基于ERAS-MDT模式的护理干预在腹壁切口疝腹腔镜手术中的应用

赖丽雅; 范栩妃; 陈吉彩; 吴大洲

doi:10.16766/j.cnki.issn.1674-4152.004024

基于ERAS-MDT模式的护理干预在腹壁切口疝腹腔镜手术中的应用

doi: 10.16766/j.cnki.issn.1674-4152.004024

温州医科大学附属第一医院疝与腹壁外科，浙江温州 325000

基金项目:

浙江省自然科学基金项目 LY20H030003

温州市科技计划项目 Y20220112

详细信息

通讯作者:
赖丽雅，E-mail: 15888407518@163.com

中图分类号: R656.2 R473.6
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- 文章访问数: 9
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- 被引次数: 0
出版历程
- 收稿日期: 2024-11-10
- 网络出版日期: 2025-08-14

Application of nursing intervention based on ERAS-MDT model in laparoscopic abdominal incision hernia surgery

Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的探讨加速康复外科(ERAS)-多学科协作(MDT)模式的护理干预方案对腹壁切口疝腹腔镜手术患者的影响，旨在改善患者预后，促进快速康复。方法采用随机数字表法将2022年1月—2024年1月于温州医科大学附属第一医院拟行腹腔镜下补片修补术治疗的110例腹壁切口疝患者分为对照组和观察组，每组55例，分别给予常规护理干预、基于ERAS-MDT模式的护理干预，比较2组患者术后恢复相关指标、住院费用、疼痛评分、焦虑情况、睡眠质量、不良事件发生率及护理满意度。结果观察组术后肛门排气时间为(6.99±1.11)h，首次进食时间为(9.31±1.02)h，下床活动时间为(9.45±1.24)h，住院时间为(6.77±1.01)d，均短于对照组的(9.23±1.37)h、(11.45±1.34)h、(12.56±2.09)h及(8.45±1.47)d(P＜0.05)，住院费用少于对照组(P＜0.05)；术后第1、3、5天VAS评分低于对照组(P＜0.05)；焦虑量表(SAI)评分、匹兹堡睡眠质量指数(PSQI)评分均低于对照组(P＜0.05)；不良事件发生率低于对照组(P＜0.05)；护理满意度评分高于对照组(P＜0.05)。结论给予腹壁切口疝腹腔镜手术患者基于ERAS-MDT模式的护理干预，可有效缓解患者术后疼痛程度，改善患者焦虑和睡眠质量，降低术后不良事件发生风险，减少住院费用，促进患者早日康复。
- 腹壁切口疝 /
- 加速康复外科 /
- 多学科协作 /
- 围手术期护理 /
- 预后
Abstract: Objective To investigate the effectiveness of ERAS combined with multidisciplinary collaboration (MDT) nursing intervention in improving postoperative outcomes in patients undergoing laparoscopic abdominal incision hernia surgery. Methods A total of 110 patients scheduled for laparoscopic patch repair of abdominal incision hernia at the First Affiliated Hospital of Wenzhou Medical University from January 2022 to January 2024 were enrolled. Patients were randomly divided into a control group and an observation group, with 55 cases in each group. The two groups were given routine nursing intervention and nursing intervention based on ERAS-MDT model, respectively. Postoperative recovery indexes, hospitalization costs, pain scores, anxiety, sleep quality, incidence of adverse events, and nursing satisfaction were compared between the two groups. Results In the observation group, the time of anal exhaust after operation [(6.99±1.11) h], the time of first feeding [(9.31±1.02) h], the time of getting out of bed [(9.45±1.24) h], and the time of hospitalization [(6.77±1.01) day] were shorter than those in the control group [(9.23±1.37) h, (11.45±1.34) h, (12.56±2.09) h, and (8.45±1.47) d, respectively (P < 0.05)]. The hospitalization cost was also lower than that in the control group (P < 0.05). The VAS scores at days 1, 3, and 5 after surgery were lower than those in the control group (P < 0.05). The scores of anxiety scale (SAI) and Pittsburgh sleep quality index (PSQI) were lower than those in the control group, respectively (P < 0.05). Additionally, the incidence of adverse events was lower than that in the control group (P < 0.05). While the nursing satisfaction score was higher than that in the control group (P < 0.05). Conclusion Nursing intervention based on ERAS-MDT model can relieve postoperative pain, improve anxiety and sleep quality of patients, reduce the risk of adverse events, reduce hospitalization costs, and promote early recovery of patients after laparoscopic abdominal incision hernia surgery.
- Abdominal incisional hernia /
- Accelerated rehabilitation surgery /
- Multidisciplinary collaboration /
- Perioperative nursing /
- Prognosis

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表 1 2组腹壁切口疝患者一般资料比较

Table 1. Comparison of general data between the two groups of patients with abdominal wall incisional hernia

