系统的规范化护理对脑胶质瘤手术患者临床疗效及应激反应的影响

Influence of systematic standardized nursing for clinical effect and stress response of patients with glioma surgery

目的分析系统规范化护理模式对脑胶质瘤手术患者临床疗效及应激反应的影响。方法选取2013年6月~2015年3月解放军第一七一医院神经外科收治的患有脑胶质瘤的80例患者作为研究对象,将其按照随机数字表法分为两组,即观察组和对照组,每组40例。两组患者均进行常规的护理,在此基础上观察组患者给予系统规范化的护理模式。对两组患者于入院时（T0）、术前1 d（T1）、气管插管前（T2）、术后即刻（T3）、术后24 h（T4）及术后72 h（T5）各项临床指标进行监测,包括心率、血压、血清白细胞介素-6（IL-6）、皮质醇等的变化情况,并采用焦虑自评量表联合心电图的辅助对患者手术治疗期间的应激反应进行探讨。结果两组T1、T2时的心率、收缩压均明显比T0高（P〈0.05）。观察组T1、T2时的心率、收缩压、舒张压均比对照组低（P〈0.05）,T3~5的心率及收缩压与对照组比较更易恢复至平稳的状态。观察组患者T2~5时血清中IL-6含量与T0比较明显增高（P〈0.05）;对照组患者T1~5时血清中IL-6含量与T0比较明显增高（P〈0.05）,且观察组T3、T4时血清中IL-6含量明显低于对照组,差异有统计学意义（P〈0.05）。两组T1~4时血清内皮质醇含量与T0时比较均明显升高（P〈0.05）,且观察组T1~4时血清中皮质醇含量均明显低于对照组,差异有统计学意义（P〈0.05）。观察组T0、T1及T5时Zung焦虑自评量表评分组内前后比较差异无统计学意义（P〉0.05）;而对照组T1、T5时Zung焦虑自评量表评分与T0时比较明显提高,且明显高于观察组T1、T5时,差异有统计学意义（P〈0.05）。两组患者应激后的R-R间期、Q-T间期均明显短于应激前（P〈0.05）,且对照组下降更显著,差异有统计学意义（P〈0.05）;两组患者手术应激后的T波、R波均较应激前明显下降（P〈0.05）,且对照组下降更显著,差异有统计学意义（P〈0.05）。结论系统规范化护理干预可降低患者的心率及血压变化幅度,减轻血清内IL-6和皮质醇含量的波动,使其神经的内分泌保持相对稳定的状态,缓解患者的焦虑情绪,有效调控其应激反应,对患者的手术治疗及术后康复具有重要的意义。

Objective To analyze the influence of systematic standardized nursing for clinical effect and stress response of patients with glioma surgery. Methods Eighty cases of patients with glioma admitted to Department of Neurosurgery of NO.171 st Hospital of PLA from June 2013 to March 2015 were selected as research objects, and they were divided into two groups according to random number table, observation group and control group, with 40 cases in each group.Both groups were taken conventional nursing care, on basis of which, the observation group was added with systematic standardized nursing. The clinical indexes of the two groups at admission（T0）, 1 d before operation（T1）, before trachea cannula（T2）, immediate postoperation（T3）, 24 h after operation（T4） and 72 h after operation（T5） were monitored, including heart rate, blood pressure, serum interleukin 6（IL-6）, cortisol, and so on. The self-rating anxiety scale combined with assist of electrocardiogram were used to investigate the stress response during operation. Results The heart rate and systolic pressure at T1, T2 of the two groups were all higher than T0（P〈0.05）. The heart rate, systolic pressure and diastolic pressure at T1, T2 of observation group were all lower than those of control group（P〈0.05）, the heart rate,systolic pressure at T3-5of observation group were more easier to recover to the steady state than control group. The contents of IL-6 at T2-5of observation group were higher than T0（P〈0.05）; the contents of IL-6 at T1-5of control group were higher than T0（P〈0.05）, and the contents of IL-6 at T3, T4 of observation group were lower than those of control group, the differences were statistically significant（P〈0.05）. The contents of cortisol at T1-4of the two groups were significantly higher than T0（P〈0.05）, and the contents of cortisol at T1-4of observation group were lower than those of control group, the differences were statistically significant（P〈0.05）. There were no statistically significant differences of Zung self-rating anxiety scale at T0, T1 and T5within the observation group（P〈0.05）; while the Zung self-rating anxiety scale at T1 and T5of control group were higher than T0, which were also higher than those at T1 and T5of observation group, the differences were statistically significant（P〈0.05）. The R-R interval and Q-T interval after stress of the two groups were all shorter than those before stress（P〈0.05）, and the control group was decreased more obviously,the difference was statistically significant（P〈0.05）; the T waves and R waves after stress of the two groups were all lower than those before stress（P〈0.05）, and the control group was decreased more obviously, the difference was statistically significant（P〈0.05）. Conclusion Systematic standardized nursing can decrease the rangeability of heart rate and blood pressure, lighten the fluctuation of the contents of IL-6 and cortisol, make neural endocrine maintain a relatively stable state, relieve the anxiety of patients, regulate the stress response effectively, which has an important significance for surgical treatment and postoperative rehabilitation of patients.