基于品质链管理的全程路径化护理在结直肠患者围术期的应用

Application of whole path nursing based on quality chain management in perioperative period of patients with colorectal cancer

目的探讨基于品质链管理的全程路径化护理对结直肠癌患者围术期指标、营养状况、心理状态及生活质量的影响。方法选取2020年6月至2022年6月在徐州市第一人民医院进行结直肠癌根治术的患者80例, 采用随机信封法分为观察组和对照组, 各40例, 对照组患者采用常规护理模式, 观察组患者在对照组的基础上给予基于品质链管理的全程路径化护理模式干预。比较两组患者围术期指标(肠鸣音恢复时间、首次排气时间、首次排便时间、住院时间)差异, 记录其入院时及出院前营养状况〔转铁蛋白(TF)、前清蛋白(PA)、血清总蛋白(ALB)、患者主观全面评定法(PG-SGA)〕、心理状态〔中文版10条目心理韧性调查量表(CD-RISC-10)、Herth希望量表(HHI)、一般自我效能量表(GSES)〕、生活质量〔胃肠生活质量量表(GIQLI)、结直肠癌患者生活质量测定量表(EORTC QLQ-C29)〕, 统计两组患者干预期间不良事件发生情况。结果观察组患者胃肠道功能恢复时间及住院时间均明显短于对照组, 差异有统计学意义(P<0.05);出院前两组患者TF、PA、ALB、PG-SGA均较入院时明显降低, 且观察组明显低于对照组, 差异有统计学意义(P<0.05);出院前, 两组患者CD-RISC-10、HHI、GSES、GIQLI、EORTC QLQ-C29评分均较入院时明显升高, 且观察组明显高于对照组, 差异有统计学意义(P<0.05);干预期间观察组不良事件发生率(5.0%)明显低于对照组(20.0%), 差异有统计学意义(P<0.05)。结论基于品质链管理的全程路径化护理可有效加快结直肠癌根治术患者术后恢复进程, 改善患者营养及心理状况, 对患者生活质量的改善具有积极作用, 且安全性较好。

Objective:To explore the effects of the whole path nursing based on quality chain management on perioperative indicators,nutritional status,mental state and quality of life of patients with colorectal cancer.Methods:A total of 80 patients who underwent radical resection of colorectal cancer in this hospital from June 2020 to June 2022 were selected and divided into observation group and control group by random envelope method,with 40 cases in each group.Patients in the control group were given routine nursing mode,while patients in the observation group were given the whole path nursing mode based on quality chain management on the basis of the control group.The perioperative indicators(bowel sound recovery time,first exhaust time,first defecation time,hospital stay)were compared between the two groups.The nutritional status〔transferrin(TF),prealbumin(PA),serum total protein(albumin,ALB),Patient-Generated Subjective Global Assessment(PG-SGA)〕,psychological states〔Chinese Version of 10-item Connor-Davidson Resilience Scale(CD-RISC-10),Herth Hope Inventory(HHI),General Self-Efficacy Scale(GSES)〕and quality of life〔Gastrointestinal Quality of Life Index(GIQLI),European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal Cancer 29(EORTC QLQ-C29)〕were recorded at admission and before discharge.The occurrence of adverse events during intervention period were counted in the two groups of patients.Results:The recovery time of gastrointestinal function and hospitalization time in the observation group were significantly shorter than those in the control group,and the differences were statistically significant(P<0.05).The levels of TF,PA,ALB and PG-SGA in the two groups before discharge were significantly lower than those on admission,and those in the observation group were significantly lower than those in the control group,and the differences were statistically significant(P<0.05).Before discharge,the CD-RISC-10,HHI,GSES,GIQLI and EORTC QLQ-C29 scores of the two groups were significantly higher than those on admission,and the observation group was significantly higher than the control group,and the differences were statistically significant(P<0.05).The incidence of adverse events in the observation group(5.0%)was significantly lower than that in the control group(20%),and the difference was statistically significant(P>0.05).Conclusions:The whole path nursing based on quality chain management can effectively accelerate the postoperative recovery process of patients with radical resection of colorectal cancer,improve the nutritional and psychological status of patients,and has a positive effect on the improvement of the quality of life of patients,with good safety.