讲解-模拟-练习-沟通-支持护理模式对腹腔镜胃癌根治术患者围手术期应激反应和术后康复的影响

Effect of the explain-simulate-practice-communication-support nursing mode on perioperative stress and postoperative rehabilitation of patients undergoing laparoscopic radical gastrectomy for gastric cancer

目的研究讲解-模拟-练习-沟通-支持(ESPCS)护理模式对腹腔镜胃癌根治术患者围手术期应激反应和术后康复的影响,为ESPCS护理模式应用于胃癌根治术患者提供依据。方法采用类实验研究方法,便利抽样法选取2019年5月至2023年5月在中国医科大学附属第一医院择期行腹腔镜胃癌根治术患者212例,按随机数字表法分为观察组和对照组,每组106例。对照组采用常规护理干预,观察组在此基础上采用ESPCS护理模式干预,干预时间3个月。比较2组患者围手术期应激激素(血清皮质醇和肾上腺素)水平、抑郁自评量表(SDS)评分、焦虑自评量表(SAS)评分、胃肠道功能指标以及简明健康生活量表(SF-36)评分。结果2组患者每组各失访2例,最终每组104例患者。对照组男65例,女39例,年龄(61.59±3.42)岁;观察组男61例,女43例,年龄(60.78±3.63)岁。观察组患者术后6 d血清皮质醇、肾上腺素水平分别为(221.46±24.15)nmol/L、(28.11±3.47)pmol/L,低于对照组的(261.84±27.91)nmol/L、(31.49±3.86)pmol/L,差异均有统计学意义(t=11.16、6.64,均P<0.05)。术后1周,观察组SDS、SAS评分分别为(41.39±2.21)、(39.62±2.31)分,低于对照组的(45.27±2.34)、(44.35±2.37)分,差异均有统计学意义(t=12.29、14.58,均P<0.05)。观察组首次排气时间、首次排便时间、肠鸣音出现时间、首次固体进食时间分别为(55.38±6.23)、(68.84±7.92)、(38.73±4.31)、(62.31±7.67)h,短于对照组的(67.51±8.39)、(84.17±9.25)、(48.43±5.79)、(75.65±8.52)h,差异均有统计学意义(t值为11.84~13.71,均P<0.05)。干预后,观察组SF-36的生理功能、生理职能、总体健康、精神健康、社会功能评分及总分分别为(82.17±4.12)、(83.21±3.67)、(75.27±3.64)、(80.63±4.31)、(77.58±4.13)、(73.89±4.86)分,高于对照组的(75.61±4.39)、(74.24±3.88)、(69.45±4.38)、(71.28±4.05)、(72.35±3.84)、(68.81±5.14)分,差异均有统计学意义(t值为7.32~17.13,均P<0.05)。结论ESPCS护理模式可有效减轻腹腔镜胃癌根治术患者的围手术期应激反应,促进胃肠道功能恢复,改善生命质量。

Objective To investigate the effect of the explain-simulate-practice-communication-support(ESPCS)nursing model on perioperative stress and postoperative rehabilitation in patients undergoing laparoscopic radical gastrectomy for gastric cancer.Provide a basis for the application of ESPCS nursing model in patients undergoing radical gastrectomy for gastric cancer.Methods This was a quasi-experimental study.A total of 212 patients who underwent laparoscopic radical gastrectomy for gastric cancer in the First Affiliated Hospital of China Medical University from May 2019 to May 2023 were selected by convenience sampling and divided into the observation group and the control group by random digital table method,with 106 patients in each group.The control group received routine nursing intervention,while the observation group received ESPCS nursing intervention for 3 months.The perioperative stress hormones(serum cortisol and epinephrine),Self-rating Depression Scale(SDS)score,Self-rating Anxiety Scale(SAS)score,gastrointestinal function indicators,and the 36-item Short Form Health Survey Questionnaire(SF-36)score were compared between the two groups.Results Two groups of patients were lost to follow-up,with a total of 104 patients in each group.The control group consisted of 65 males and 39 females,aged(61.59±3.42)years old,while the observation group consisted of 61 males and 43 females,aged(60.78±3.63)years old.Six days after operation,serum cortisol and epinephrine levels in the observation group were(221.46±24.15)nmol/L and(28.11±3.47)pmol/L,respectively,which were lower than those in the control group(261.84±27.91)nmol/L and(31.49±3.86)pmol/L,respectively,and the differences were statistically significant(t=11.16,6.64,both P<0.05).After 1 week of operation,the SDS and SAS scores in the observation group were(41.39±2.21),(39.62±2.31)points,respectively,which were lower than those in the control group(45.27±2.34),(44.35±2.37)points,and the differences were statistically significant(t=12.29,14.58,both P<0.05).The time of first exhaust,first defecation,intestinal ringing and first solid eating in the observation group were(55.38±6.23),(68.84±7.92),(38.73±4.31),(62.31±7.67)h,respectively,which were lower than those in the control group(67.51±8.39),(84.17±9.25),(48.43±5.79),(75.65±8.52)h,the differences were statistically significant(t values were 11.84-13.71,all P<0.05).After intervention,the scores of physiological function,role physical,general health,mental health,social function and the total score of SF-36 in the observation group were(82.17±4.12),(83.21±3.67),(75.27±3.64),(80.63±4.31),(77.58±4.13),(73.89±4.86)points,respectively,which were higher than those in the control group(75.61±4.39),(74.24±3.88),(69.45±4.38),(71.28±4.05),(72.35±3.84),(68.81±5.14)points,the differences were statistically significant(t values were 7.32-17.13,all P<0.05).Conclusions The ESPCS nursing model can effectively alleviate the perioperative stress reaction of gastric cancer patients undergoing laparoscopic radical gastrectomy,promote the recovery of gastrointestinal function and improve the quality of life.