快速康复外科结合临床护理路径模式对肺癌胸腔镜手术患者围手术期的效果观察

目的探讨快速康复外科(FTS)理念结合临床护理路径(CNP)模式在肺癌胸腔镜手术患者围手术期护理方面的效果。方法选取2017年12月至2019年12月间陕西省肿瘤医院收治的86例胸腔镜围术期肺癌患者,采用随机数表法分为对照组与观察组,每组43例。比较两组患者围术期相关指标(低体温概率、气管拔管时间、首次下床活动、自主咳嗽时间及引流管留置天数),术前、术后6h及术后48h疼痛数字评分(NRS),术后30 d并发症发生情况,护理满意度及住院天数方面的差异。结果观察组低体温概率、气管拔管时间、首次下床活动、自主咳嗽时间及引流管留置天数均小于对照组,差异均有统计学意义(均P <0.05)。两组患者不同时点的NRS评分比较,两种护理措施和时点对NRS有交互作用,差异有统计学意义(P <0.05),术前两组患者NRS评分比较,差异无统计学意义(P>0.05)。观察组术后4h及术后48 h的NRS评分均比对照组低,差异均有统计学意义(均P <0.05)。观察组的并发症发生率4.7%,低于对照组的18.6%,差异有统计学意义(P <0.05)。观察组的护理总满意度为93.0%,高于对照组的72.1%,术后住院天数为(5.76±0.68) d,短于对照组的(8.45±0.64) d,差异均有统计学意义(均P <0.05)。结论 FTS理念结合CNP护理模式在肺癌患者胸腔术围术期的干预中效果明显,值得临床应用。

Efficacy of perioperative nursing based on fast track surgery and on psychological status and immunity of Patients with cancer pain

Objective To analyze the efficacy of perioperative nursing based on fast track surgery( FTS) concept combined with the clinical nursing pathway( CNP) in patients undergoing thoracoscopic surgery for lung cancer. Methods Eighty-six patients undergoing thoracoscopic surgery for lung cancer were selected at Shaanxi Cancer Hospital between December 2017 and December 2019. They were randomly divided into an observation group and a control group with 43 in each group. The perioperative indices including probability of low body temperature,time to tracheal extubation,time to out-of-bed activities,time to spontaneous cough and days of drainage tube indwelling,score of numerical rating scale( NRS) at 6 h before and after operation and 48 h after the operation,complications at 30 d after the operation,nursing satisfaction and days of hospital stay were compared between the two groups. Results The probability of low body temperature,time to tracheal extubation,time to out-of-bed activities,time to spontaneous cough and days of drainage tube indwelling were lower in the observation group than in the control group( all P <0. 05). There were significant differences in NRS scores between the two groups at different time points and the interaction was discovered in nursing measures and time points on NRS between the two groups( P <0. 05). NRS scores were not significantly different between the two groups before the operation( P > 0. 05).After the operation,the scores of NRS at 4 and 48 h after the surgery were lower in the observation group than in the control group( all P < 0. 05). The incidence of complications was 4. 7% in the observation group which was significantly lower than 18. 6% of the control group( P < 0. 05). Patient satisfaction with nursing was 93. 0% in the observation group which was higher than 72. 1% of the control group and the length of postoperative hospital stay was 5. 76 ± 0. 68 d in the observation group which was shorter than 8. 45± 0. 64 d of the control group( all P < 0. 05). Conclusion Perioperative nursing based on FTS concept combined with CNP nursing shows obvious efficacy for the intervention in patients undergoing thoracoscopic surgery for lung cancer,and it is worthy of clinical application.