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Application and Effect Evaluation of Precision Nursing Care of Enhanced Rehabilitation After Surgery in the Perioperative Period of Colorectal Cancer
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摘要:
目的 探讨围术期精准护理对结直肠癌患者术后恢复、应激反应、心理状态的影响。 方法 将100例择期行腹腔镜结直肠癌手术患者随机分为实验组和对照组，每组各50例。实验组在术前、术中、术后3个阶段实行系统性、规范性、专业性的精准护理，对照组实施常规护理。两组比较的主要结局指标包括：术后首次排气、排便、下床活动、进食流质、术后住院时间，术前1 d及术后1、3、5 d监测患者的C-反应蛋白（C-reactive protein, CRP），白细胞介素-6（interleukin-6, IL-6）和胰岛素抵抗指数（homeostatic model assessment of insulin resistance, HOMR-IR）；次要结局指标包括：评估入院及术后48 h患者焦虑、抑郁程度，分别采用焦虑自评量表（self-rating anxiety scale, SAS）和抑郁自评量表（self-rating depression scale, SDS）。 结果 实验组患者术后首次排气、排便、下床活动、进食流质、术后住院时间均低于对照组（P<0.05）；两组患者CRP、IL-6水平术后均高于术前，且对照组术后高于实验组，差异均有统计学意义（P<0.05）；两组患者术后不同时间应激状态不同，术后3 d CRP、IL-6数值达到最高，之后有所下降。实验组患者的HOMR-IR低于对照组，且术后1 d、术后3 d差异均有统计学意义（P<0.05）。两组患者焦虑、抑郁评分差值比较，差异有统计学意义（P<0.05）。出院前患者满意度实验组高于对照组，差异有统计学意义（P<0.05）。 结论 实施加速康复外科精准护理能有效促进结直肠癌患者术后恢复，减轻围术期应激反应，改善焦虑抑郁状况，提升患者满意度，值得临床推广应用。 Abstract:Objective To examine the effect of perioperative precision nursing care of enhanced recovery after surgery (ERAS) on the postoperative recovery, stress response, and psychological state of colorectal cancer patients. Methods A total of 100 patients undergoing elective laparoscopic colorectal cancer surgery were randomly assigned to an experimental group and a control group, with 50 patients in each group. The experimental group received systematic, standardized, and specialized precision nursing care in three stages, the preoperative, intraoperative, and postoperative stages, while the control group received routine nursing care. The main outcome indicators compared between the two groups included the time of the first postoperative passage of flatus and stool, ambulation, liquid-diet meal, postoperative length-of-stay, and C-reactive protein (CRP), interleukin-6 (IL-6), and homeostatic model assessment of insulin resistance (HOMR-IR) measured 1 day before surgery and 1, 3, and 5 days after surgery. Secondary outcome indicators included the anxiety and depression levels of patients measured upon admission to the hospital and 48 h after surgery by Self-rating Anxiety Scale (SAS) and Self-rating Sepression Scale (SDS), respectively. Results In the experimental group, the time of the first postoperative passage of flatus and stool, ambulation, and liquid-diet meal and the postoperative length-of-stay were all lower than those in the control group. The postoperative CRP and IL-6 levels of the two groups were significantly higher than the preoperative levels, and the control group had higher CRP and IL-6 levels than the experimental group did, all showing significant difference (P<0.05). The two groups presented different stress states at different points of time after surgery, with the CRP and IL-6 levels reaching the highest 3 days after surgery and then dropping to some degree afterwards. The HOMR-IR of the patients in the experimental group was significantly lower than that of the control group and the difference was significant at both 1 d and 3 d after surgery (P<0.05). Comparison of the difference in the anxiety and the depression scores in the two groups showed significant difference (P<0.05). Before discharge, patient satisfaction of the experimental group was significantly higher than that of the control group (P<0.05). Conclusion The implementation of ERAS precision nursing care can effectively promote the postoperative recovery of colorectal cancer patients, reduce the perioperative stress response, alleviate anxiety and depression, improve patient satisfaction, and hence should be extensively applied in clinical practice. -
