Efficacy of Integrated Nursing Care Combined with Enhanced Recovery after Surgery in Patients Undergone Cerebral Aneurysm Interventional Embolization
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摘要:
目的 探讨医护一体化结合快速康复外科（enhanced recovery after surgery，ERAS）在破裂脑动脉瘤介入栓塞术中应用及其对患者康复质量、短期预后的影响。 方法 选取2019年1月至2021年1月云南大学附属医院收治的158例破裂脑动脉瘤患者作为研究对象，以上病例均为脑动脉瘤入院后在1～10 d内行介入栓塞手术，根据入院建档顺序不同分组，每组79例，给予对照组传统围术期护理方案，给予观察组医护一体化结合ERAS干预。观察比较2组早期恢复情况（尿管留置时间、术后清醒时间、住院时间）、干预前及出院时功能恢复情况：认知功能（MMSE）、神经功能（NIHSS）、日常生活能力（ADL）、平均活动时间及并发症情况。 结果 观察组术后清醒、尿管留置及住院时间均短于对照组，差异有统计学意义（P < 0.05）；出院时观察组MMSE、ADL评分高于对照组，NIHSS评分低于对照组，观察组平均活动时间（包含主动或被动活动）较对照组多，差异有统计学意义（P < 0.05）；观察组并发症发生率（6.33%）明显低于对照组（16.46%），差异有统计学意义（P < 0.05）。 结论 医护一体化结合ERAS干预能有效改善患者预后，降低患者生理及心理应激状态，加速术后康复进程，改善认知、神经及日常生活能力，并可降低并发症风险，对术后短期恢复具有积极影响。 -
关键词:
- 医护一体化 /
- 快速康复外科 /
- 脑动脉瘤；动脉瘤性蛛网膜下腔出血 /
- 康复质量 /
- 认知功能
Abstract:Objective To explore the application of integrated nursing care combined with Enhanced Recovery after Surgery （ERAS） in patients undergone interventional embolization for ruptured cerebral aneurysms and its effect on recovery quality and short-term prognosis. Methods A total of 158 patients with ruptured cerebral aneurysms admitted to The Affiliated Hospital of Yunnan University from January 2019 to January 2021 were selected as the research subjects. All the patients were treated with interventional embolization within 1～10 days after admission. The patients were divided into two groups according to the order of admission.The control group （79 patients） was given traditional perioperative nursing care. The observation （79 patients） group was given integrated medical care combined with ERAS intervention. The early recovery （catheter indwelling time, postoperative awake time, length of hospital stay）, functional recovery before intervention and at discharge, including cognitive function （MMSE）, neurological function （NIHSS）, daily living ability （ADL）, average activity time and complications, were observed and compared between the two groups. Results The time of postoperative awakening, indwelling catheter and hospitalization length in the observation group were significantly shorter than those in the control group （P < 0.05）. The scores of MMSE and ADL in the observation group were higher than those in the control group, while the NIHSS score in the observation group was lower than that in the control group, and the average activity time （including active or passive activity） in the observation group was significantly longer than that in the control group （P < 0.05）. The incidence of complications in the observation group was 6.33%, which was significantly lower than 16% in the control group （P < 0.05）. Conclusion The integrated nursing care combined with ERAS intervention effectively improved the prognosis of patients, reduced the physiological and psychological stress state of patients, accelerated the process of postoperative rehabilitation, improved cognitive, neurological and activities of daily life, and reduced the risk of complications, which has a positive effect on short-term postoperative recovery. -
表 1 一般资料比较[
$ \bar x \pm s $ /n（%）]Table 1. Comparison of general data [
$ \bar x \pm s $ /n（%）]项目 观察组 对照组 t/χ2 P 性别 0.103 0.749 男 36（45.57） 34（43.04） 女 43（54.43） 45（56.96） 年龄（岁） 43.56 ± 5.10 42.10 ± 6.56 1.562 0.120 出血量（mL） 65.32 ± 15.26 69.58 ± 16.85 1.666 0.098 发病至入院时间（h） 5.45 ± 0.59 5.63 ± 0.62 1.869 0.064 入院GCS评分（分） 9.06 ± 1.32 9.41 ± 1.48 1.569 0.119 术前意识状态 1.877 0.171 清醒 59（74.68） 66（83.54） 昏迷 20（25.32） 13（16.46） 
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表 2 2组术后恢复情况比较（
$ \bar x \pm s $ ）Table 2. Comparison of Postoperative Recovery between The Two Groups （
$ \bar x \pm s $ ）组别 n 术后清醒时间
（h）尿管留置时间（d） 住院时间
（d）观察组 79 22.52 ± 1.69 11.10 ± 2.52 25.10 ± 4.12 对照组 79 28.36 ± 2.45 13.25 ± 3.12 27.38 ± 5.85 t 17.440 4.765 2.832 P < 0.001* < 0.001* 0.005* *P < 0.05。
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表 3 2组功能恢复情况比较（
$\bar x \pm s $ ）Table 3. Comparison of Functional Recovery between The Two Groups （
$\bar x \pm s $ ）时间 组别 n MMSE（h） ADL（h） NIHSS（h） 平均活动时间（min/d） 干预前 观察组 79 5.85 ± 1.32 24.32 ± 5.33 15.10 ± 3.32 24.15 ± 5.02 对照组 79 6.15 ± 1.61 25.01 ± 4.85 14.42 ± 3.45 23.86 ± 5.15 t 1.281 0.851 1.262 0.358 P 0.202 0.396 0.209 0.721 出院时 观察组 79 15.10 ± 3.01 57.63 ± 6.02 8.26 ± 2.41 38.10 ± 2.64 对照组 79 12.03 ± 2.74 51.24 ± 5.74 11.06 ± 2.33 24.68 ± 4.15 t 6.704 6.828 7.424 24.251 P < 0.001* < 0.001* < 0.001* < 0.001* *P < 0.05。
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表 4 2组并发症情况比较[n（%）]
Table 4. Comparison of Complications between The Two Groups [n（%）]
组别 n 泌尿系统
感染肺部感染 压力性损伤 发生率 观察组 79 3（3.80） 2（2.53） 0（0.00） 5（6.33） 对照组 79 4（5.06） 8（10.13） 1（1.27） 13（16.46） χ2 4.013 P 0.045* *P < 0.05。
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