Construction of Rehabilitation Log and Its Effect on Recovery after Laparoscopic Hepatocellular Carcinoma Resection
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摘要:
目的 基于ERAS的理念和腹腔镜肝癌切除术后患者的康复需求，构建腹腔镜肝癌切除术后康复日志，研究其应用效果。 方法 选择2021年1月至12月行腹腔镜肝癌切除术的患者120例，根据围手术期处理方法不同（ERAS组79例，非ERAS组41例），采用随机数字法分为对照组和实验组。对照组采取整体护理及围手术期常规健康指导，实验组采用医、护、患共管模式，应用康复日志。比较2组患者康复情况及满意度。 结果 实验组与对照组并发症例数，差异无统计学意义（P > 0.05），其他指标实验组明显优于对照组（P < 0.05）。 结论 构建康复日志并应用有助于腹腔镜肝切除术后患者掌握术后康复知识，提高患者的主动性，促进家属的积极参与，加速患者康复。 Abstract:Objective Based on the concept of ERAS and the rehabilitation needs of patients after laparoscopic hepatocellular carcinoma resection, to construct a rehabilitation log after laparoscopic hepatocellular carcinoma resection and study its application effect. Methods A total of 120 patients undergoing laparoscopic hepatocellular carcinoma resection from January to December 2021 were selected and randomly divided into control group and experimental group according to perioperative management methods （79 cases in ERAS group and 41 cases in non-ERAS group）. The control group adopted holistic nursing and routine perioperative health guidance, while the experimental group adopted the mode of medical, nursing and patient co-management, and applied the recovery log. The recovery and satisfaction of the two groups were compared. Results There was no significant difference in the number of complications between the experimental group and the control group （P > 0.05）, and other indicators of the experimental group were significantly better than the control group （P < 0.05）. Results: There was no statistically significant difference between the two groups in bleeding after ambulation, but other indexes were significantly better than the control group （P < 0.01）. Conclusion The construction and application of rehabilitation log can help patients master postoperative rehabilitation knowledge after laparoscopic hepatectomy, improve the initiative of patients, promote the active participation of family members, and accelerate the recovery of patients. -
表 1 2组患者基本情况比较[（
$\bar x \pm s$ ）/n（%）]Table 1. Comparison of basic information between the two groups [（
$\bar x \pm s$ ）/n（%）]组别 年龄（岁） 性别
（男/女）围手术期处理
（ERAS组/非ERAS组）临床分期 Ⅰa期 Ⅰb期 Ⅱa期 实验组（n = 60） 53.43 ± 9.80 39/21 44/16 38（63.33） 15（25.00） 7（11.17） 对照组（n = 60） 53.57 ± 12.98 33/27 35/25 37（61.67） 18（30.00） 5（8.33） t/χ2 −0.073 1.25 3.001 0.619 P 0.942 0.264 0.083 0.734 注：临床分期为原发性肝癌诊疗指南（2022版）。 
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表 2 2组术后24 h下床活动人数、并发症例数、术后住院时间比较（
$ \bar x \pm s $ ）Table 2. Comparison of 24 h postoperative ambulation cases，the number of complications and postoperative hospital stay between the two groups （
$ \bar x \pm s $ ）组别 术后24 h下床活动人数（n） 并发症例数（n） 术后住院时间（d） 腹胀 腹痛 出血 实验组（n = 60） 57 4 6 1 4.78 ± 0.89 对照组（n = 60） 50 8 10 2 5.57 ± 0.77 t 4.227 1.481 1.154 0.209 −5.181 P 0.04* 0.224 0.283 0.648 < 0.001* *P < 0.05。
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表 3 2组患者术后首次进食时间及量、过渡至正常饮食时间比较（
$ \bar x \pm s $ ）Table 3. Comparison of time and amount of first postoperative eating and transition to normal eating time between the two groups （
$ \bar x \pm s $ ）组别 术后首次进食时间（h） 进食量（mL） 过渡至正常饮食时间（h） 实验组（n = 60） 7.40 ± 1.30 47.67 ± 12.26 26.78 ± 5.17 对照组（n = 60） 7.98 ± 1.20 42.17 ± 11.94 34.30 ± 8.56 t −2.549 2.489 −5.825 P 0.012* 0.014* < 0.001* *P < 0.05。
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表 4 2组患者术后疼痛、满意度比较（
$ \bar x \pm s $ ）Table 4. Comparison of postoperative pain and satisfaction between the two groups （
$ \bar x \pm s $ ）组别 术后疼痛评分（分） 医疗服务满意度（%） 实验组（n = 60） 3.68 ± 0.62 98.02 ± 1.11 对照组（n = 60） 5.52 ± 0.81 93.35 ± 2.05 t −13.857 15.506 P < 0.001* < 0.001* *P < 0.05。
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