医护一体化护理对食管癌患者术后应激反应与近期生存质量的影响

Effect of all-in-one nursing intervention on the stress response and postoperative quality of life in patients following esophageal cancer surgery

目的：探讨医护一体化护理干预对食管癌患者术后应激反应和近期生存质量的影响。方法将62例食管癌患者采用随机数字表法随机分为干预组32例和对照组30例，两组患者均于手术当日晨（术前）、术后第5天（术后）采集静脉血分别测定应激反应指标含量，包括空腹血糖（ FBG）、C-反应蛋白（CRP）、白细胞介素-6（IL-6）、血浆皮质醇（Cor）。对照组采用常规护理模式，干预组采用医护一体化护理模式。采用生存质量问卷调查表评价两组患者术前和术后2周的生存质量，并进行比较。结果术前干预组与对照组患者FBG、CRP、IL-6和Cor的水平差异均无统计学意义（P＞0．05）。术后第5天，对照组患者的FBG、CRP和Cor水平高于干预组，差异有统计学意义（ t值分别为3．724，7．203，4.137；P＜0．05），IL-6水平差异无统计学意义（t＝0．452，P＞0．05）。两组患者术后第5天FBG、CRP、IL-6和Cor的水平均高于术前水平，差异有统计学意义（ t值分别为3．031，5．361，2．864，3．534和6．990，10.755，2．415，8．166；P＜0．05）。生存质量评价中，两组患者术前各功能项目和症状项目得分差异无统计学意义（P＞0．05）；手术后2周干预组的全部功能项目得分高于对照组，差异有统计学意义（P＜0.05）；干预组症状项目得分均低于对照组，其中7项得分差异有统计学意义（P＜0．05），2项差异无统计学意义（ P＞0．05）。结论医护一体化护理干预能减轻食管癌患者术后的应激反应，提高患者的近期生存质量。

Objective To investigate the effect of all-in-one nursing intervention on the stress response and postoperative quality of life in patients following esophageal cancer surgery .Methods From the October 2012 to March 2013 , 62 patients with radical operation of esophageal carcinoma were divided into all-in-one nursing intervention group （32 cases） and the routine nursing group （30 cases）.The blood samples of the two groups of patients were collected before operation （surgery day） （T0） and on the fifth day after operation （T1） to measure stress response indicators , including fasting blood glucose （ FBG ） , C-reactive protein （ CRP ） , interleukin -6 （IL-6）, plasma cortisol （Cor）.And using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-30 （ QOL ） evaluated the early quality of life , before operation and the second week after opreation .Results The stress reaction index before operation had no significant difference between two group （P〉0.05）.On the fifth day after operation, the FBG, CRP and Cor levels of two groups were significantly higher than the preoperative level （t=3.724,7.203,4.137, respectively;P〈0.05）, but there was no significantly difference in the IL-6 level （t =0.452,P〉0.05）.The FBG, CRP, IL-6 and Cor levels of two groups on the fifth day after operation were significantly higher than the preoperative level （ t =3.031,5.361,2.864,3.534,6.990,10.755,2.415,8.166, respectively;P〈0.05）.Scores of each function item and symptom before operation had no significant difference between the two groups （P〉0.05）.And two weeks after the operation , the functions of the research group were higher than those in the control group （ P〈0.05 ） .Symptoms scores of study group was lower than those in the control group , and there were statistically significant differences in seven aspects （ P〈0.05）, but the other two aspects had no significant differences （P〉0.05）.Conclusions All-in-one nursing intervention can significantly reduce stress reaction and improve the quality of life in postoperative patients with esophageal cancer .