手汗症日间胸腔镜手术实施加速康复外科管理的临床效果

摘要
图/表
参考文献
相关文章 (15)

全文: PDF (986 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨手汗症日间胸腔镜手术实施加速康复外科(ERAS)管理的临床效果。方法选取日间手术模式下行胸腔镜下交感神经切断术治疗的手汗症患者164例,将2022-06至2023-04收治的78例患者纳入对照组,实施常规管理;将2023年5-12月收治的86例患者纳入干预组,实施ERAS管理。记录并对比两组手术指标、疼痛程度、并发症发生率及满意度。结果干预组和对照组各手术指标相比,差异无统计学意义;干预组术后24 h[4(4,4)分]、3 d[3(3,4)分]、7 d[2(2,3)分]的VAS评分均低于对照组术后24 h[5(4,5)分]、3 d[4(4,5)分]、7 d[4(4,4)分],差异有统计学意义(P＜0.05);干预组总并发症发生率(18.6%)低于对照组(35.9%),差异有统计学意义(P＜0.05);干预组患者满意度[(95.69±2.19)分]高于对照组[(93.31±3.73)分],差异有统计学意义(P＜0.05)。结论 ERAS管理日间模式胸腔镜下交感神经切断术治疗手汗症可减轻患者疼痛程度,减少并发症,提升患者满意度,值得推广应用。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	把赛君
	王忠月
	宋萍萍
	许华晔

关键词 ： ERAS理念, 日间模式手术, 胸腔镜下交感神经切断术, 手汗症, 并发症, 护理管理

Abstract：Objective To investigate the clinical effect of enhanced recovery after surgery (ERAS) management in daytime thoracoscopic sympathectomy for palmar hyperhidrosis. Methods A total of 164 patients with palmar hyperhidrosis who underwent thoracoscopic sympathectomy were selected under day-care surgery, and 78 patients treated from June 2022 to April 2023 were included in the control group and received conventional management. A total of 86 patients treated from May 2023 to December 2023 were included in the intervention group and received ERAS management. Surgical indicators, pain scores, complication rates, and patient satisfaction were recorded and compared between the two groups. Results There were no statistically significant differences between the two groups (P>0.05). The VAS pain scores at 24 h [4 (4, 4) points], 3 d [3 (3, 4) points], and 7 d[2 (2, 2) points] in the intervention group were lower than those in the control group at 24 h [5 (4, 5) points], 3 d[4 (4, 5) points], and 7 d [4 (4, 4) points], with statistically significant differences (P<0.05). The overall complication rate in the intervention group (18.6%) was lower than that in the control group (35.9%), with statistically significant difference (P<0.05). The patient satisfaction score in the intervention group (95.69±2.192) was higher than that in the control group (93.31±3.732) (P<0.05). Conclusions ERAS management in daytime thoracoscopic sympathectomy for palmar hyperhidrosis can alleviate pain, reduce complications, and improve patient satisfaction, which is worthy of popularization and application.

Key words： ERAS concept daytime mode surgery thoracoscopic sympathectomy palmar hyperhidrosis complication nursing management

收稿日期: 2024-04-17

ZTFLH:	R473.6
	R655

基金资助:2020年度南京市卫生科技发展专项资金重点项目(ZKX20017)

通讯作者: 许华晔,E-mail:huaye0825@163.com

作者简介: 把赛君,本科学历,主管护师。

引用本文:

把赛君, 王忠月, 宋萍萍, 许华晔. 手汗症日间胸腔镜手术实施加速康复外科管理的临床效果[J]. 武警医学, 2024, 35(9): 749-753. BA Saijun, WANG Zhongyue, SONG Pingping, XU Huaye. Clinical effect of enhanced recovery after surgery (ERAS) management in daytime thoracoscopic sympathectomy for palmar hyperhidrosis. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(9): 749-753.

