Yuan Chen-Dong, Zhou Bao-Zhu, Wang Ning-Yan, Wan Qing-Qing, Hu Zhen-Zhen
Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China.
World J Gastroenterol. 2025 Feb 28;31(8):102331. doi: 10.3748/wjg.v31.i8.102331.
Although the 2021 Chinese Clinical Practice Guidelines for Enhanced Recovery after Surgery (ERAS) provide recommendations for ERAS in gastrointestinal surgery, the clinical application of standard ERAS nursing models is challenging due to the variety of diseases involved in gastrointestinal surgery and the complex factors contributing to patient stress responses. Moreover, stress responses are more severe in older adult patients. Therefore, precision medicine is required to improve the quality of nursing care and promote postoperative recovery in gastrointestinal surgery.
To establish an evidence-based ERAS model based on stress response nursing care and demonstrate nursing benefits through clinical practice.
This randomized clinical trial first established an evidence-based nursing ERAS protocol in older adult patients based on literature related to perioperative nursing measures for gastrointestinal surgery stress response. Next, 392 older adult patients who underwent gastrointestinal surgery and were admitted to our hospital between December 2021 and June 2023 were categorized into two groups to receive evidence-based (study group) or conventional (control group) ERAS nursing models, respectively. Intraoperative physiological parameters during surgery and postoperative recovery indicators were compared between the groups.
Among 64 domestic and international studies, the stress responses of older adult patients mainly included emotional anxiety, sleep disorders, gastrointestinal discomfort, physical weakness, pain, and swelling. The appropriate nursing interventions included comprehensive psychological counseling, pre- and postoperative nutritional support, temperature control, pain management, and rehabilitation training. Compared with the control group, the study group showed lower heart rate, mean arterial pressure, blood glucose level, and adrenaline level; shorter duration of drainage tube placement, time to first flatus, time to first ambulation, and postoperative hospital stay; lower anxiety scores on postoperative day 3; and lower incidences of postoperative infection, obstruction, poor wound healing, and gastrointestinal reactions were lower in the study group (all < 0.05).
The evidence-based nursing measures targeting stress responses based on the conventional ERAS nursing model resulted in stable intraoperative physiological parameters during surgery, promoted postoperative recovery, and reduced the incidence of complications.
尽管《2021 年中国加速康复外科临床实践指南》为胃肠外科手术的加速康复提供了建议，但由于胃肠外科手术涉及多种疾病以及导致患者应激反应的复杂因素，标准加速康复外科护理模式的临床应用具有挑战性。此外，老年患者的应激反应更为严重。因此，需要精准医疗来提高胃肠外科护理质量并促进术后康复。
建立基于应激反应护理的循证加速康复外科模型，并通过临床实践证明护理效果。
这项随机临床试验首先基于胃肠外科手术应激反应围手术期护理措施的相关文献，为老年患者建立循证护理加速康复外科方案。接下来，将 2021 年 12 月至 2023 年 6 月期间在我院接受胃肠外科手术的 392 例老年患者分为两组，分别接受循证（研究组）或传统（对照组）加速康复外科护理模式。比较两组手术中的术中生理参数和术后恢复指标。
在 64 项国内外研究中，老年患者的应激反应主要包括情绪焦虑、睡眠障碍、胃肠道不适、身体虚弱、疼痛和肿胀。适当的护理干预措施包括综合心理咨询、术前和术后营养支持、体温控制、疼痛管理和康复训练。与对照组相比,研究组心率、平均动脉压、血糖水平和肾上腺素水平较低；引流管放置时间、首次排气时间、首次下床活动时间和术后住院时间较短；术后第 3 天焦虑评分较低；研究组术后感染、梗阻、伤口愈合不良和胃肠道反应的发生率也较低（均<0.05）。
基于传统加速康复外科护理模式针对应激反应的循证护理措施，可使手术中术中生理参数稳定，促进术后恢复，并降低并发症发生率。
