ERAS护理模式对多发伤患者术后免疫指标、炎性应激及生活质量的影响

Influence of a nursing model based on enhanced recovery after surgery on postoperative inflammatory stress,immune indexes and life quality in patients with multiple injuries

目的研究加速康复外科(ERAS)指导的护理模式对多发伤患者术后炎性应激、免疫指标和生活质量的影响。方法将2021年8月至2021年12月收治并给予手术治疗的70例多发伤患者纳入研究范围,患者按照随机数字表法分为对照组和试验组,每组35例,对照组采用常规护理模式,试验组采用ERAS理念指导的护理模式。比较2组护理前后应激反应指标[去甲肾上腺素(NE)、皮质醇(COR)、血管紧张素Ⅱ(AngⅡ)]、炎性因子[白介素6(IL-6)、肿瘤坏死因子α(TNF-α)、降钙素原(PCT)]、氧化应激指标[超氧化物歧化酶(SOD)、丙二醛(MDA)]、细胞免疫指标(CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+))、体液免疫指标(IgA、IgM、IgG)及生活质量。结果2组护理前NE、COR、AngⅡ、IL-6、TNF-α、PCT、SOD、MDA、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、IgA、IgM、IgG、WHOQOL评分比较,差异无统计学意义(P>0.05)。2组护理后NE、COR、AngⅡ、IL-6、TNF-α、PCT、MDA、CD8^(+)均较护理前降低,SOD、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IgA、IgM、IgG、WHOQOL评分均较护理前升高,差异均有统计学意义(P<0.05),且试验组护理后NE、COR、AngⅡ、IL-6、TNF-α、PCT、MDA、CD8^(+)低于对照组,SOD、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)、IgA、IgM、IgG、WHOQOL评分高于对照组,差异均有统计学意义(P<0.05)。结论ERAS理念指导的护理模式可减轻多发伤患者术后炎症应激反应,改善患者免疫功能和生活质量。

Objective To explore the effect of a nursing model based on enhanced recovery after surgery(ERAS)on postoperative inflammatory stress,immune indexes and life quality in patients with multiple injuries.Methods A total of 70 postoperative patients with multiple injuries who were admitted in our hospital from Aug 2021 to Dec 2021 were randomly assigned into experimental group(n=35)and control group(n=35).Conventional nursing care and nursing care based on ERAS were given to patients of control group and experimental group,respectively.Stress response(norepinephrine[NE),cortisol[COR],angiotensinⅡ[AngⅡ],inflammatory factors(interleukin-6[IL-6],tumor necrosis factorα[TNF-α],procalcitonin[PCT]),oxidative stress indexes(superoxide dismutase[SOD],malondialdehyde[MDA]),cellular immune indexes(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)),humoral immunity index(IgA,IgM,IgG),as well as quality-of-life before and after nursing were compared between two groups.Results Before nursing,there were no significant differences in NE,COR,AngⅡ,IL-6,TNF-α,PCT,SOD,MDA,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),IgA,IgM,IgG and WHOQOL scores between two groups(P>0.05).NE,COR,AngⅡ,IL-6,TNF-α,PCT,MDA and CD8^(+)were significantly reduced after nursing in both groups,and SOD,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IgA,IgM,IgG,and WHOQOL scores were significantly enhanced(P<0.05).After nursing,NE,COR,AngⅡ,IL-6,TNF-α,PCT,MDA,and CD8^(+)in experimental group were significantly lower than those of control group,and SOD,CD3^(+),CD4^(+),CD4^(+)/CD8^(+),IgA,IgM,IgG,and WHOQOL scores in experimental group were significantly higher than those of control group(P<0.05).Conclusion ERAS-based nursing care can alleviate inflammatory stress reaction,and improve the immune function and life quality in multiple injuries patients undergoing surgery.