循证干预对食管癌根治术患者围手术期治疗效果及生活质量的影响
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摘要
目的探讨循证干预对食管癌根治术患者围手术期治疗效果及生活质量的影响。方法回顾性分析80例接受食管癌根治术患者的临床资料。根据干预方式不同,分为观察组(循证干预)42例和对照组(常规护理干预)38例。比较两组患者的手术一般指标(术后引流管留置时间、卧床时间、住院时间)及干预前后皮质醇水平、C反应蛋白水平、焦虑自评量表(SAS)评分、视觉疼痛模拟(VAS)评分、生活质量(躯体功能、物质生活、心理功能、情感职能)评分,以及术后干预期间并发症(吻合口瘘、脓胸、食管-气管瘘、伤口感染)的总发生率。结果观察组患者术后引流管留置时间、卧床时间、住院时间均明显短于对照组(P﹤0.01)。干预后,两组患者的SAS、VAS评分均低于本组干预前(P﹤0.05),且干预后观察组患者的SAS、VAS评分均明显低于对照组(P﹤0.01)。干预后,两组患者的皮质醇、C反应蛋白水平均高于本组干预前(P﹤0.05),干预后观察组患者的皮质醇、C反应蛋白水平均明显低于对照组(P﹤0.01)。干预后,两组患者的躯体功能、物质生活、心理功能、情感职能评分均高于本组干预前(P﹤0.05),且干预后观察组患者的躯体功能、物质生活、心理功能、情感职能评分均明显高于对照组(P﹤0.01)。术后干预期间,两组患者均出现吻合口瘘、脓胸、食管-气管瘘及伤口感染,但观察组患者上述并发症的总发生率为7.14%,低于对照组的28.95%(P﹤0.05)。结论与常规护理干预比较,给予食管癌根治术患者围手术期循证干预,可缩短患者的住院时间,缓解焦虑情绪,减轻疼痛,提高生活质量,降低术后应激反应,且并发症的总发生率低,是一种安全、有效的干预方法,值得临床推广应用。
Objective To investigate the influence of perioperative evidence-based intervention on the efficacy and quality of life of patients undergoing radical esophagectomy for esophageal cancer.Method A retrospective analysis containing 80 cases treated with radical esophagectomy was performed.In the cohort of patients,42 patients who were administered with evidence-based intervention were assigned as study group,while another 38 patients with conventional nursing care were included as control group.The catheter indwelling time,postoperative bed rest time and hospital stay were compared,besides,the level of cortisol,C-reactive protein,and scores of self-rating anxiety scale(SAS),visual analogue score(VAS),quality of life(physical function,material life,psychological function,and emotional function) were evaluated,in addition,the overall incidence of complications(anastomotic leakage,empyema,esophago-tracheal fistula,and wound infection) during the interventions were recorded.Result The catheter indwelling time,postoperative bed rest time and hospital stay of the study group were significantly shorter than those of the control group(P<0.01).After intervention,the SAS and VAS score of the two groups were decreased compared with that before intervention(P<0.05),additionally,significantly lower SAS and VAS score were recorded in study group compared with those in the control group(P<0.01).After intervention,the level of cortisol and C-reactive protein were increased in both groups(P<0.05),and lower level of them were noted in study group than in control group(P<0.01).After intervention,the two groups of patients had improved scores regarding physical function,material life,psychological function,and emotional function(P<0.05),similarly,marked increase of these scores were observed in study group compared with control group(P<0.01).During the postoperative intervention,both groups had complications such as anastomotic leakage,empyema,esophago-tracheal fistula,and wound infection,however,the overall incidence of these complications in study group was 7.14%,which was significantly lower than that in the control group at 28.95%(P<0.05).Conclusion Compared with conventional nursing care,the evidence-based intervention is a safe and effective intervention,which may reduce anxiety,alleviate pain,improve the quality of life,and lower the postoperative stress reaction,with moderate overall incidence of complications.
