系统化规范护理对脑胶质瘤患者围术期应激反应的影响

Influence of Systematic and Standardized Nursing on the Perioperative Stress response of Glioma Patients

目的探讨护理干预对脑胶质瘤患者围术期应激反应的影响。方法选取哈尔滨医科大学附属第四医院2015年7月—2017年7月收治的脑胶质瘤患者96例,按照护理干预模式不同将其分为对照组与观察组,每组48例。对照组给予常规护理,观察组给予系统规范化护理,比较两组患者入院当天(T_0)、术前1d(T_1)、插管前(T_2)、手术结束时(T_3)、术后24h(T_4)、术后72h(T_5)的心率(HR)、平均动脉压(MAP)、皮质醇及白介素6(IL-6)水平,并比较T_0、T_1、T_5时焦虑自评量表(SAS)评分及应激前后心电图。结果 T_1、T_2时,观察组患者HR水平低于对照组,MAP水平高于对照组(P<0.05)。T_1、T_2、T_3、T_4时,观察组患者皮质醇、IL-6水平低于对照组(P<0.05)。T_1、T_5时,两组患者SAS评分低于T_0时,且观察组患者SAS评分低于对照组(P<0.05)。应激后两组患者R-R间期、Q-T间期、T波、R波低于应激前,应激后观察组患者R-R间期、Q-T间期、T波、R波高于对照组(P<0.05)。结论系统规范化护理可减小脑胶质瘤患者围术期HR、血压波动,维持神经内分泌平衡状态,有效调控应激反应,有利于保证手术疗效及术后患者的康复。

Objective To study the influence of systematic and standardized nursing on the perioperative stress response of glioma patients.Methods A total of96cases of glioma patients were selected from July2015to July2017in Fourth Affiliated Hospital of Harbin Medical University,which were divided into control group and observation group according to nursing intervention model,48cases in each group.The control group was given routine care,observation group was given systematic and standardized nursing.The HR,MAP,cortisol and IL-6levels on admission day(T0),preoperative1d(T1),before intubation(T2),end of operation(T3),postoperative24h(T4),postoperative72h(T5)were compared between the two groups,and SAS scores inT0,T1,T5and electrocardiogram before and after stress were compared between the two groups.Results At the time of T1、T2,the observation group of HR was lower than control group,MAP was higher than control group(P<0.05).At the time of T1,T2,T3,T4,the observation group of cortisol and IL-6levels were lower than control group(P<0.05).At the time of T1,T5,the two groups of SAS scores were lower than T0,and the observation group of SAS scores were lower than control group(P<0.05).After stress,the two groups of R-R interval,Q-T interval,T wave and R wave were lower than before the stress,and the R-R interval,Q-T interval,T wave and R wave of observation group were higher than control group(P<0.05).Conclusions Systematic and standardized nursing can reduce the fluctuation of HR and blood pressure during the perioperative period,maintain the neuroendocrine balance state,effectively control the stress reaction,and improve the operation effect and promote the rehabilitation of patients after operation.