链接本文:

https://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 https://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2024/V35/I9/749

[1]	Joshi G P. Enhanced recovery pathways for ambulatory surgery[J]. Curr Opin Anaesthesiol,2020,33(6):711-717.
[2]	马庆鑫,张磊,蒋丽莎,等.基于临床路径的中心式日间手术管理实践[J].华西医学,2021,36(7):954-958.
[3]	黄丽芳,沈春辉,王继勇.手汗症术后疼痛特点及其中医证型分布规律研究[J].广州中医药大学学报,2021,38(9):1780-1785.
[4]	Lauwers F, Poulet V, Turblin P, et al.From ambulatory surgery to enhanced recovery after surgery: lessons from the Rugby World Cup in France[J].J Stomatol Oral Maxillofac Surg,2023,124(6):101678.
[5]	俞德梁,刘小南,高博欣,等.计划性手术模式:日间手术管理的新实践[J].中国卫生质量管理,2021,28(7):37-39,47.
[6]	中华医学会麻醉学分会“成人日间手术加速康复外科麻醉管理专家共识”工作小组.成人日间手术加速康复外科麻醉管理专家共识[J].协和医学杂志,2019,10(6):562-569.
[7]	Kaye A D, Renschler J, Cramer K,et al.The role of clinical pharmacology in enhanced recovery after surgery protocols: a comprehensive review[J].Anaesthesiol Intensive Ther,2020,52(2):154-164.
[8]	蔡林生,余扬,宁显谷,等.日间手术模式下胸腔镜胸交感神经切断术治疗手汗症的安全性和可行性[J].中国胸心血管外科临床杂志,2023,30(2):280-285.
[9]	Campos J R, Fonseca H V, Wolosker N.Quality of life changes following surgery for hyperhidrosis[J].Thorac Surg Clin,2016,26(4):435-443.
[10]	Kapoor I, Prabhakar H, Mahajan C.Enhanced recovery after surgery program for ambulatory surgery may possibly include more components[J]. Anesth Analg,2022,135(1):e2.
[11]	Fiorelli A, Messina G, Chiodini P, et al.Cardiac autonomic changes after thoracic sympathectomy: a prospective, randomized study[J]. Ann Thorac Surg,2017,103(1): 216-224.
[12]	史校铭,焦子宸,张子睿,等.集中管理日间手术模式下胸腔镜手术与普通住院手术模式治疗肺结节的疗效及安全性比较[J].川北医学院学报,2023,38(6):806-809.
[13]	夏萍,王卫,夏志鹏,等.日间手术全程管理模式探索及实践[J].中国医院,2023,27(8):99-101.
[14]	Shayesteh A, Boman J, Janlert U, et al.Primary hyperhidrosis: implications on symptoms, daily life, health and alcohol consumption when treated with botulinum toxin[J]. J Dermatol,2016,43(8):928-933.
[15]	Rajan N, Rosero E B, Joshi G P. Patient selection for adult ambulatory surgery: a narrative review[J]. Anesth Analg,2021,133(6):1415-1430.
[16]	孙卫格,张冉,骆洁,等.基于Kano模型的日间手术患者全流程管理服务需求调查[J].中国护理管理,2023,23(7): 994-998.
[17]	Hampton H, Torre M, Satalich J, et al.Benefits of implementing an enhanced recovery after surgery protocol in ambulatory surgery[J]. Orthop J Sports Med,2022,10(11): 23259671221133412.
[18]	刘学海,李彦宁,王江龙,等.微小双孔法胸腔镜双侧胸交感神经链切断术在治疗手汗症中的应用[J].陆军军医大学学报,2022,44(13):1390-1394.
[19]	Raft J, Richebé P. Anesthesia for thoracic ambulatory surgery[J].Curr Opin Anaesthesiol,2019,32(6):735-742.
[20]	兰欣,钱步月,卫荣,等.日间手术全流程闭环重塑探讨与实践[J].中国卫生信息管理杂志,2021,18(4):531-535.
[21]	Glowka L, Tanella A, Hyman J B. Quality indicators and outcomes in ambulatory surgery[J]. Curr Opin Anaesthesiol,2023,36(6):624-629.
[22]	杨兵,胡文文,孙仲涛,等.胸腔镜交感神经切断术治疗原发性手汗症疗效分析[J].中国临床医生杂志,2023,51(3):327-330.
[23]	周艳,周燕,蔡斌,等.平急结合的日间手术术前管理流程优化探索[J].中华医院管理杂志,2021,37(3):221-224.
[24]	吴美,夏露,程云,等.日间手术病房老年患者围手术期管理的证据总结[J].护士进修杂志,2021,36(18):1723-1727.
[25]	Cukierman D S, Cata J P, Gan T J. Enhanced recovery protocols for ambulatory surgery[J]. Best Pract Res Clin Anaesthesiol,2023,37(3):285-303.