Objective To investigate the influence of perioperative evidence-based intervention on the efficacy and quality of life of patients undergoing radical esophagectomy for esophageal cancer.Method A retrospective analysis containing 80 cases treated with radical esophagectomy was performed.In the cohort of patients,42 patients who were administered with evidence-based intervention were assigned as study group,while another 38 patients with conventional nursing care were included as control group.The catheter indwelling time,postoperative bed rest time and hospital stay were compared,besides,the level of cortisol,C-reactive protein,and scores of self-rating anxiety scale(SAS),visual analogue score(VAS),quality of life(physical function,material life,psychological function,and emotional function) were evaluated,in addition,the overall incidence of complications(anastomotic leakage,empyema,esophago-tracheal fistula,and wound infection) during the interventions were recorded.Result The catheter indwelling time,postoperative bed rest time and hospital stay of the study group were significantly shorter than those of the control group(P<0.01).After intervention,the SAS and VAS score of the two groups were decreased compared with that before intervention(P<0.05),additionally,significantly lower SAS and VAS score were recorded in study group compared with those in the control group(P<0.01).After intervention,the level of cortisol and C-reactive protein were increased in both groups(P<0.05),and lower level of them were noted in study group than in control group(P<0.01).After intervention,the two groups of patients had improved scores regarding physical function,material life,psychological function,and emotional function(P<0.05),similarly,marked increase of these scores were observed in study group compared with control group(P<0.01).During the postoperative intervention,both groups had complications such as anastomotic leakage,empyema,esophago-tracheal fistula,and wound infection,however,the overall incidence of these complications in study group was 7.14%,which was significantly lower than that in the control group at 28.95%(P<0.05).Conclusion Compared with conventional nursing care,the evidence-based intervention is a safe and effective intervention,which may reduce anxiety,alleviate pain,improve the quality of life,and lower the postoperative stress reaction,with moderate overall incidence of complications.
引文
[1]马明全,姜宏景,弓磊,等.胸腔镜与开放食管癌根治术后并发症及应激反应的比较研究[J].中华胃肠外科杂志,2016, 19(4):401-405.
[2]刘孝民,王亚格,肖中岳.微创及传统开放食管癌根治术疗效分析及远期随访结果的Meta分析[J].重庆医学,2017, 46(12):1638-1641.
[3]韩佳韫,吴俊晶,韩超.丙泊酚与右美托咪定全凭静脉麻醉对食管癌根治术患者肺氧合功能及肺部并发症的影响[J].山东医药, 2017, 57(5):65-67.
[4]马明全,姜宏景,弓磊,等.胸腔镜与开放食管癌根治术后并发症及应激反应的比较研究[J].中华胃肠外科杂志,2016, 19(4):401-405.
[5]孙叶飞,张敬浩.循证护理模式在结直肠癌患者腹腔镜根治术围术期中的应用[J].中国医科大学学报, 2016, 45(10):936-938.
[6] Soutome S, Yanamoto S, Funahara M, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery:a multicenter case-control study with propensity score matching analysis[J]. Medicine(Baltimore), 2017, 96(33):e7436.
[7]刘贤臣,唐茂芹,彭秀桂,等.焦虑自评量表SAS的因子分析[J].中国神经精神疾病杂志, 1995, 21(6):359-360.
[8] Woodforde JM, Merskey H. Some relationships between subjective measures of pain[J]. J Psychosom Res, 1972, 16(3):173-178.
[9] Ware JE Jr, Gandek B. Overview of the SF-36 health survey and the international quality of life assessment(IQOLA)project[J]. J Clin Epidemiol, 1998, 51(11):903-912.
[10]张丽,周晓玲.临床心理护理程序对食管癌患者生活质量改善的效果研究[J].实用临床医药杂志, 2016, 20(18):67-69.
[11] Akiyama Y, Iwaya T, Endo F, et al. Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy[J]. Support Care Cancer,2017, 25(12):3733-3739.
[12]方强,胡彬,任光国,等.加速康复外科在食管癌根治术中的临床价值[J].中华消化外科杂志, 2016, 15(11):1093-1099.
[13]刘玉婷,刘玉革,维拉.右美托咪定对食管癌根治术单肺通气患者血清炎性反应的影响[J].临床麻醉学杂志,2016, 32(11):1053-1056.
