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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 619 -624. doi: 10.3877/cma.j.issn.1674-392X.2023.05.026

论著

Robocare护理模式联合高频胸壁振荡在腹腔镜腹壁切口疝修补术的应用
李梅, 孔珊珊†()   
  1. 431600　湖北孝感，汉川市人民医院手术室
  • 收稿日期:2022-12-30 出版日期:2023-10-18
  • 通信作者: 孔珊珊

Application of Robocare nursing mode combined with high-frequency chest wall oscillation in laparoscopic abdominal incision hernia repair

Mei Li, Shanshan Kong†()   

  1. Operating Room, Hanchuan People's Hospital in Hubei Province, Xiaogan, Hubei 431600, China
  • Received:2022-12-30 Published:2023-10-18
  • Corresponding author: Shanshan Kong
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引用本文：

李梅, 孔珊珊. Robocare护理模式联合高频胸壁振荡在腹腔镜腹壁切口疝修补术的应用[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(05): 619-624.

Mei Li, Shanshan Kong. Application of Robocare nursing mode combined with high-frequency chest wall oscillation in laparoscopic abdominal incision hernia repair[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 619-624.

目的

研究Robocare护理模式联合高频胸壁振荡在腹腔镜腹壁切口疝修补术中的应用价值。

方法

选择2019年1月至2022年1月在汉川市人民医院行腹腔镜腹壁切口疝修补术的114例患者为研究对象，使用随机数表法分为观察组和对照组，每组57例。对照组采用常规护理模式，观察组在对照组基础上采用Robocare护理模式，2组术后均采用高频胸壁振荡排痰。比较2组围手术期指标，包括下床时间、排气时间、腹腔引流管拔除时间、住院时间、术后1周Karnofsky评分；比较2组护理开始前1 d、患者出院后3个月健康调查量表36（SF-36）评分、焦虑自评量表（SAS）、抑郁自评量表（SDS）；记录2组术后并发症发生情况；比较2组对本次护理满意度。

结果

与对照组比较，观察组腹腔引流管拔除时间、住院时间较短，术后1周Karnofsky评分较高（P<0.05）；2组下床时间、排气时间比较差异无统计学意义（P>0.05）。护理前，2组SF-36量表各项评分比较差异无统计学意义（P>0.05）；护理后，2组SF-36量表各项评分均有所提高（P<0.05），观察组SF-36量表各项评分及护理前后差值均高于对照组（P<0.05）。护理前，2组SAS、SDS评分比较差异无统计学意义（P>0.05）；护理后，2组SAS、SDS评分有所降低（P<0.05），观察组SAS、SDS评分护理前后差值高于对照组（P<0.05）。观察组较对照组术后并发症发生率低（P<0.05），对护理满意度高（P<0.05）。

结论

Robocare护理模式联合高频胸壁振荡用于腹腔镜腹壁切口疝修补术有利于促进患者体力恢复、降低切口疝并发症总发生率、缩短住院时间，并可明显缓解患者焦虑、抑郁情绪，改善患者的生活质量，提高患者对护理服务的满意度。

关键词: 切口疝, 疝修补术, Robocare护理模式, 高频胸壁振荡, 并发症, 生活质量
Objective

To study the application value of Robocare nursing mode combined with high frequency chest wall oscillation in laparoscopic abdominal wall incisional hernia repair.

Methods

A total of 114 patients who underwent laparoscopic abdominal wall incisional hernia in Hanchuan People's Hospital from January 2019 to January 2022 were selected as the study subjects, and were divided into an observation group and a control group by the random number table method, with 57 patients in each group. The control group adopted conventional nursing mode, and the observation group adopted Robocare nursing mode on the basis of the control group. Both groups were treated with high-frequency chest wall oscillation after the operation. Perioperative indexes were compared between the two groups, including time to get out of bed, exhaust time, abdominal drainage tube removal time, length of hospital stay, and Karnofsky score 1 week after surgery. Short form 36 (SF-36) score, the Self-rated Anxiety Scale (SAS) and the Self-rated Depression Scale (SDS) were compared between the two groups 1 day before nursing and 3 months after discharge. The postoperative complications of the two groups were recorded. The satisfaction of nursing was compared between the two groups.

Results

Compared with the control group, the abdominal drainage tube removal time and hospital stay were shorter in the observation group, and the Karnofsky score was higher 1 week after surgery (P<0.05). There was no significant difference between the two groups in getting out of bed time and exhaust time (P>0.05). Before nursing, there was no significant difference in the scores of the SF-36 scale between the two groups (P>0.05); After nursing, the scores of SF-36 scale in both groups were improved (P<0.05); The scores of SF-36 scale and the difference before and after nursing in the observation group were higher than those in the control group (P<0.05); Before nursing, there was no significant difference in SAS and SDS scores between the two groups (P>0.05). After nursing, the SAS and SDS scores of the two groups decreased (P<0.05); The difference of SAS and SDS scores before and after nursing in the observation group was higher than that in control group (P<0.05); Compared with the control group, the incidence of postoperative complications in the observation group was lower (P<0.05); Compared with the control group, the observation group had higher satisfaction with this nursing (P<0.05).

Conclusion

Robocare nursing mode combined with high-frequency chest wall oscillations for laparoscopic abdominal incisional hernia repair can promote the physical recovery of patients, reduce the incidence of complications such as incisional hernia recurrence, shorten the length of hospital stay, significantly reduce anxiety and depression, improve the quality of life of patients, and improve the satisfaction of patients with nursing services.

