快速康复外科理念在乳腺癌术后基层医院-社区管理模式中的应用

Application of fast track surgery concept in community-managed work of grassroots hospitals after breast cancer surgery

目的观察快速康复外科理念(fast track surgery concept,FTS)在乳腺癌术后基层医院-社区管理模式中的应用效果。方法将我院收治的78例乳腺癌患者随机分为观察组和对照组,每组39例。手术治疗出院后对照组患者行常规社区管理护理服务,观察组则在社区管理护理服务中应用FTS。比较两组患者社区管理干预后1个月,评价肩关节活动度(ROM),包括肩后伸、肩前屈、肩内收、肩外展4个锻炼项目。结果观察组治疗依从性为100%,对照组为76. 92%,观察组明显高于对照组,差异有统计学意义(P <0. 05)。社区管理干预1个月后,观察组肩后伸、肩前屈、肩内收、肩外展锻炼项目ROM平均评分均高于对照组,差异有统计学意义(P <0. 05);且干预后3个月和6个月两组患者SF-36量表评分下心理健康、社会功能、生命活力、总体健康各维度平均评分较干预前均提高,差异具有统计学意义(P <0. 05),但观察组各维度提高幅度均大于对照组,差异有统计学意义(P <0. 05)。结论在乳腺癌术后基层医院-社区管理模式中应用FTS能有效提高患者治疗依从性,提高功能锻炼效果及生活质量。

Objective To observe the applicability of fast track surgery concept（ FTS） in a mode in which the community shares the work of a grassroots hospital after breast cancer surgery. Methods Seventy-eight cases of breast cancer treated in our hospital were randomly divided into the observation group and the control group（ n = 39 cases）. After surgery,the patients in the control group received the routine community-managed nursing service,while the observation group underwent FTS in the community-managed nursing service. Results The compliance of the observation group was 100%,while that of the control group was 76. 92%. After one month of community-managed interventions,the average ROM scores of four types of physical exercise-shoulder extension,shoulder flexion,shoulder adduction and shoulder abduction-were higher in the observation group than in the control group（ P〈0. 05）,and the average scores of mental health,social function,life vitality and overall health three months and six months after nursing were significantly increased in both groups（ P〈0. 05）,especially in the observation group（ P〈0. 05）. Conclusions The application of FTS in a mode where the community takes over the work of a grass-roots hospital after breast cancer surgery can effectively improve the compliance of patients,the effect of functional exercise and the patients＇ quality of life.