快速康复外科理念配合心理支持对肺癌患者围手术期心理状态、术后疼痛及生活质量的影响

Effects of ERAS concept combined with psychological support on perioperative psychological states,postoperative pain and quality of life in patients with lung cancer

目的:探讨快速康复外科(ERAS)理念配合心理支持对肺癌患者围手术期心理状态、术后疼痛及生活质量的影响。方法:遴选204例肺癌患者随机分为对照组(n=102)和观察组(n=102),对照组给予围手术期常规干预,观察组给予围手术期ERAS理念配合心理支持干预,观察两组患者术后恢复情况、干预前及干预后(出院前1d)心理状态、术后疼痛程度和干预前后的生活质量。结果:干预后,观察组术后首次排气时间(t=-15.467,P<0.05)、首次下床时间(t=-35.949,P<0.05)、胸管引流时间(t=-11.534,P<0.05)、住院时间(t=-8.520,P<0.05)均显著短于对照组,肺部感染率显著低于对照组(χ~2=4.708,P<0.05);干预后,观察组和对照组围手术期的汉密尔顿焦虑量表(HAMA)(t=28.851,21.672;P<0.05)和汉密尔顿抑郁量表(HAMD)评分(t=17.039,16.151;P<0.05)显著降低,观察组下降幅度显著大于对照组(t=-8.506,-8.299;P<0.05),观察组和对照组的术后第1~3d的疼痛视觉模拟评分(VAS)均呈下降趋势(F=695.225,433.546;P<0.05),观察组术后第2、3d的VAS评分显著高于对照组(t=-4.686,-7.661;P<0.05),观察组和对照组的诺丁汉健康调查表(NHP)评分中关于精力(t=21.498,18.512;P<0.05)、疼痛(t=22.620,14.938;P<0.05)、情感(t=27.191,16.894;P<0.05)、睡眠(t=32.283,26.506;P<0.05)、社交(t=25.636,17.948;P<0.05)、躯体(t=21.340,14.179;P<0.05)共6个维度评分显著降低,观察组变化幅度显著大于对照组(t=-7.898,-14.638,-10.388,-11.827,-7.616,-8.128;P<0.05)。结论:ERAS理念配合心理支持可促进患者术后康复,纠正患者围手术期不良心理状态,有效减轻其术后疼痛程度,利于患者生活质量提高。

Objective:To explore the effects of enhanced recovery after surgery(ERAS)concept combined with psychological support on perioperative psychological states,postoperative pain and quality of life in patients with lung cancer.Methods:A total of 204 cases of patients with lung cancer were randomly divided into control group(n=102)and observation group(n=102).Control group was given routine perioperative intervention,and observation group was given perioperative ERAS concept combined with psychological support intervention.Postoperative recovery,psychological states before and after intervention(at 1 d before discharge),postoperative pain degree and quality of life before and after intervention were observed in the two groups.Results:After intervention,the first postoperative exhaust time(t=-15.467,P<0.05),first ambulation(t=-35.949,P<0.05),chest tube drainage time(t=-11.534,P<0.05)and hospital stay(t=-8.520,P<0.05)in observation group were significantly shorter than those in control group,and the lung infection rate was significantly lower than that in control group(χ~2=4.708,P<0.05).After intervention,the scores of perioperative Hamilton Anxiety Scale(HAMA)(t=28.851,21.672;P<0.05)and Hamilton Depression Scale(HAMD)(t=17.039,16.151;P<0.05)were significantly decreased in observation group and control group,and the decline in observation group was significantly greater than that in control group(t=-8.506,-8.299;P<0.05).The pain visual analogue scale(VAS)score showed a downward trend from 1 to 3 d after operation(F=695.225,433.546;P<0.05),and the VAS scores in observation group at 2 nd and 3 rd after operation were significantly higher than those in control group(t=-4.686,-7.661;P<0.05).The 6 dimensions scores of energy(t=21.498,18.512;P<0.05),pain(t=22.620,14.938;P<0.05),emotion(t=27.191,16.894;P<0.05),sleep(t=32.283,26.506;P<0.05),social contact(t=25.636,17.948;P<0.05)and body(t=21.340,14.179;P<0.05)of Nottingham Health Profile(NHP)scale in observation group and control group were significantly decreased,and the changes in observation group were significantly greater than those in control group(t=-7.898,-14.638,-10.388,-11.827,-7.616,-8.128;P<0.05).Conclusion:ERAS concept combined with psychological support can promote postoperative rehabilitation and correct perioperative adverse psychological states,and effectively reduce the postoperative pain degree,and it is conducive to the improvement of patients’quality of life.