加速康复(ERAS)框架下的精准护理在腰椎结核手术患者中的应用

Application of Precision Nursing within the Enhanced Recovery after Surgery (ERAS) Framework in Patients Undergoing Lumbar Tuberculosis Surgery

摘要: 目的：探讨加速康复(Enhanced Recovery after Surgery, ERAS)框架下的精准护理在腰椎结核手术患者围术期护理中的应用效果。方法：选取2021年1月至2023年1月在新疆维吾尔自治区人民医院骨科中心脊柱二病区因“腰椎结核”为诊断并且接受手术治疗的患者80例，按照抛硬币法将纳入的患者随机分为ERAS组(41例)和对照组(39例)，EARS组围手术期采用加速康复理念进行精准护理，对照组围手术期采用骨科常规护理。收集两组患者的一般临床资料(性别、年龄、体重指数、手术节段)以及观察指标(手术时间、术中出血量、术后视觉疼痛模拟评分(Visual Analogue Scale, VAS)、首次排气时间、术后下地时间、满意度、住院时间)及术后并发症(压力性损伤、肠梗阻、肺部感染、下肢深静脉血栓、便秘、院内感染)发生率。结果：两组患者术后均无严重并发症出现。两组患者一般资料如性别、年龄、体重指数、手术节段等指标比较差异性无统计学意义(P > 0.05)。两组患者各组在手术时间和术中出血量的差异性无统计学意义(P > 0.05)；然而，ERAS组在首次排气时间、术后下地时间、住院时间、并发症发生率、视觉模拟评分(VAS)均显著低于常规组并且术后满意度方面明显高于常规组(P < 0.05)；组内比较两组在VAS评分降低存在显著统计学意义(P < 0.05)。结论：加速康复框架下的精准护理可以提高腰椎结核患者术后恢复的质量、降低并发症发生率以及提升患者满意度。

Abstract: Objective: To explore the application effect of precision nursing under the Enhanced Recovery after Surgery (ERAS) framework in the perioperative nursing of patients undergoing lumbar tuberculosis surgery. Methods: A total of 80 patients diagnosed with “lumbar tuberculosis” and treated surgically at the Orthopedic Center, Second Ward, People’s Hospital of Xinjiang Uygur Autonomous Region from January 2021 to January 2023 were selected. Patients were randomly divided into the ERAS group (41 cases) and the control group (39 cases) using the coin toss method. The ERAS group received precision nursing based on the ERAS concept during the perioperative period, while the control group received routine orthopedic nursing. General clinical data (gender, age, body mass index, surgical segment) and observation indicators (operation time, intraoperative blood loss, postoperative visual analog scale (VAS) for pain, time to first flatus, time to ambulation, satisfaction, length of hospital stay) and the incidence of postoperative complications (pressure ulcers, intestinal obstruction, pulmonary infection, lower extremity deep vein thrombosis, constipation, hospital-acquired infection) were collected for both groups. Results: No severe complications occurred in either group postoperatively. There were no statistically significant differences in general data such as gender, age, body mass index, and surgical segment between the two groups (P > 0.05). There were no statistically significant differences in operation time and intraoperative blood loss between the two groups (P > 0.05). However, the ERAS group had significantly shorter times to first flatus, ambulation, and hospital stay, lower complication rates, and lower VAS scores compared to the control group (P < 0.05), and higher satisfaction rates (P < 0.05). Intragroup comparison showed a significant statistical difference in the reduction of VAS scores between the two groups (P < 0.05). Conclusion: Precision nursing under the ERAS framework can improve the quality of postoperative recovery, reduce the incidence of complications, and enhance patient satisfaction in patients with lumbar tuberculosis.