阶段性康复联合治疗性沟通系统干预模式应用于胆囊癌手术患者的效果观察

Effect observation of staged rehabilitation combined with therapeutic communication system intervention mode in patients undergoing gallbladder cancer surgery

目的探讨阶段性康复联合治疗性沟通系统(TCS)干预模式应用于胆囊癌手术患者中的效果。方法采用前瞻性研究,选择2018年3月至2022年2月无锡市第二人民医院收治的行胆囊癌手术患者106例,其中男56例,女50例;年龄(64.28±7.03)岁;疾病分期:T1b期40例、T2期35例、T3期31例。简单随机分为两组,对照组实施围术期常规干预,研究组实施阶段性康复联合TCS干预模式。比较两组术后恢复情况、干预前后心理状态、生活质量变化及术后并发症发生率。统计学方法采用t检验、χ^(2)检验。结果研究组术后排气时间为(23.72±2.08)h、初次下床活动时间为(3.47±1.09)h、住院时间为(7.31±1.79)d,均短于对照组(t=31.688、10.531、9.224,均P<0.001);研究组术后3个月生理职能评分为(68.25±7.06)分、生理功能评分为(71.28±7.28)分、躯体疼痛评分为(71.84±6.96)分、社会功能评分为(75.22±7.59)分、情感职能评分为(74.11±7.58)分、心理健康评分为(69.92±7.05)分、活力评分为(72.41±7.51)分、总体健康评分为(70.04±7.25)分,均高于对照组(t=6.150、6.474、7.746、6.009、9.696、5.922、5.150、4.912,均P<0.001);研究组术后3个月躯体化评分为(1.24±0.35)分、强迫评分为(1.26±0.40)分、焦虑评分为(1.29±0.36)分、抑郁评分为(1.35±0.42)分、恐怖评分为(1.36±0.41)分、偏执评分为(1.28±0.39)分、敌对评分为(1.30±0.38)分、精神病性评分为(1.45±0.34)分、人际关系敏感评分为(1.27±0.38)分,均明显低于对照组(t=10.569、12.243、13.832、13.490、14.699、12.994、12.484、8.838、11.347,均P<0.001);研究组术后并发症总发生率为7.55%(4/53),低于对照组的32.08%(17/53),两组比较差异有统计学意义(χ^(2)=10.036,P=0.002)。结论阶段性康复联合TCS干预模式应用于胆囊癌手术患者可促进术后恢复,改善心理状态及生活质量,降低并发症发生率。

Objective To explore the effect of staged rehabilitation combined with therapeutic communication system(TCS)interventionmode in patients undergoing gallbladder cancer surgery.Methods A prospective study was conducted on 106 patients who underwent gallbladder cancer surgery inWuxi Second People'sHospital fromMarch 2018 to February 2022,including 56males and50females,aged(64.28±7.03)years,diseasestage:40casesofstageT1b,35casesof stage T2,and 31 cases of stage T3.They were simply randomly divided into two groups.The control group received perioperative routine intervention,and the study group received staged rehabilitation combined with TCS intervention mode.The postoperative recovery,psychological states before and after intervention,change in quality of life,and incidence of postoperative complications were compared between the two groups.t test andχ^(2) test were used for statistical analysis.Results The postoperative exhaust time,first out-of-bed time,and hospital stay of the study group were(23.72±2.08)h,(3.47±1.09)h,and(7.31±1.79)d,which were shorter than those of the control group(t=31.688,10.531,and 9.224;all P<0.001).The score of physiological role in the study group 3 months after surgery was(68.25±7.06),the score of physical function was(71.28±7.28),the score of physical pain was(71.84±6.96),the score of social function was(75.22±7.59),the score of emotional function was(74.11±7.58),the score of mental health was(69.92±7.05),the score of vitality was(72.41±7.51),and the score of overall health was(70.04±7.25),which were higher than those in the control group(t=6.150,6.474,7.746,6.009,9.696,5.922,5.150,and 4.912;all P<0.001).The somatization score in the study group 3 months after surgery was(1.24±0.35),the compulsion score was(1.26±0.40),the anxiety score was(1.29±0.36),the depression score was(1.35±0.42),the terror score was(1.36±0.41),the paranoia score was(1.28±0.39),the hostility score was(1.30±0.38),the score of psychosis was(1.45±0.34),and the score of interpersonal sensitivity was(1.27±0.38),which were significantly lower than those in the control group(t=10.569,12.243,13.832,13.490,14.699,12.994,12.484,8.838,and 11.347;all P<0.001).The total incidence of postoperative complications in the study group was 7.55%(4/53),which was lower than 32.08%(17/53)in the control group,with a statistically significant difference(χ^(2)=10.036,P=0.002).Conclusion Staged rehabilitation combined with TCS intervention mode applied in patients undergoing gallbladder cancer surgery can promote the postoperative recovery,improve their psychological state and quality of life,and reduce the incidence of complications.