摘要
目的探讨加速康复外科护理在脑胶质瘤患者围手术期的应用价值。方法将福建省肿瘤医院2018年1月至2023年2月收治的72例脑胶质瘤患者按随机数字表法分为对照组(n=36)和观察组(n=36),分别给予围手术期常规护理及围手术期加速康复外科护理,比较两组患者术后康复情况(术后首次进食时间、首次排便时间、首次下床活动时间、首次下床活动持续时间、拨出尿管时间、住院时间及术后并发症发生情况),术前及术后3 d采用酶联免疫吸附试验法测定皮质醇和白细胞介素-6,术前及术后7 d采用Karnofsky功能状态(KPS)评分评价患者的健康状况,采用改良Barthel指数(MBI)评价患者日常生活能力改善情况,采用焦虑自评量表和抑郁自评量表评价患者焦虑和抑郁情绪变化情况。结果观察组术后首次进食时间(8.15±1.33)h、首次排便时间(53.36±6.13)h、首次下床活动时间(30.23±2.69)h、首次下床活动持续时间(18.56±2.64)min、拨出尿管时间(6.36±0.75)h、住院时间(8.48±0.47)d短于对照组[(12.28±1.61)h、(78.55±16.64)h、(39.55±2.56)h、(26.56±4.06)min、(10.45±2.24)h、(14.26±0.81)d],差异有统计学意义(P<0.05)。观察组术后并发症发生率为2.78%(1/36),低于对照组22.22%(8/36),差异有统计学意义(P<0.05)。观察组术后3 d的皮质醇(82.41±7.42)mg/ml、白细胞介素-6(166.60±10.17)ng/L高于术前[(70.15±6.49)mg/ml、(109.30±8.65)ng/L],但低于对照组术后3 d[(100.63±19.67)mg/ml、(206.08±11.84)ng/L],差异有统计学意义(P<0.05)。观察组术后7 d的KPS评分(63.74±2.96)分、MBI评分(72.92±3.11)分高于治疗前[(41.99±5.50)分、(51.81±2.99)分]及对照组术后7 d[(54.64±3.74)分、(61.23±3.76)分],观察组术后7 d的SAS评分(42.05±3.64)分、SDS评分(42.11±3.16)分低于治疗前评分[(60.31±2.78)分、(61.08±3.25)分]及对照组术后7 d评分[(50.71±3.53)分、(51.16±3.80)分],差异有统计学意义(P<0.05)。结论加速康复外科护理对脑胶质瘤患者围手术期应用能够减轻术后应激反应,有助于降低术后并发症以及促进术后康复,使患者更快恢复日常生活能力,减轻术后焦虑及抑郁情绪。
Objective To investigate the application value of accelerated rehabilitation surgery nursing in perioperative patients with brain glioma.Methods 72 patients with brain glioma admitted to Fujian Cancer Hospital from January 2018 to February 2023 were divided into control group(n=36 cases)and observation group(n=36 cases)according to a random number table,and were given perioperative routine nursing and perioperative accelerated rehabilitation surgical nursing,respectively.The postoperative recovery conditions of the two groups were compared(first time to eat,first time to defecate,first time to get out of bed,duration of first time to get out of bed,time to release urinary tube,length of hospital stay and postoperative complications).Cortisol and interleukin-6 were measured by ELISA before and 3 days after surgery.The Karnofsky Functional status(KPS)score was used to evaluate the patient's health status before and 7 days after surgery,the modified Barthel index(MBI)was used to evaluate the improvement of daily living ability,and the changes of anxiety and depression were evaluated by Self-rating Anxiety Scale and Self-rating Depression Scale.Results In the observation group,the time of first feeding(8.15±1.33)h,the time of first defecation(53.36±6.13)h,the time of first getting out of bed(30.23±2.69)h,the duration of first getting out of bed(18.56±2.64)min,the time of allocating urinary tube(6.36±0.75)h,and the time of hospitalization(8.48±0.47)d was shorter than that of control group[(12.28±1.61)h,(78.55±16.64)h,(39.55±2.56)h,(26.56±4.06)min,(10.45±2.24)h,(14.26±0.81)d],and the difference was statistically significant(P<0.05).The incidence of postoperative complications in the observation group was 2.78%(1/36),which was lower than that in the control group 22.22%(8/36),and the difference was statistically significant(P<0.05).The levels of cortisol(82.41±7.42)mg/ml and interleukin-6(166.60±10.17)ng/L in the observation group were higher than those before surgery(70.15±6.49)mg/ml,(109.30±8.65)ng/L.However,it was lower than that of the control group at 3d after operation[(100.63±19.67)mg/ml,(206.08±11.84)ng/L],and the difference was statistically significant(P<0.05).KPS score(63.74±2.96)and MBI score(72.92±3.11)in the observation group were higher than those before treatment[(41.99±5.50),(51.81±2.99)]and control group[(54.64±3.74),(61.23±3.76)]on the 7 d after treatment.The SAS score(42.05±3.64)and SDS score(42.11±3.16)of the observation group were lower than those before treatment[(60.31±2.78),(61.08±3.25)]and that of the control group[(50.71±3.53),(51.16±3.80)]on the 7d after treatment.The difference was statistically significant(P<0.05).Conclusions The perioperative application of accelerated rehabilitation surgery nursing in glioma patients can alleviate postoperative stress response,help reduce postoperative complications and promote postoperative rehabilitation,enable patients to recover daily life ability faster,and alleviate postoperative anxiety and depression.
作者
王云钦
柯清仙
WANG Yunqin;KE Qingxian(Department of Head and Neck Surgery,The Oncology Clinical Medical College of Fujian Medical University,Fujian Cancer Hospital,Fuzhou 350014,China)
出处
《中国医药指南》
2024年第6期153-156,共4页
Guide of China Medicine
关键词
脑胶质瘤
围手术期
加速康复外科护理
临床研究
Brain glioma
Perioperative period
Accelerated rehabilitation surgical care
Clinical research