组别	例数	性别(男/女，例)	年龄(x±s，岁)	BMI(x±s)	原手术(胆囊切除术/阑尾切除术/子宫切除术/小肠穿孔修补术，例)	疝环大小(x±s，cm)	病程(x±s，月)
对照组	55	25/30	53.23±5.66	23.47±3.15	16/20/11/8	6.89±1.23	5.11±1.01
观察组	55	28/27	52.90±7.31	23.55±4.12	13/19/15/8	7.21±1.44	4.89±1.13
统计量		0.328^a	0.265^b	0.114^b	0.951^a	1.253^b	1.077^b
P值		0.567	0.792	0.909	0.813	0.213	0.284
注：^a为χ²值，^b为t值。

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表 2 ERAS-MDT干预流程

Table 2. The ERAS-MDT intervention process

时间点	干预项目	执行成员
术前	入院评估：基本信息、疾病状况	外科医师、护士
	心理干预：渐进性肌肉放松训练、音乐干预、支持性心理治疗，共2次，每次10~15 min	心理咨询师
	睡眠管理：睡眠教育2~3次，每次5~10 min	护士
	常规干预：禁食禁饮、备皮、伴发疾病的治疗等	护士
术中	生命体征监测，充气式保温毯保暖、输液加温，给予积极的语言安慰	麻醉师、外科医师
	局麻、腹腔镜下补片修补术治疗
术后	疼痛管理：精准疼痛评估，多模式镇痛管理，物理镇痛、药物镇痛、疼痛教育	疼痛科医师
	呼吸道管理：高频胸壁振荡、叩背等方法	呼吸科医师
	腹压监测及管理：严密监测腹压，根据病因实施有效的减压措施，例如使用弹性腹带、尽快通便、掌握正确的咳嗽咳痰方法等	外科医师
	睡眠管理：晚睡前用热水泡脚、肌肉放松训练15 min，有条件者可带上眼罩、耳塞	护士
	营养支持：生命体征平稳后少量多次饮水(每次10 mL)或咀嚼口香糖(术后第1天开始，每日3次，每次15~20 min，每次2~4粒，直到肛门排气)促进胃肠蠕动。根据胃肠功能恢复情况，拟定个性化的饮食计划	营养师
	康复指导：先在床上适当活动，若无不适尽早下床活动	康复科医师
	并发症预防：严密观察做好防范，预防切口积液、肺内感染、粘连性肠梗阻等并发症	护士
	进行心理指导(方法同术前)，共3次，每次15 min。	心理咨询师
	全程疾病宣教	护士
	出院指导	护士

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表 3 2组腹壁切口疝患者术后恢复相关指标及住院费用比较(x±s)

Table 3. Comparison of postoperative recovery related indicators and hospitalization costs between two groups of patients with abdominal incisional hernia(x±s)

组别	例数	肛门排气时间(h)	首次进食时间(h)	下床活动时间(h)	住院时间(d)	住院费用(万元)
对照组	55	9.23±1.37	11.45±1.34	12.56±2.09	8.45±1.47	2.09±0.45
观察组	55	6.99±1.11	9.31±1.02	9.45±1.24	6.77±1.01	1.56±0.36
t值		9.421	9.424	9.491	6.986	6.821
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 4 2组腹壁切口疝患者VAS评分比较(x±s, 分)

Table 4. Comparison of VAS scores between the two groups of patients with abdominal incisional hernia(x±s, points)

组别	例数	术后当日	术后第1天	术后第3天	术后第5天	F值	P值
对照组	55	4.19±0.78	3.68±0.69	3.01±0.47	2.36±0.57	10.234	＜0.001
观察组	55	4.01±1.11	3.05±0.68	2.37±0.56	1.55±0.34	17.651	＜0.001
F值		0.891	16.451	19.451	20.411
P值		0.561	＜0.001	＜0.001	＜0.001

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表 5 2组腹壁切口疝患者焦虑情况和睡眠质量比较(x±s, 分)

Table 5. Comparison of anxiety and sleep quality between the two groups of patients with abdominal incisional hernia(x±s, points)

组别	例数	SAI		PSQI
组别	例数	干预前	干预后	干预前	干预后
对照组	55	45.67±9.45	35.21±5.46^b	9.23±1.15	6.09±2.11^b
观察组	55	45.77±6.21	23.39±4.10^b	8.79±2.14	4.56±1.02^b
统计量		0.066^a	17.561^c	1.343^a	15.227^c
P值		0.948	＜0.001	0.182	＜0.001
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

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表 6 2组腹壁切口疝患者护理满意度比较(x±s, 分)

Table 6. Comparison of nursing satisfaction between two groups of patients with abdominal incisional hernia(x±s, points)

组别	例数	服务质量	服务态度	护患沟通
对照组	55	5.67±1.14	6.03±1.11	6.34±1.24
观察组	55	8.10±1.23	6.77±1.07	7.90±1.40
t值		10.746	3.560	6.186
P值		＜0.001	0.001	＜0.001

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