快速康复与系统化干预对低保空巢直肠癌保肛术患者生活质量的影响

Influence of fast track surgery and systematic intervention on the quality of life of empty-nest operation patients with anus for rectal cancer living on basic subsistence allowances

目的探讨快速康复和系统化干预对低保空巢直肠癌保肛术患者生活质量的影响。方法将94例低保空巢直肠癌保肛术患者按照随机数字表法分为观察组（46例）和对照组（48例），对照组采用常规护理，观察组采用快速康复和系统化干预，采用健康调查简易量表评价两组患者的生活质量；采用欧洲营养风险筛查量表评估营养不良风险，并对两组患者术后并发症发生率、排气排便时间、住院时间等临床指标进行比较。结果观察组患者在体能（84．90±17．29）、体能影响（76．03±37．55）、身体疼痛（79．23±19．56）、一般健康（58．12±21．78）、精力（72．00±17．99）、社会活动（85．96±18．28）、心理健康（77．09±37．07）、精神影响（79．69±15．79）维度的得分明显高于对照组的（75．29±19．45），（55．15±46．38），（69．29±25．76），（49．47±21．80），（64．26±19．71），（73．90±22．48），（61．76±44．29），（75．29±15．52）分，两组比较，差异有统计学意义（t分别为3．8，3．88，3．85，4．01，5．12，6．08，3．11，4．31；P〈0．01）。术前观察组与对照组直肠癌患者营养不良（43．48％比45．83％）和存在营养风险（52．17％比45．80％）比较，差异无统计学意义（P〉0．05）。术后第7天对照组营养不良（54．2％）和存在营养风险（37．5％）发生率明显高于观察组的8．7％和17．39％，两组比较，差异有统计学意义（X2=9．27，P〈0．01）；观察组患者在拔除胃管时间[（0．5±0．14）d]，首次排气排便时间（[（2．94±0．78）d]、首次下床时间[（0．55±0．43）d]、住院时间[（6．81±2．36）d]及住院费用[（21065．45±2365．67）元]等方面均较对照组[（5．52±1．52）d，（5．22±1．10）d，（3．75±0．94）d，（9．66±3．71）d，（24355．34±3245．23）元]明显缩短，两组比较，差异有统计学意义（t分别为6．46，3．06，4．73，4．18，8．22；P〈0．01）。结论快速康复外科与系统化干预可促进低保空巢低位直肠癌保肛术患者肠功能恢复，改善患者术后的生活质量。

] Objective To explore the influence of fast track surgery and systematic intervention （FTS） on the quality of life of empty-nest operation patients with anus for rectal cancer living on basic subsistence allowances. Methods Totals of 94 cases with anus for rectal cancer living empty-nest on basic subsistence were randomly divided into observational group （ n = 46 ） which received FTS, and control group （ n = 48 ） received traditional management. They were investigated with health survey simple scale and nutritional risk screening scale. The complication incidence, exhaust and defecation time, and hospitalization time were observed and compared. Results The score of observational group in physical ability （ 84.90 ± 17.29 vs 75.29 ± 19.45 ）, role physical （76.03±37.55 vs 55.15±46.38） ,body aches （79.23 ± 19.56 vs 69.29±25.76） ,general health （58.12± 21.78 vs 49.47 ± 21.80）, effort （72. 00 ± 17.99 vs 64.26 ± 19.71 ）, social activities （85.96 ±18.28 vs 73.90 ± 22.48）, mental health （77.09 ± 37.07 vs 61.76 ± 44.29）, rote emotional （79.69 ± 15.79 vs 75.29 ± 15.52） ,were significantly higher than that of control group （ t = 3.8,3.88,3.85, 4.01,5.12,6.08,3. 11,4.31 ;P 〈0.01 ）. No significant difference was found in the incidence of malnutrition and nutritional risk between two groups before surgery （P 〉 0.05 ）. While after surgery 7th day, the incidence of malnutrition （54.2% vs 8.7% ）and nutritional risk （37.5% vs 17.39% ） of control group were significantly higher than that of observational group （ X2 = 9.27 ,P 〈 0.01 ）. And the time of removing gastric tube the first exhaust defecation time, first off the bed time, length of stay, expenditure in observational group were significantly lower than than that of controlgroup [ （0.5 ± 0.14） vs （5.52 ± 1.52） d, （2.94 ± 0.78 ） vs （5.22± 1.10） d, （0.55 20.43） vs （3.75±0.94）d,（6.81 ±22.36） vs （9.66±3.71）d,（21 065.45±2365.67） vs （24 355.34 ± 3 245.23 ）￥ ; P 〈 0.01 ]. Conclusions Fast track surgery and systematic intervention do good for the cure of the empty-nest operation patients with anus for rectal cancer living on basic subsistence allowances and improve their quality of life.