[14] Lauridsen SV, Thomsen T, Kaldan G, et al. Smoking and alcohol cessation intervention in relation to radical cystectomy:a qualitative study of cancer patients’experiences[J]. BMC Cancer, 2017, 17(1):793.
[15]刘洪巧,毛永玲.循证护理在食管癌术后常见并发症预防中的应用[J].现代中西医结合杂志, 2017, 19(2):245-246.
[16] Gerent ARM, Almeida JP, Fominskiy E, et al. Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery:a randomized clinical trial and meta-analysis[J]. Crit Care, 2018, 22(1):133-135.
[17] Kang XQ, Xu G, Tian HY, et al. An analysis of the intervention effect of perioperative evidence-based nursing on orthopedic trauma patients’vagal reflex[J]. Eur Rev Med Pharmacol Sci, 2015, 19(14):2537-2543.
[2]刘孝民,王亚格,肖中岳.微创及传统开放食管癌根治术疗效分析及远期随访结果的Meta分析[J].重庆医学,2017, 46(12):1638-1641.
[3]韩佳韫,吴俊晶,韩超.丙泊酚与右美托咪定全凭静脉麻醉对食管癌根治术患者肺氧合功能及肺部并发症的影响[J].山东医药, 2017, 57(5):65-67.
[4]马明全,姜宏景,弓磊,等.胸腔镜与开放食管癌根治术后并发症及应激反应的比较研究[J].中华胃肠外科杂志,2016, 19(4):401-405.
[5]孙叶飞,张敬浩.循证护理模式在结直肠癌患者腹腔镜根治术围术期中的应用[J].中国医科大学学报, 2016, 45(10):936-938.
[6] Soutome S, Yanamoto S, Funahara M, et al. Effect of perioperative oral care on prevention of postoperative pneumonia associated with esophageal cancer surgery:a multicenter case-control study with propensity score matching analysis[J]. Medicine(Baltimore), 2017, 96(33):e7436.
[7]刘贤臣,唐茂芹,彭秀桂,等.焦虑自评量表SAS的因子分析[J].中国神经精神疾病杂志, 1995, 21(6):359-360.
[8] Woodforde JM, Merskey H. Some relationships between subjective measures of pain[J]. J Psychosom Res, 1972, 16(3):173-178.
[9] Ware JE Jr, Gandek B. Overview of the SF-36 health survey and the international quality of life assessment(IQOLA)project[J]. J Clin Epidemiol, 1998, 51(11):903-912.
[10]张丽,周晓玲.临床心理护理程序对食管癌患者生活质量改善的效果研究[J].实用临床医药杂志, 2016, 20(18):67-69.
[11] Akiyama Y, Iwaya T, Endo F, et al. Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy[J]. Support Care Cancer,2017, 25(12):3733-3739.
[12]方强,胡彬,任光国,等.加速康复外科在食管癌根治术中的临床价值[J].中华消化外科杂志, 2016, 15(11):1093-1099.
[13]刘玉婷,刘玉革,维拉.右美托咪定对食管癌根治术单肺通气患者血清炎性反应的影响[J].临床麻醉学杂志,2016, 32(11):1053-1056.
[14] Lauridsen SV, Thomsen T, Kaldan G, et al. Smoking and alcohol cessation intervention in relation to radical cystectomy:a qualitative study of cancer patients’experiences[J]. BMC Cancer, 2017, 17(1):793.
[15]刘洪巧,毛永玲.循证护理在食管癌术后常见并发症预防中的应用[J].现代中西医结合杂志, 2017, 19(2):245-246.
[16] Gerent ARM, Almeida JP, Fominskiy E, et al. Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery:a randomized clinical trial and meta-analysis[J]. Crit Care, 2018, 22(1):133-135.
[17] Kang XQ, Xu G, Tian HY, et al. An analysis of the intervention effect of perioperative evidence-based nursing on orthopedic trauma patients’vagal reflex[J]. Eur Rev Med Pharmacol Sci, 2015, 19(14):2537-2543.