Key words: Incisional hernia, Herniorrhaphy, Robocare nursing model, High frequency chest wall oscillation, Complications, Quality of life
表1 2组患者一般资料比较[例（%）]
组别 例数 性别 年龄(岁,±s) 体重指数(kg/m2,±s) 文化程度 民族 来源地
男性 女性 初中 高中 大专及以上 汉族 少数民族 本地 外地
观察组 57 33(57.89) 24(42.11) 63.15±9.37 23.62±2.79 29(50.88) 16(28.07) 12(21.05) 48(84.21) 9(15.79) 36(63.16) 21(36.84)
对照组 57 30(52.63) 27(47.37) 62.73±8.52 23.86±3.02 31(54.39) 14(24.56) 12(21.05) 52(91.23) 5( 8.77) 39(68.42) 18(31.58)
t/χ2   0.319 0.250 0.441 0.200 1.303 0.351
P   0.572 0.803 0.660 0.905 0.254 0.554
组别 例数 在职状态 切口类型 疝环直径 即往手术情况
在职 退休 小切口 中切口 大切口 乙状结肠切除术 直肠癌根治术 阑尾手术 子宫切除术
观察组 57 26(45.61) 31(54.39) 35(61.40) 14(24.56) 8(14.04) 7.12±2.57 13(22.81) 24(42.11) 7(12.28) 8(14.04)
对照组 57 22(38.60) 35(61.40) 31(54.39) 20(35.09) 6(10.53) 7.03±2.16 15(26.32) 20(35.09) 8(14.04) 10(17.54)
t/χ2   0.576 1.587 0.202 1.488
P   0.448 0.452 0.840 0.685
表2 2组患者围手术期相关指标比较（±s）
组别 例数 下床时间(h) 排气时间(d) 腹腔引流管拔除时间(d) 住院时间(d) 术后1周Karnofsky评分(分)
观察组 57 34.36± 9.72 2.06±0.37 3.74±0.48 4.48±0.65 86.52±11.37
对照组 57 35.12±10.59 2.12±0.45 4.52±0.83 6.07±1.56 81.69±12.84
t   0.399 0.399 6.142 7.103 2.126
P   0.778 0.778 <0.001 <0.001 0.036
表3 2组患者护理前后SF-36量表评分比较（分，±s）
组别 例数 生理功能 生理职能 躯体疼痛 总体健康
护理前 护理后 护理前后差值 护理前 护理后 护理前后差值 护理前 护理后 护理前后差值 护理前 护理后 护理前后差值
观察组 57 60.35±13.02 81.37±13.06* 21.02±2.38 56.13± 8.26 75.16±10.25* 19.03±1.99 53.16±12.08 69.28±11.36* 16.12±3.72 56.17± 9.52 71.39±13.06* 15.22±3.54
对照组 57 59.12±12.84 72.36±10.59* 13.24±2.25 57.36±11.52 68.29± 9.36* 10.93±2.16 54.72± 9.37 65.26±14.75* 10.54±2.91 57.21±10.32 66.35±11.82* 9.14±1.55
t   0.508 4.046 17.934 0.655 3.737 20.822 0.770 1.630 8.920 0.559 2.160 11.878
P   0.613 <0.001 <0.001 0.514 <0.001 <0.001 0.443 0.106 <0.001 0.577 0.033 <0.001
组别 例数 活力 社会功能 情感职能 精神健康
护理前 护理后 护理前后差值 护理前 护理后 护理前后差值 护理前 护理后 护理前后差值 护理前 护理后 护理前后差值
观察组 57 50.23±11.37 73.55±10.96* 23.32±2.84 58.27±13.25 72.03±10.14* 13.76±3.11 61.25±7.32 69.08±8.74* 7.83±1.42 52.71±13.96 69.81± 8.55* 17.10±3.48
对照组 57 51.59±10.62 67.15±13.09* 15.56±2.47 56.74± 9.08 66.38±11.25* 9.64±2.17 59.86±8.15 65.13±7.32* 5.27±0.83 54.03±11.05 65.72±10.09* 11.69±2.52
t   0.660 2.830 15.566 0.719 2.816 8.202 0.958 2.616 11.751 0.560 2.335 9.506
P   0.511 0.006 <0.001 0.474 0.006 <0.001 0.340 0.010 <0.001 0.577 0.021 <0.001
表4 2组患者护理前后SAS、SDS评分比较（分，±s）
组别 例数 SAS SDS
护理前 护理后 护理前后差值 护理前 护理后 护理前后差值
观察组 57 51.19±6.03 40.08±4.46* 11.11±1.57 43.61±4.82 34.15±3.39* 9.46±1.43
对照组 57 52.26±5.85 43.62±5.17* 8.64±0.68 42.49±5.03 37.04±3.25* 5.45±1.78
t   0.962 3.914 10.899 1.214 4.646 13.259
P   0.338 <0.001 <0.001 0.227 0.001 <0.001
表5 2组患者术后并发症发生情况比较[例（%）]
组别 例数 血清肿 肠梗阻 肺部感染 手术部位感染 切口疝复发 并发症发生率
观察组 57 1(1.75) 0 2(3.51) 1(1.75) 0 4( 7.02)
对照组 57 3(5.26) 1(1.75) 2(3.51) 2(3.51) 4(7.02) 12(21.05)
表6 2组患者护理满意度比较[例（%）]
组别 例数 十分满意 满意 不满意 总满意度
观察组 57 31(54.39) 24(42.11) 2( 3.51) 55(96.49)
对照组 57 20(35.09) 28(49.12) 9(15.79) 48(84.21)
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