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表 1 两组患者一般临床资料比较
Table 1. 🌳 Comparison of general clinical data between the two groups
General clinical data Experimental group
(n=50)Control group
(n=50)χ2/t P Sex/case 1.960 0.162 Male 29 28 Female 21 22 Age/yr. 60.44±10.29 63.06±8.75 −1.371 0.174 Body mass/kg 58.79±8.74 59.69±8.83 −0.507 0.613 Operative site/case 2.560 0.110 Rectal carcinoma 28 30 Carcinoma of colon 22 20 Operation time/min 131.51±13.78 133.74±9.21 −0.947 0.346 ASA/case Ⅱ 26 27 0.360 0.549 Ⅲ 24 23 
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表 2 两组患者术后恢复情况比较
Table 2. 𒆙 Comparison of the postoperative recovery between the two groups
Group Time of the first
passage of flatus/hTime of the first
ambulation session/hTime of the first
liquid-diet meal*/hTime of the first
passage of stool/hLength-of-stay
after surgery/dExperimental (n=50) 40.56±11.34 18.62±3.64 28.77±5.65 75.91±13.64 6.57±0.72 Control (n=50) 60.68±8.39 28.20±5.99 59.46±7.58 94.50±20.37 9.85±1.37 t 10.083 −9.659 −22.960 −5.362 −14.972 P 0.014 0.001 0.027 0.005 0.001 * The liquid-diet food that patients have for the first time after surgery includes clear liquid-diet food other than lukewarm water, with the most common types being rice soup, nutrition powder, etc.
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表 3 两组患者手术前后炎性指标及胰岛素抵抗指数对比
Table 3. 🔜 Comparison of inflammatory index and HOMR-IR before and after surgery between the two groups
Index Experimental
group (n=50)Control
group (n=50)t P CRP/(mg/L) Preoperative 5.25±0.62 5.21±0.39 0.455 0.120 1 d after surgery 37.97±9.04 54.92±14.35 −7.062 0.007 3 d after surgery 53.33±14.97 64.85±19.52 −3.313 0.040 5 d after surgery 27.33±7.13 38.85±10.29 −6.504 0.041 F 211.571 184.889 P <0.001 <0.001 IL-6/(pg/L) Preoperative 1.05±0.35 1.17±0.40 −1.466 0.316 1 d after surgery 40.85±12.14 51.62±19.96 −3.259 <0.001 3 d after surgery 45.67±12.54 68.65±18.23 −7.345 0.029 5 d after surgery 17.79±4.57 22.31±4.03 −5.233 0.031 F 287.537 409.261 P <0.001 <0.001 HOMA-IR Preoperative 1.65±0.69 1.67±0.58 −0.870 0.284 1 d after surgery 4.76±0.81 9.22±1.07 −23.382 0.046 3 d after surgery 4.51±0.59 7.64±1.17 −16.879 <0.001 5 d after surgery 3.79±0.86 4.48±0.95 −3.776 0.885 F 176.183 609.866 P <0.001 <0.001 CRP: C-reactive protein; IL-6: interleukin-6; HOMR-IR: homeostatic model assessment of insulin resistance.
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表 4 两组患者焦虑、抑郁差值比较
Table 4. ไ Comparison of the difference in anxiety and depression scores between the two groups
Group SAS difference* SDS difference* Experimental (n=50) 27.77±7.79 28.90±6.97 Control (n=50) 24.68±6.67 24.55±7.92 t 2.127 2.921 P 0.036 0.004 SAS: Self-rating Anxiety Scale; SDS: Self-rating Depression Scale. * The difference is the score upon admission minus the score 48 hours after surgery.
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Table 5. 🉐 Comparison of patient satisfaction before discharge in the two groups
Group Health education Nursing service Traditional Chinese medicine nursing Technical level Psychological support Experimental (n=50) 19.5±0.71 18.66±1.89 18.92±0.94 18.58±1.23 19.24±0.92 Control (n=50) 18.2±1.09 17.56±1.09 17.90±1.07 17.82±1.29 16.94±1.82 t 7.712 3.373 5.610 3.213 9.100 P <0.001 0.01 <0.001 0.02 <0.001
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