个体化护理干预对胸椎旁神经阻滞胸腔镜下肺癌根治术患者疗效的影响

Effect of individualized nursing intervention on treatment efficacy in patients with thoracic paravertebral nerve block undergoing thoracoscopic radical resection for lung cancer

目的探讨个体化护理干预对胸椎旁神经阻滞胸腔镜下肺癌根治术患者炎性因子、免疫功能及镇痛效果的影响。方法选取2013年8月至2015年12月间北京肿瘤医院收治的128例接受胸椎旁神经阻滞胸腔镜下肺癌根治术患者,采用随机数表法分为椎旁组和对照组,每组64例。椎旁组患者在常规护理基础上接受围手术期个体化护理,对照组患者采用常规护理,比较两组患者炎性因子、免疫功能和镇痛效果的差异。结果术后第3d和第7d,椎旁组CD3+、CD4+、CD4+/CD8+、红细胞免疫复合物花环率和红细胞免疫粘附抑制因子均明显低于对照组,CD8+、红细胞C3b受体花环率和红细胞免疫粘附促进因子均显著高于对照组,差异均有统计学意义(均P<0.05)。术后第7d,椎旁组患者红细胞免疫指标与术前比较,差异无统计学意义(P>0.05)。术后第3d和第7d,对照组患者各项指标与术前比较,差异均有统计学意义(均P<0.05)。术后第3d和第7d,椎旁组C反应蛋白、白介素-6、肿瘤坏死因子-α和白介素-10均低于对照组,组间比较,差异均有统计学意义(均P<0.05)。术后第3d和第7d,椎旁组患者各时间段视觉疼痛模拟评分法评分均显著低于对照组,组间比较,差异均有统计学意义(均P<0.05)。结论个体化护理能够有效减轻患者术后炎性反应,促进免疫功能恢复,提升术后镇痛效果,适合临床推广。

Objective To explore the effect of individualized nursing intervention on treatment efficacy in patients with thoracic paravertebral nerve block undergoing thoracoscopic radical resection for lung cancer. Methods A total of 128 patients with thoracic paravertebral nerve block undergoing thoracoscopic radical resection for lung cancer at Beijing Cancer Hospital from August 2013 to December 2015 were selected and randomly divided into an observation group and a control group with 64 patients in each group using the random number table method. The observation group received perioperative individualized nursing care and the control group received routine nursing care. Inflammatory factors,immune function and analgesic efficay were compared between the two groups. Results At 3 d and 5 d after the surgery,CD3＋,CD4＋,CD4＋/CD8＋,red cell immune complex rosette rate and red cell immune adherence inhibitor were significantly lower in the observation group than in the control group（ all P〈0. 05）. At 7 d,the above indexes were significantly higher in the observation group than in the control group and RBC-C3 bRR was significantly lower in the observation group than in the control group（ P〈0. 05）. In addition,at 3 d and 7 d after the surgery,CRP,IL-6,TNF-α,IL-10 were lower in the observation group than in the control group（ all P〈0. 05）. The VAS scores were significantly lower in the observation group than in the control group at each time point（ P〈0. 05）. Conclusion Individualized nursing can effectively reduce the postoperative inflammatory response,promote the recovery of immune function and improve the postoperative analgesic efficacy,which is suitable for clinical promotion.