医护一体化联合加速康复外科理念对肝癌肝切除患者低蛋白血症的影响

Effect of doctor and nurse integration combined with enhanced recovery after surgery on hypoproteinemia in patients with liver cancer after hepatectomy

目的研究医护一体化联合加速康复外科(ERAS)理念对肝癌肝切除患者低蛋白血症的影响。方法选取2014年8月~2017年1月湖南省人民医院收治的肝癌肝切除术后伴低蛋白血症患者78例,根据随机数字表法分为对照组和观察组,每组各39例。对照组患者采用医护一体化模式进行干预,观察组患者采用医护一体化联合ERAS理念进行干预。比较两组患者干预后疲劳感改善情况、并发症情况、负性情绪评分、营养指标和胰岛素样生长因子-1(IGF-1)、谷丙转氨酶(ALT)水平变化情况。结果干预后,两组疲劳感率、体重、握力均较干预前改善,差异有统计学意义(P<0.05),且观察组患者干预后疲劳感率低于对照组,体重、握力大于对照组,差异有统计学意义(P<0.05)。观察组患者首次排气、排便、恢复完全口服饮食时间均短于对照组,差异有统计学意义(P<0.05)。干预后,两组前白蛋白、转铁蛋白、白蛋白水平均较干预前上升,且观察组前白蛋白、转铁蛋白、白蛋白水平均高于对照组,差异有统计学意义(P<0.05)。干预后,两组IGF-1水平高于干预前,ALT水平低于干预前,且观察组患者干预后IGF-1、ALT水平优于对照组,差异有统计学意义(P<0.05)。干预后,两组焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均较干预前下降,且观察组患者干预后SAS、SDS评分均低于对照组,差异有统计学意义(P<0.05)。观察组患者满意度评分高于对照组,差异有统计学意义(P<0.05),但两组患者并发症情况比较,差异无统计学意义(P>0.05)。结论肝癌肝切除后伴低蛋白血症患者采用医护一体化结合ERAS理念进行干预可减轻患者疲劳感,改善机体营养水平,降低患者血清IGF-1水平,减少患者负性情绪,提高患者满意度。

Objective To study the effect of medical and nursing integration combined with enhanced recovery after surgery（ERAS） on hypoproteinemia in hepatectomy patients. Methods From August 2014 to January 2017, in Hu＇nan Provincial People′s Hospital, 78 patients with hypoproteinemia after hepatectomy were selected, according to the random number method, they were divided into the control group and observation group, with 39 cases in each group. The control group was given doctor and nurse integration, the observation group was given doctor and nurse integration combined with enhanced recovery. The improvement of fatigue feeling, complications, negative emotion score, nutrition index and insulin-like growth factor-1（IGF-1） and alanine aminotransferase（ALT） level in the two groups after intervention were analyzed. Results After intervention, the fatigue feeling rate, body weight and grip strength in two groups improved compared with before intervention, and the fatigue feeling rate in observation group was lower than control group, body weight and grip strength in observation group were stronger than control group, the differences were statistically significant（P 〈 0.05）. The time of intestinal exhaust time, defecate, restore complete oral diet in observation group was less than control group, the differences were statistically significant（P 〈 0.05）. After intervention, the level of prealbumin, transferrin, albumin in two groups increased, and the level of prealbumin, transferrin, albumin in observation group were higher than control group, the differences were statistically significant（P 〈 0.05）. After intervention,the levels of IGF-1 in two groups were higher than before intervention, the levels of ALT were lower than before intervention, and the levels of IGF-1 and ALT in observation group were better than control group, the differences were statistically significant（P 〈 0.05）. After intervention, self-rating anxiety scale（SAS）, self-rating depression scale（SDS） scores in two groups were reduced comprared with before intervention, and those in observation group were lower than control group, the differences were statistically significant（P 〈 0.05）. The satisfaction score in observation group was higher than control group, the difference was statistically significant（P 〈 0.05）, but there was no statistical difference in the incidence of complications between two groups（P 〉 0.05）. Conclusion Patients with hypoproteinemia after liver cancer treated with the combination of medical care and ERAS concept can reduce the fatigue, improve the body nutrition level, lower the serum IGF-1 level, reduce the negative emotions of patients, and improve the patient satisfaction.