Lu Guanzhen, Yan Qiang, Huang Yutao, Zhong Yan, Shi Ping
Affiliated Central Hospital of Huzhou Teachers College, Huzhou, Zhe Jiang Province, China.
Nursing Department, Huzhou Teachers College, Huzhou, Zhe Jiang Province, China.
Curr Ther Res Clin Exp. 2013 Jun;74:68-73. doi: 10.1016/j.curtheres.2013.02.004.
Blood potassium levels were very important during perioperative management of patients undergoing abdominal surgery. According to various worldwide studies on the causes of hypokalemia and fast-track surgeries, prehospital hypokalemia was ignored.
The aim of this study to construct a prevention and control system of hypokalemia through proper clinical pathways and investigate the effects in terms of fast postoperative recovery of patients undergoing open abdominal surgery.
A total of 104 patients were randomized to an observation group or a control group. The prevention and control system of hypokalemia was constructed; it was composed of 3 major modules: blood potassium monitoring, etiologic intervention, and treatment of hypokalemia. In the observation group, blood was sampled at scheduled time points (the blood potassium monitoring module) and interventions involved the preadmission and pre- and postoperative periods (etiologic intervention module). In the control group, blood sampling was delayed until after admission (blood potassium monitoring module) and interventions were only performed during the pre- and postoperative periods (etiologic intervention module). In terms of blood potassium, indices regarding gastrointestinal motility and postoperative complications were compared.
The severity of hypokalemia, postoperative defecation time, arrhythmia, fatigue syndrome, and urine retention differed statistically between the 2 groups (P < 0.05). The times to detect hypokalemia and resolve the blood condition before and after the surgery and at the first bowel sound, defecation and evacuation times differed significantly between the 2 groups (P < 0.01).
The prevention and control system of hypokalemia with the starting point being before admission was more effective and allows early prevention, detection, correction, surgery, and recovery of patients undergoing open abdominal surgeries and also could be used in other specialized nursing fields.
血钾水平在腹部手术患者围手术期管理中非常重要。根据全球关于低钾血症病因及快速康复手术的各项研究，院前低钾血症被忽视。
本研究旨在通过适当的临床路径构建低钾血症防控体系，并调查其对开腹手术患者术后快速康复的影响。
将104例患者随机分为观察组和对照组。构建低钾血症防控体系，其由3个主要模块组成：血钾监测、病因干预和低钾血症治疗。观察组在预定时间点采血（血钾监测模块），干预涉及入院前及术前和术后阶段（病因干预模块）。对照组采血延迟至入院后（血钾监测模块），干预仅在术前和术后阶段进行（病因干预模块）。比较两组在血钾、胃肠动力指标及术后并发症方面的情况。
两组在低钾血症严重程度、术后排便时间、心律失常、疲劳综合征和尿潴留方面差异有统计学意义（P<0.05）。两组在手术前后及首次肠鸣音、排便和排气时间检测低钾血症及纠正血钾情况的时间差异有显著性（P<0.01）。
以入院前为起点的低钾血症防控体系更有效，可实现开腹手术患者的早期预防、检测、纠正、手术及康复，也可应用于其他专科护理领域。
