Research on preoperative systematic nursing in preventing constipation in patients after lumbar disc herniation surgery
术前系统化护理在腰椎间盘突出症手术后患者便秘预防中的研究

摘要

目的 评价系统化术前护理策略对腰椎间盘突出症（LDH）患者行椎间融合术后便秘症状的预防作用及其机制。方法 前瞻性纳入2024年1月至2025年5月于本院脊柱外科行单节段腰椎后路椎间融合术（PLIF）的150例LDH患者，遵循随机数字表法分配至干预组（n=75，实施系统化术前护理）与对照组（n=75，实施常规围术期护理）。系统化护理方案涵盖术前风险评估、肠道功能预适应训练、多维营养支持方案、情绪调控模块及术后早期功能恢复规划。结果 干预组术后72小时自主排便率（81.33%）显著高于对照组（52.00%，χ2=14.520，P<0.001）。术后7天内，干预组便秘发生率（33.33%）显著低于对照组（60.00%，χ2=10.714，P=0.001）。干预组首次排便时间为（46.72±12.35）小时，短于对照组的（72.58±16.84）小时（t=11.328，P<0.001）。干预组术后第3天腹胀VAS评分为（3.15±1.02）分，显著低于对照组的（5.24±1.31）分（t=10.947，P<0.001）。阿片类药物日均消耗量干预组为（15.63±4.21）mg，低于对照组（22.85±5.73）mg（t=9.124，P<0.001）。结论 系统化术前护理干预可有效降低LDH患者术后便秘发生率，促进肠道功能早期恢复，减少镇痛药物依赖，优化围术期康复进程，提升护理服务质量，具有显著的临床应用价值。

Abstract

Objective To evaluate the preventive effect and mechanism of systematic preoperative nursing strategies on constipation symptoms in patients with lumbar disc herniation (LDH) after interbody fusion surgery.
Methods A total of 150 LDH patients who underwent single segment lumbar posterior interbody fusion (PLIF) in the spine surgery department of our hospital from January 2024 to May 2025 were prospectively included. They were randomly assigned to an intervention group (n=75, receiving systematic preoperative care) and a control group (n=75, receiving routine perioperative care) using a random number table method. The systematic nursing plan includes preoperative risk assessment, intestinal function pre adaptation training, multidimensional nutritional support program, emotional regulation module, and early postoperative functional recovery planning.
Results The 72 hour postoperative spontaneous defecation rate in the intervention group (81.33%) was significantly higher than that in the control group (52.00%, χ2=14.520, P<0.001). Within 7 days after surgery, the incidence of constipation in the intervention group (33.33%) was significantly lower than that in the control group (60.00%, χ2=10.714, P=0.001). The first defecation time of the intervention group was (46.72±12.35) hours, which was shorter than the control group’s (72.58±16.84) hours (t=11.328, P<0.001). On the third day after surgery, the VAS score for abdominal distension in the intervention group was (3.15±1.02) points, significantly lower than the control group’s (5.24±1.31) points (t=10.947, P<0.001). The daily average consumption of opioid drugs in the intervention group was (15.63±4.21) mg, which was lower than that in the control group (22.85±5.73) mg (t=9.124, P<0.001).
Conclusion   Systematic preoperative nursing intervention can effectively reduce the incidence of postoperative constipation in LDH patients, promote early recovery of intestinal function, reduce dependence on analgesic drugs, optimize the perioperative rehabilitation process, improve the quality of nursing services, and have significant clinical application value.