快速康复外科-多学科综合治疗团队干预模式对老年原发性胃癌患者自我效能及营养指标的影响

Effect of the intervention model of enhanced recovery after surgery-multiple disciplinary team on self-efficacy and nutritional indicators in elderly patients with primary gastric cancer

目的 探讨快速康复外科(ERAS)-多学科综合治疗团队(MDT)干预模式对老年原发性胃癌患者自我效能及营养指标的影响。方法 依据干预方式的不同将164例原发性胃癌患者分为观察组(n=88)和对照组(n=76),对照组患者给予常规围手术期管理干预,观察组患者给予ERAS-MDT干预模式。比较两组患者的手术相关指标、疼痛情况[视觉模拟评分法(VAS)]、自我效能[中文版癌症自我管理效能感量表(C-SUPPH)]、营养指标[白蛋白(ALB)、血红蛋白(Hb)、前白蛋白(PAB)]及并发症发生情况。结果 观察组患者术后肛门排气时间、术后下床活动时间、术后住院时间、术后首次进食时间均短于对照组,VAS评分低于对照组患者,差异均有统计学意义(P﹤0.05)。干预后,两组患者压力释放、自我决策、积极态度评分均高于本组干预前,观察组患者压力释放、自我决策、积极态度评分均高于对照组,差异均有统计学意义(P﹤0.05)。干预后,两组患者ALB、PAB、Hb水平均高于本组干预前,观察组患者ALB、PAB、Hb水平均高于对照组,差异均有统计学意义(P﹤0.05)。观察组患者并发症总发生率为6.82%,低于对照组患者的17.11%,差异有统计学意义(P﹤0.05)。结论 ERAS-MDT干预模式能明显改善老年原发性胃癌患者的手术相关指标,减轻疼痛程度,改善自我效能和营养状况,安全性高。

Objective To explored the effect of the intervention model of enhanced recovery after surgery(ERAS)-multiple disciplinary team(MDT)on self-efficacy and nutritional indicators in elderly patients with primary gastric can-cer.Method A total of 164 patients with primary gastric cancer were divided into observation group(n-88)and control group(n-76)according to different intervention methods.Patients in the control group were given conventional perioper-ative management intervention,and patients in the observation group were given the ERAS-MDT intervention model.The surgery-related indicators,pain conditions[visual analogue scale(VAS)],self-efficacy[Chinese strategies used by people to promote health(C-SUPPH)],nutritional indicators[albumin(ALB),hemoglobin(Hb),prealbumin(PAB)],and the occurrence of complications were compared between the two groups.Result The postoperative anal exhaust time,postoperative ambulation time,postoperative hospitalization time,and postoperative first eating time of the observation group were shorter than those of the control group,and the VAS score was lower than that of the control group,and the differences were statistically significant(P<0.05).After the intervention,the scores of stress relief,self-decision-making,and positive attitude in the two groups were higher than those before the intervention,the above scores of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).After the in-tervention,the levels of ALB,PAB,and Hb in the two groups were higher than those before the intervention,the levels of ALB,PAB,and Hb in the observation group were higher than those in the control group,and the differences were statisti-cally significant(P<0.05).The total incidence of complications in the observation group was 6.82%,lower than 17.11%in the control group,and the difference was statistically significant(P<0.05).Conclusion ERAS-MDT intervention mod-el can significantly improve surgical related indicators,reduce pain levels,improve self-efficacy and nutritional status in elderly patients with primary gastric cancer,and has high safety.