surgery based on cluster nursing in elderly patients with colorectal cancer[J]. Chinese Nursing Research, 2019, 33(17): 2979-2982. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ201917014.htm
[22]	吴倩倩, 冀海斌, 方秀新, 等. 术后早期活动对腹部手术病人快速康复影响的Meta分析[J]. 循证护理, 2020, 6(3): 205-211. https://www.cnki.com.cn/Article/CJFDTOTAL-XZHL202003004.htm WU Q Q, JI H B, FANG X X, et al. Impact of early postoperative activities on rapid recovery of patients undergoing abdominal surgery: a Meta-analysis[J]. Chinese Evidence-Based Nursing, 2020, 6(3): 205-211. https://www.cnki.com.cn/Article/CJFDTOTAL-XZHL202003004.htm
[23]	TIAN Y L, CAO S G, LI L P, et al. Effects of perioperative enhanced recovery after surgery pathway management versus traditional management on the clinical outcomes of laparoscopic-assisted radical resection of distal gastric cancer: study protocol for a randomized controlled trial[J]. Trials, 2020, 21(1): 369.
[24]	MENDES D I A, FERRITO C R A C, GONCALVES M I R. Nursing interventions in the enhanced recovery after surgery^Ⓡ: scoping Review[J]. Rev Bras Enferm, 2018, 71(suppl 6): 2824-2832.