RAM护理干预对肠癌术后肠胃功能恢复与心理状态的影响

Effect of nursing intervention based on Roy adaptation model on postoperative gastrointestinal function recovery and incidence of postoperative delirium in patients with colorectal cancer

目的探讨肠癌手术患者采用罗伊适应模式(Roy adaptation model,RAM)护理模式干预后肠胃功能恢复与心理状态的影响,为临床应用提供依据.方法将2014-08/2016-08天津医科大学第二医院收治的120例肠癌患者随机分为观察组和对照组,对照组患者采用常规护理方案进行干预,观察组患者采用RAM护理模式进行干预;对两组患者禁食时间、排气时间、肠鸣音恢复时间、排便时间等肠胃功能评价指标进行记录;在患者出院后2 wk复查时使用汉密尔顿抑郁量表(Hamilton depression scale,HAMD)及汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)量表对患者心理状态进行评估,调查术后3 d内患者谵妄发生率并统计患者临床满意度及护理疗效.结果出院后2 wk时观察组患者临床有效率显著高于对照组(P<0.05);手术治疗后观察组患者禁食时间、排气时间、肠鸣音恢复时间及排便时间显著低于对照组(P<0.05);出院后2 wk时观察组患者HAMD及HAMA评分显著优于对照组(P<0.05);观察组患者术后3 d内谵妄发生率显著低于对照组(P<0.05);观察组患者满意度明显优于对照组,且差异存统计学意义(P<0.05).结论肠癌手术患者采用RAM护理模式进行干预后,可有效改善患者肠胃功能及心理状态,具有较高的临床应用价值.

AIM To evaluate the effect of nursing intervention based on the Roy adaptation model（RAM） on gastrointestinal function recovery and mental state in patients with colorectal cancer.METHODS From August 2014 to August 2016,120 patients with colorectal cancer treated at our hospital were randomly divided into an observation group and a control group.The control group underwent conventional nursing intervention,and the observation group was given RAM nursing intervention.Fasting time and times to first exhaust,defecation,and recovery of bowel sound were recorded.Two weeks after the patients were discharged,Hamilton depression scale（HAMD） and Hamilton anxiety scale（HAMA）were used to evaluate their psychological status of patients.The incidence of delirium within 3 d after surgery,clinical curative effect and nursing satisfaction of patients were also recorded.RESULTS At 2 wk after the patients were discharged,the rate of clinical efficiency was significantly higher in the observation group than in the control group（P 0.05）;fasting time and times to first exhaust,defecation,and recovery of bowel sound were significantly shorter in the observation group（P 0.05）;and HAMD and HAMA scores were significantly better in the observation group than in the control group（P 0.05）.The incidence of delirium within 3d after surgery was significantly lower in the observation group than in the control group（P 0.05）.Patients＇ satisfaction was significantly better in the observation group than in the control group（P 0.05）.CONCLUSION RAM nursing intervention can effectively improve the gastrointestinal function and psychological status of patients after surgery for colorectal cancer.