术前健康教育对老年肺癌患者术后应激反应、负性情绪及疼痛程度的影响

Effect of preoperative health education on postoperative stress response,negative emotion,and pain degree in elderly lung cancer patients

目的探讨术前健康教育对老年肺癌患者术后应激反应、负性情绪及疼痛程度的影响。方法选取108例老年肺癌患者,均接受肺癌根治术治疗,依据术前访视方式的不同分为常规组和观察组,每组54例。常规组患者接受常规术前访视,观察组患者在常规术前访视的基础上接受术前健康教育。比较两组患者的应激反应指标[皮质醇(Cor)、促肾上腺皮质激素(ACTH)、肾上腺素、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、应对方式、心理状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、疼痛程度[视觉模拟评分法(VAS)]、肺功能指标[用力肺活量(FVC)、第一秒用力呼气容积(FEV_(1))、呼气流量峰值(PEF)、最大自主通气量(MVV)、呼吸频率、潮气量]、术后恢复指标和并发症发生情况。结果术后24 h,观察组患者hs-CRP、IL-6、TNF-α、Cor、ACTH、肾上腺素水平均低于常规组,差异均有统计学意义(P﹤0.05)。术后,观察组患者积极应对评分高于常规组,消极应对、SAS、SDS评分均低于常规组,差异均有统计学意义(P﹤0.05)。术后12、24、72 h,观察组患者VAS评分均明显低于常规组,差异均有统计学意义(P﹤0.01)。术后7天,常规组患者FVC、FEV_(1)、PEF、MVV、潮气量均低于本组术前和观察组,呼吸频率高于本组术前和观察组,差异均有统计学意义(P﹤0.05)。观察组患者每日排痰量明显多于常规组,拔管时间、呼吸机使用时间、下床活动时间、重症监护室驻留时间、住院时间均明显短于常规组,差异均有统计学意义(P﹤0.01)。常规组患者术后并发症总发生率为22.22%,高于观察组患者的7.41%,差异有统计学意义(P﹤0.05)。结论术前健康教育可减轻老年肺癌患者术后应激反应程度,缓解负性情绪和疼痛程度,促进术后恢复,降低并发症发生率。

Objective To explore the effect of preoperative health education on postoperative stress response,nega-tive emotions,and pain degree in elderly lung cancer patients.Method A total of 108 elderly lung cancer patients were selected,all of whom underwent radical surgery for lung cancer.They were divided into conventional group and observa-tion group based on different preoperative visit methods,with 54 cases in each group.Patients in the conventional group received routine preoperative visit,while patients in the observation group received preoperative health education on the basis of routine preoperative visit.The stress response indicators[cortisol(Cor),adrenocorticotropic hormone(ACTH),epinephrine,high-sensitive C-reactive protein(hs-CRP),tumor necrosis factor-α(TNF-α),interleukin-6(IL-6)],coping strategies,psychological status[self-rating depression scale(SDS),self-rating anxiety scale(SAS)],pain degree[visual analogue scale(VAS)],lung function indicators[forced vital capacity(FVC),forced expiratory volume in one second(FEV_(1)),peak expiratory flow(PEF),maximal voluntary ventilation(MVV),respiratory frequency,tidal volume],postop-erative recovery indicators,and incidence of complications were compared between the two groups.Result At 24 h after surgery,the Cor,ACTH,epinephrine,hs-CRP,IL-6,TNF-αin observation group were lower than those in conventional group,and the differences were statistically significant(P<0.05).After surgery,the positive coping score in observation group was higher than that in conventional group,while the negative coping,SAS and SDS scores were lower than those in conventional group,and the differences were statistically significant(P<0.05).At 12,24,and 72 h after surgery,the VAS scores in observation group were significantly lower than those in conventional group,and the differences were sta-tistically significant(P<0.01).Seven days after surgery,the FVC,FEV_(1),PEF,MVV,and tidal volume in conventional group were lower than those before surgery and observation group,the respiratory rate were higher than those before sur-gery and observation group,and the differences were statistically significant(P<0.05).The daily sputum output of the ob-servation group was significantly more than that of the conventional group,and the extubation time,ventilator usage time,mobilization time,intensive care unit stay time,and hospitalization time were all significantly shorter than those of the conventional group,and the differences were statistically significant(P<0.01).The total incidence of postoperative com-plications in the conventional group was 22.22%,which was higher than 7.41%in the observation group,and the differ-ence was statistically significant(P<0.05).Conclusion Preoperative health education can alleviate the degree of postop-erative stress response in elderly lung cancer patients,alleviate negative emotions and pain degree,promote postoperative recovery,and reduce the incidence of complications.