1 江苏省人民医院神经外科ICU，南京 210029
|| 江苏省卫生厅“兴卫工程”重点个人医学研究基金 (RC201156)；江苏省重点医学学科 (RC201156)；江苏省人民医院课题项目 (YHK201758)。
目的：探讨快速康复细节化护理在经鼻蝶入路垂体腺瘤切除术患者中的应用效果。方法：采用非同期对照的方法，选取江苏省人民医院神经外科2018年1月至12月收治的80例经鼻蝶入路垂体腺瘤切除术患者为对照组，2019年1月至12月收治的80例经鼻蝶入路垂体腺瘤切除术患者为观察组。对照组采用常规护理，观察组采用快速康复细节化护理。观察两组术后应激指标、疼痛、术后恢复以及并发症等。结果：观察组、对照组各脱落病例2例。观察组术后1 d的皮质醇(cortisol，Cor)、去甲肾上腺激素(norepinephrine，NE)水平均低于对照组；术后3 d的白细胞介素6(interleukin-6，IL-6)、C反应蛋白(C-reactive protein，CRP)、肿瘤坏死因子α(tumor necrosis factor-α，TNF-α)水平均低于对照组，差异有统计学意义(均P<0.05)。观察组术后肠鸣音恢复时间、排气时间及住院时间均少于对照组，差异有统计学意义(均P<0.05)。观察组术后3个月的Barthel指数评分高于对照组，差异有统计学意义(P<0.05)。两组术后并发症无统计学意义(P>0.05)。结论：快速康复细节化护理能够进一步减轻经鼻蝶入路垂体腺瘤切除术患者术后的应激反应和炎症反应，促进胃肠功能和自理能力恢复。
Application of rapid rehabilitation nursing on postoperative patients undergoing pituitary adenoma resection via nasal sphenoid approach
CorrespondingAuthor: Zhao Qian
This work was supported by the Key Individual Medical Research Fund “Xingwei Project” of Jiangsu Provincial Health Department (RC201156), Jiangsu Provincial Key Medical Discipline (RC201156) and the Research Project of Jiangsu Provincial People’s Hospital (YHK201758), China.
Objective: To explore the application effect of nursing pathway guided by the concept of rapid rehabilitation on patients undergoing transsphenoidal pituitary adenoma resection. Methods: A total of 160 cases of transsphenoidal pituitary adenoma resection in the Department of Neurosurgery of Jiangsu Provincial People’s Hospital were randomly divided into a control group (80 cases; from January to December 2018) and an observation group (80 cases; from January to December 2019). The control group was treated with routine nursing, and the observation group was treated with nursing pathway guided by the concept of rapid rehabilitation. The stress index, pain, postoperative recovery and complications of the two groups were observed. Results: Two cases of abscission occurred in the observation group and the control group, respectively. The levels of cortisol (Cor) and norepinephrine (NE) in the observation group on the 1st day after operation were lower than those in the control group, the levels of interleukin-6 (IL-6), C-reactive protein (CRP) and tumor necrosis factor-α (TNF-α) on the 3rd day after operation were lower than those in the control group, and the difference was statistically significant (P<0.05). The pain scores at 24 and 48 h after operation in the observation group were lower than those in the control group, the recovery time of bowel sounds, exhaust time and hospitalization time in the observation group were shorter than those in the control group, and the difference was statistically significant (P<0.05). The Barthel index score of the observation group was higher than that of the control group at the 3rd months after the operation, and the difference was statistically significant (P<0.05). There was no significant difference in postoperative complications between the two groups (P>0.05). Conclusion: The nursing path guided by the concept of rapid rehabilitation can further reduce the stress reaction and inflammatory reaction, reduce the degree of pain, and promote the recovery of gastrointestinal function and self-care ability in patients undergoing transsphenoidal pituitary adenoma resection.
rapid rehabilitation; detailed nursing; transsphenoidal approach; pituitary adenoma resection; postoperative recovery