胸腔镜肺叶切除肺癌患者肺康复临床护理流程的构建与应用

Construction and application of clinical nursing procedure of pulmonary rehabilitation for thoracoscopic surgery of lung cancer

目的构建胸腔镜肺叶切除肺癌患者肺康复临床护理流程,并探讨对患者的应用效果。方法按入院时间将2018年12月至2019年5月入院的41例患者设为对照组,采用围手术期常规护理;2019年6—10月入院的41例患者设为干预组,采用常规护理加围手术期肺康复临床护理流程。比较2组患者入院时、术前、出院时和术后30 d 6分钟步行距离(6MWT)和6MWT后即刻呼吸困难(Brog)评分、术后肺部并发症发生率、术后30 d生命质量(QLQ-C30)评分。结果干预组6MWT在术前、出院时和术后30 d分别为(471.22±54.89)、(325.38±17.65)、(407.27±13.84)m,与对照组的(440.95±70.51)、(306.69±21.49)、(355.94±26.10)m相比,差异有统计学意义(t值为-2.169、-4.304、-11.128,P<0.05)。干预组术后肺部并发症总发生率为4.9%(2/41),与对照组的19.5%(8/41)相比差异有统计学意义(χ2值为0.088,P<0.05)。干预组术后30 d躯体功能和认知功能评分分别为80(73,87)、83(83,83)分,与对照组的73(33,80)、83(67,100)相比差异有统计学意义(Z值为-2.862、-2.448,P<0.05),疲劳、疼痛、呼吸困难和失眠症状评分较对照组明显减弱(P<0.05)。结论本研究构建的胸腔镜肺叶切除肺癌患者肺康复临床护理流程可促进患者心肺耐力的提高,有利于心肺功能的恢复,降低术后肺部并发症的发生风险,提高躯体和认知功能水平,改善术后相关症状和生命质量。

Objective To construct clinical nursing procedure of pulmonary rehabilitation for thoracoscopic surgery of lung cancer,and to test its application effect.Methods The control group(n=41)received routine nursing care from December 2018 to May 2019;the intervention group(n=41)received clinical nursing pathway of pulmonary rehabilitation from June to October,2019.The 6MWT,Brog score and incidence of pulmonary complications and quality of life were compared between the two groups.Results The results showed that 6-minute walk test(6 MWT)was(471.22±54.89)m,(325.38±17.65)m,and(407.27±13.84)m before surgery,at discharge time and 30 d after discharge,in the intervention respectively,which were longer than those of the control group[(440.95±70.51)m,(306.69±21.49)m,and(355.94±26.10)m](t values were-2.169,-4.304,-11.128,P<0.05).The total incidence of postoperative pulmonary complications was 4.9%(2/41)in the intervention,which was less than 19.5%(8/41)in the control group(χ2 value was 0.088,P<0.05).The values of physical function and cognitive function 30 d after surgery was 80(73,87),83(83,83)in the intervention,respectively,higher than those of the control group[73(33,80),83(67,100)](Z values were 2.862,2.448,P<0.05).The fatigue,pain,dyspnea,insomnia and loss of appetite scores was significantly lower(P<0.05).Conclusion Clinical nursing procedure of pulmonary rehabilitation for patients undergoing thoracoscopic surgery of lung cancer can promote and conducive the cardiopulmonary endurance,reduce the risk of postoperative pulmonary complications,increase the level of physical and cognitive function,improve postoperative symptoms and the quality of life.