四项行动法模式护理对小儿阑尾炎手术术后心理状态、睡眠质量及应激反应的影响

Effect of Four Action Mode Nursing on Psychological State, Sleep Quality and Stress Response after Appendicitis Operation in Children

目的 探讨四项行动法模式护理对小儿阑尾炎手术术后心理状态、睡眠质量及应激反应的影响。方法 回顾性分析2021年10月至2022年10月期间在我院接受手术治疗的100例阑尾炎患儿的临床资料,根据患儿家长的意愿将其分入研究组和参考组,每组各50例。参考组患儿采用常规干预,研究组患儿采用四项行动法模式护理。对两组阑尾炎手术患儿术后心理状态、睡眠质量(总睡眠时间、睡眠潜伏期)及应激反应(皮质醇、促肾上腺皮质激素、去甲肾上腺素)变化情况以及术后恢复指标(住院时间、首次排气时间、首次排便时间、首次下床活动时间)进行对比分析。结果 两组阑尾炎手术患儿术前焦虑、抑郁等各项心理状态评分和总睡眠时间、睡眠潜伏期等睡眠质量评分以及皮质醇、促肾上腺皮质激素、去甲肾上腺素等应激反应指标水平相比无明显差异(均P> 0.05),术后各项心理状态、睡眠质量及应激反应指标均出现显著变化(均P <0.05),且研究组焦虑、抑郁等各项心理状态评分和总睡眠时间、睡眠潜伏期等睡眠质量评分改善幅度显著大于参考组(均P <0.05),而皮质醇、促肾上腺皮质激素、去甲肾上腺素等应激反应指标水平变化幅度则明显小于参考组(均P <0.05)。研究组住院时间、首次排气时间、首次排便时间、首次下床活动时间等各项术后恢复指标均显著短于参考组(均P <0.05)。研究组阑尾炎手术患儿发生1例恶心呕吐、1例厌食,无切口感染和肺部感染发生,并发症发生率为4.00%,参考组阑尾炎手术患儿发生4例恶心呕吐、2例切口感染和4例厌食和1例肺部感染,并发症发生率为22.00%,研究组阑尾炎手术组并发症发生率明显低于参考组(均P <0.05)。结论 四项行动法模式护理能有效改善小儿阑尾炎手术术后不良心理,提升患儿的睡眠质量,减轻应激反应,降低不良反应发生率。

Objective To explore the effect of four action mode nursing on psychological state, sleep quality and stress response after appendicitis operation in children. Methods The clinical data of 100 children with appendicitis who received surgical treatment in our hospital from October 2021 to October 2022 were retrospectively analyzed, and they were divided into study group and reference group according to the wishes of their parents, with 50cases in each group. The children in the reference group were treated with routine intervention, and the children in the study group were treated with fouraction nursing mode. The psychological state, sleep quality(total sleep time, sleep latency), stress response(cortisol, adrenocorticotropin, norepinephrine)and postoperative recovery indicators(length of hospital stay, first exhaust time, first defecation time, first getting out of bed time) of the two groups of children with appendicitis surgery were compared and analyzed. Results There were no significant differences in the scores of anxiety, depression and other psychological states before operation, the scores of total sleep time, sleep latency and other sleep quality scores, and the levels of stress response indexes such as cortisol, corticotropin and norepinephrine between the two groups(all P>0.05). The psychological state, sleep quality and stress response indexes were significantly changed after surgery(all P<0.05), and the study group improved the psychological state scores such as anxiety and depression, as well as the total sleep time and sleep latency significantly more than the reference group(all P<0.05). The change range of stress response indexes such as cortisol, adrenocorticotropic hormone and norepinephrine in the study group was significantly smaller than that in the reference group(P<0.05). The time of hospitalization, first exhaust time, first defecation time, first getting out of bed and other postoperative recovery indexes in the study group were significantly shorter than those in the reference group(all P<0.05). In the study group, there was 1 case of nausea and vomiting and 1 case of anorexia,and no incision infection or lung infection, with a complication rate of 4.00%;in the reference group, there were 4 cases of nausea and vomiting, 2 cases of incision infection, 4 cases of anorexia and 1 case of lung infection, with a complication rate of 22.00%. The complication rate of appendicitis operation group was significantly lower than that of reference group(all P<0.05). Conclusion The four action mode nursing can effectively improve the adverse psychology of children after appendicitis operation, improve the sleep quality of children, reduce the stress reaction, reduce the incidence of adverse reactions.