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李敏, 江志伟, 许睿, 等. 加速康复外科精准护理在结直肠癌围术期的应用及效果评价[J]. koko体育app 学报(医学版), 2023, 54(4): 746-751. DOI:
引用本文: 李敏, 江志伟, 许睿, 等. 加速康复外科精准护理在结直肠癌围术期的应用及效果评价[J]. koko体育app 学报(医学版), 2023, 54(4): 746-751. DOI:
LI Min, JIANG Zhiwei, XU Rui, et al. Application and Effect Evaluation of Precision Nursing Care of Enhanced Rehabilitation After Surgery in the Perioperative Period of Colorectal Cancer[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(4): 746-751. DOI:
Citation: ꦇ LI Min, JIANG Zhiwei, XU Rui, et al. Application and Effect Evaluation of Precision Nursing Care of Enhanced Rehabilitation After Surgery in the Perioperative Period of Colorectal Cancer[J]. Journal of Sichuan University (Medical Sciences), 2023, 54(4): 746-751. DOI:

加速康复外科精准护理在结直肠癌围术期的应用及效果评价

Application and Effect Evaluation of Precision Nursing Care of Enhanced Rehabilitation After Surgery in the Perioperative Period of Colorectal Cancer

  • 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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