基于预康复的全程管理在免充气经口腔镜甲状腺癌患者中的应用

陆天雅; 陈娇龙; 刘建军; 胡成文

doi:10.16766/j.cnki.issn.1674-4152.003050

基于预康复的全程管理在免充气经口腔镜甲状腺癌患者中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003050

1.
中国科学技术大学附属第一医院西区(安徽省肿瘤医院)头颈外科，安徽合肥 230031
2.
中国科学技术大学附属第一医院西区(安徽省肿瘤医院)护理部

基金项目:

国家自然科学基金青年科学基金项目 81802640

安徽省护理学会科研课题 AHHLa202105

详细信息

通讯作者:
胡成文，E-mail: huchengwen318@126.con

中图分类号: R736.1 R473.6
计量
- 文章访问数: 151
- HTML全文浏览量: 23
- PDF下载量: 5
- 被引次数: 0
出版历程
- 收稿日期: 2022-11-04
- 网络出版日期: 2023-08-26

Whole-process management based on pre-habilitation concept in patients of the gasless transoral endoscopic thyroidectomy

1.
Department of Head and Neck Surgery, West District of the First Affiliated Hospital of USTC (Anhui Provincial Cancer Hospital), University of Science and Technology of China, Hefei, Anhui 230031, China

摘要

摘要: 目的研究基于预康复理念的全程管理对免充气经口腔镜甲状腺癌患者术后疼痛、自我效能、焦虑抑郁情绪及术后康复的影响。方法选取中国科学技术大学附属第一医院2021年1月—2021年6月收治的60例预住院接受免充气经口腔镜甲状腺癌手术患者为对照组，实施常规护理；选取2021年7月—2021年12月收治的60例预住院接受免充气经口腔镜甲状腺癌手术患者为观察组，实施基于预康复理念的全程管理。采用数字疼痛评分评价2组术后3 d的疼痛情况；出院时采用患者一般自我效能感量表评价2组患者一般自我效能感；入院时、出院时、出院1个月使用医院焦虑抑郁量表评价2组焦虑抑郁情绪。结果干预后，观察组术后3 d疼痛评分均低于对照组(均P < 0.05)；观察组患者自我效能感得分[(29.2±4.7)分]高于对照组[(24.6±4.8)分, t=5.009，P < 0.001]；观察组出院时和出院1个月焦虑和抑郁评分低于对照组(均P < 0.05)；随着术后康复2组焦虑和抑郁评分逐渐下降(均P < 0.05)；观察组术后颌下水肿、皮肤淤血发生率为17.2%、5.2%, 均低于对照组的35.2%、16.7%(均P < 0.05)。结论基于预康复理念的全程管理能有效减轻免充气经口腔镜甲状腺癌患者术后疼痛程度，提高患者自我效能感，改善负性情绪，促进患者快速康复。
- 预康复 /
- 免充气 /
- 腔镜 /
- 甲状腺癌 /
- 全程管理
Abstract: Objective To study the effects of whole-process management based on the concept of pre-habilitation on pain, self-efficacy, anxiety, depression and postoperative rehabilitation in patients undergoing gasless transoral endoscopic thyroidectomy. Methods A total of 60 patients who were pre-hospitalized in the First Affiliated Hospital of USTC from January 2021 to June 2021 and received gasless transoral endoscopic thyroidectomy were selected as the control group and received routine care. A total of 60 patients who were pre-hospitalized in the First Affiliated Hospital of USTC from July 2021 to December 2021 and received gasless transoral endoscopic thyroidectomy were selected as the observation group and received the whole-process management based on pre-habilitation concept. Numeric rating scale digital was used to evaluate the pain of 3 days after operation of the 2 groups. General self-efficacy scale was used to evaluate the general self-efficacy of the two groups at discharge. Anxiety and depression of all patients were assessed by the hospital anxiety and depression scale at 3 times of admission, discharge and 1 month after discharge. Results After intervention, the Numeric rating scale in the observation group were lower than that in the control group at 3 days after operation (all P < 0.05); The self-efficacy score of patients in the observation group [(29.2?.7) points] was higher than that in the control group [(24.6?.8) points, t=5.009, P < 0.001]; The scores of anxiety and depression in the control group were higher than those in the observation group at discharge and 1 month after discharge (all P < 0.05); With the prolongation of postoperative time, anxiety and depression scores in each group decreased gradually, and there were time interaction and intergroup interaction between the two groups (all P < 0.05). The incidence of submandibular edema and skin congestion after operation in the observation group (17.2% and 5.2%) were significantly lower than those in the control group (35.2% and 16.7%, all P < 0.05). Conclusion The whole-process management based on the concept of pre-rehabilitation can effectively reduce the postoperative pain degree of patients with transendoscopic thyroid cancer, improve their self-efficacy, improve their negative mood, reduce their postoperative complications and promote the rapid recovery of patients.
- Pre-habilitation /
- Gasless /
- Endoscopic /
- Thyroid cancer /
- Whole-process management

