为什么患者在增强恢复胸腔镜切除后留在医院? 一个前性观察性研究
Lin Huang1, Henrik Kehlet2, René Horsleben Petersen1
1Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
概括
手术后的疼痛,空气泄漏和社会因素是手术后增强康复 (ERAS) 后延长住院的主要原因,3端口视频辅助胸腔镜手术 (VATS) 切除. 独自生活或肺功能受损的患者面临更高的长时间住院的风险.
科学领域:
- 胸部外科手术 胸部外科手术
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
背景情况:
- 手术后增强恢复 (ERAS) 协议旨在优化患者的康复并减少住院时间 (LOS).
- 视频辅助胸腔镜手术 (VATS) 是肺切除的最小侵入性方法.
- 在VATS后长时间住院可能会增加医疗费用,并对患者的治疗结果产生负面影响.
研究的目的:
- 调查ERAS三端口VATS切除后长时间住院 (LOS>中位数) 的主要原因.
- 为了确定与此程序后长时间住院风险增加相关的预测因素.
主要方法:
- 进行了一项前性观察性研究,其中连续150名患者接受了ERAS 3-port VATS切除.
- 每天两次评估患者住院情况,以确定和分析长时间住院的原因.
- 多变量后勤回归被用于确定长时间住院预测因素.
主要成果:
- 平均LOS为1天,其中36.7%的患者经历了长时间住院治疗.
- 长期停留的主要原因包括术后疼痛 (16.0%),空气泄漏 (14.7%) 和社会因素 (14.7%).
- 预计1秒内强制呼气量减少 (FEV1%pre) 和一氧化碳扩散能力 (DLCO%pre) 与风险降低有关,而吸烟和单身生活增加了风险.
结论:
- 疼痛,空气泄漏和社会因素是ERAS三端口VATS切除后长时间住院的重要因素.
- 吸烟,肺功能下降或独自生活的患者有更高的风险延长住院时间.
- 优化疼痛管理,及时解决空气泄漏问题,并考虑社会支持对于减少LOS至关重要.
相关概念视频
Endoscopic Studies II: Thoracocentesis
212
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
212
Endoscopic Studies I: Bronchoscopy and Thoracoscopy
177
Endoscopy is a non-surgical medical technique used to examine a person's internal organs and vessels. This lesson will focus on two types of endoscopic studies: bronchoscopy and thoracoscopy.
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
Bronchoscopy
Description
Bronchoscopy is a procedure that involves direct visualization of the larynx, trachea, and bronchi for diagnostic and therapeutic purposes. A flexible fiber optic or rigid bronchoscope is used to carry out the procedure. The fiber-optic bronchoscope is more frequently used due...
177
Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
57
Sigmoidoscopy and laparoscopy are distinct medical procedures that enable physicians to internally inspect different parts of the GI tract. Although they serve different purposes, each is essential for diagnosing and, in some cases, treating various medical conditions.
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
57
Pneumothorax-II
124
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
124
Flail Chest-II
160
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
160
Cardiomyopathy VII: Pre and Post Operative Nursing Management
3
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...
3


