基于快速康复外科理念的护理模式在StanfordB型胸主动脉夹层患者杂交手术围术期的应用效果

Application Effect of Nursing Mode Based on the Concept of Fast Track Surgery in Patients with Type B Thoracic Aortic Dissection During Perioperative Period of Hybrid Surgery

目的分析基于快速康复外科(FTS)理念的护理模式在Stanford B型胸主动脉夹层(TBTAD)患者杂交手术围术期的应用效果。方法选取2020年1月—2021年8月首都医科大学附属北京安贞医院心脏外科收治的128例行杂交手术的TBTAD患者作为研究对象,采用随机数字表法将其分为对照组和观察组,各64例。对照组患者围术期接受常规护理,观察组患者围术期接受基于FTS理念的护理。比较两组术前及术后24、72 h血清炎症因子[白介素(IL)-6、IL-8、肿瘤坏死因子α(TNF-α)水平]及应激反应指标[皮质醇(Cor)、肾上腺素(E)水平],治疗情况(ICU入住时间、呼吸机辅助呼吸时间、肛门首次排气时间、首次下床时间、住院时间),术前、术后1周、出院时世界卫生组织生存质量测定量表简表(WHOQOL-BREF)评分,术后并发症发生率。结果护理方法和时间在血清IL-6、IL-8、TNF-α、Cor、E水平上存在交互作用(P<0.05);护理方法、时间在血清IL-6、IL-8、TNF-α、Cor、E水平上主效应均显著(P<0.05)。观察组术后72 h血清IL-6、IL-8、TNF-α、Cor、E水平低于对照组(P<0.05)。两组术后24、72 h血清IL-6、IL-8、TNF-α、Cor、E水平分别高于本组术前,术后72 h血清IL-6、IL-8、TNF-α、Cor、E水平分别低于本组术后24 h(P<0.05)。观察组呼吸机辅助呼吸时间、肛门首次排气时间、首次下床时间、住院时间短于对照组(P<0.05)。护理方法和时间在WHOQOL-BREF评分上存在交互作用(P<0.05);护理方法、时间在WHOQOL-BREF评分上主效应均显著(P<0.05)。观察组术后1周、出院时WHOQOL-BREF评分高于对照组(P<0.05)。两组术后1周、出院时WHOQOL-BREF评分分别低于本组术前,出院时WHOQOL-BREF评分分别高于本组术后1周(P<0.05)。两组肺部感染、肾功能不全、深静脉血栓形成、脑梗死发生率比较,差异无统计学意义(P>0.05)。结论基于FTS理念的护理模式可减轻TBTAD患者杂交手术围术期炎症反应及应激反应,提高患者治疗效果及术后生存质量,且不会增加并发症发生风险。

Objective To analyze the application effect of nursing mode based on the concept of fast track surgery(FTS)in patients with type B thoracic aortic dissection(TBTAD)during perioperative period of hybrid surgery.Methods From January 2020 to August 2021,128 cases of TBTAD patients undergoing hybrid surgery who were admitted to the Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University were selected as the research objects,and they were divided into the control group and the observation group by random number table method,with 64 patients in each group.During perioperative period,patients in the control group received the routine nursing,while patients in the observation group received the nursing based on the concept of FTS.Serum inflammatory factors[interleukin(IL)-6,IL-8 and tumor necrosis factorα(TNF-α)level]and stress response indexes[cortisol(Cor)and epinephrine(E)level]before operation and at 24,72 hours after operation,treatment situation(ICU stay time,ventilator-assisted breathing time,first anal exhaust time,first time to get out of bed,hospital stay),and the World Health Organization Quality of Life-BREF(WHOQOL-BREF)score before operation,at 1 week after operation and at discharge,incidence of postoperative complications were compared between the two groups.Results There was an interaction between nursing methods and time on serum levels of IL-6,IL-8,TNF-α,Cor,and E(P<0.05),both nursing methods and time produced significant main effects on serum levels of IL-6,IL-8,TNF-α,Cor and E(P<0.05).At 72 hours after operation,serum levels of IL-6,IL-8,TNF-α,Cor and E in the observation group were lower than those in the control group(P<0.05).Serum levels of IL-6,IL-8,TNF-α,Cor and E at 24,72 hours after operation in the two groups were higher than those before operation,and serum levels of IL-6,IL-8,TNF-α,Cor and E at 72 hours after operation in the two groups were lower than those at 24 hours after operation,respectively(P<0.05).Ventilator-assisted breathing time,first anal exhaust time,first time to get out of bed,hospital stay in the observation group were shorter than those in the control group(P<0.05).There was an interaction between nursing methods and time on the WHOQOL-BREF score(P<0.05),both nursing methods and time produced significant main effects on the WHOQOL-BREF score(P<0.05).At 1 week after operation and at discharge,WHOQOL-BREF score in the observation group was higher than that in the control group(P<0.05).Score of WHOQOL-BREF at 1 week after operation and at discharge in the two groups was lower than that before operation,and WHOQOL-BREF score at discharge in the two groups was higher than that at 1 week after operation,respectively(P<0.05).There was no significant difference in the incidence of pulmonary infection,renal insufficiency,deep vein thrombosis and cerebral infarction between the two groups(P>0.05).Conclusion The nursing mode based on the concept of FTS can reduce the inflammation and stress response of patients with TBTAD during perioperative period of hybrid surgery,improve the therapeutic effect and the postoperative quality of life of patients,and without increasing the risk of complications.