HTML全文

表 1 2组甲状腺癌患者一般资料比较

Table 1. Comparison of general data of thyroid cancer patients between the two groups

组别	例数	年龄(x±s，岁)	性别(例)		肿瘤直径[M(P₂₅, P₇₅), cm]	文化程度(例)				病程(例)
组别	例数	年龄(x±s，岁)	男性	女性	肿瘤直径[M(P₂₅, P₇₅), cm]	小学及以下	初中	高中	大专及以上	1个月及以内	1~6个月	6个月及以上
对照组	54	35.0±7.6	5	49	0.60(0.40，0.80)	2	8	4	40	32	10	12
观察组	58	35.1±8.1	6	52	0.50(0.40，0.82)	5	6	5	42	33	7	18
统计量		0.068^a	0.037^b		1.079^c	0.277^c				0.560^c
P值		0.946	0.847		0.280	0.782				0.576
注：^a为t值，^b为χ²值，^c为Z值。

下载: 导出CSV

表 2 2组甲状腺癌患者疼痛评分广义估计方程分析

Table 2. Analysis of generalized estimation equation for pain score in 2 groups of thyroid cancer patients

参数	B	SE	Waldχ²	OR值	95% CI	P值
对照组	0.540	0.084	40.667	1.716	1.454~2.024	<0.001
术后1 d	1.034	0.059	301.734	2.812	2.504~4.549	<0.001
术后2 d	0.862	0.045	362.500	2.368	2.166~2.588	<0.001
注：分组因素以观察组为参照，时间因素以术后3 d为参照。

下载: 导出CSV

表 3 2组甲状腺癌患者各时点医院焦虑抑郁评分比较(x±s, 分)

Table 3. Comparison of hospital anxiety and depression scores of thyroid cancer patients between the two groups at each time point(x±s, points)

组别	例数	医院焦虑亚量表得分比较			医院抑郁亚量表得分比较
组别	例数	入院时	出院时	出院1个月	入院时	出院时	出院1个月
对照组	54	8.3±2.3	8.0±2.2	7.2±2.0^ab	7.5±2.1	6.8±2.2	6.4±3.6^bc
观察组	58	8.1±1.9	6.4±1.5	5.6±2.8^ab	7.3±1.8	5.2±1.6	4.4±2.9^ab
t值		0.566	4.347	3.407	0.603	4.486	3.252
P值		0.573	<0.001	0.001	0.548	<0.001	0.020
注：与入院时比较, ^aP<0.05；与出院时比较, ^bP>0.05；与入院时比较, ^cP>0.05。

下载: 导出CSV

表 4 2组甲状腺癌患者康复客观指标比较

Table 4. Comparison of objective indicators of rehabilitation of thyroid cancer patients between two groups

组别	例数	术后第1次下床活动时间(x±s, h)	颌下水肿[例(%)]	皮肤淤血[例(%)]	引流管留置时间(x±s, d)	住院时间(x±s, d)	住院费用(x±s, 元)
对照组	54	12.2±4.7	19(35.2)	9(16.7)	5.9±1.3	6.8±1.5	22 213.4±2 513.8
观察组	58	7.2±1.5	10(17.2)	3(5.2)	5.1±0.9	5.6±1.2	20 080.7±3 579.1
统计量		7.838^a	4.692^b	3.862^b	3.610^a	4.482^a	3.624^a
P值		<0.001	0.030	0.049	<0.001	<0.001	<0.001
注：^a为t值，^b为χ²值。

下载: 导出CSV

参考文献(20)

[1]	万焱华, 刘贤伟, 刘奇盛. 经口腔前庭入路腔镜甲状腺切除术治疗甲状腺疾病的临床效果[J]. 中国医学创新, 2022, 19(10): 28-31. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCX202210006.htm WAN Y H, LIU X W, LIU Q S. Clinical Effect of Transoral Endoscopic Thyroidectomy Vestibular Approach in the Treatment of Thyroid Diseases[J]. Medical Innovation of China, 2022, 19(10): 28-31. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYCX202210006.htm
[2]	RAMIREZ P T, FRUMOVITZ M, PAREJA R, et al. Minimally invasive versus abdominal radical hysterectomy for cervical cancer[J]. N Engl J Med, 2018, 379(20): 1895-1904. doi: 10.1056/NEJMoa1806395
[3]	方静, 郑绪才, 陈公仆, 等. 免充气经口腔镜甲状腺切除术24例分析[J]. 中华内分泌外科杂志, 2020, 14(1): 13-14, 17. FANG J, ZHENG X C, CHEN G P, et al. Totally gasless transoral video-assisted thyroidectomy: initial report of 24 cases[J]. Chinese Journal of Endocrine Surgery, 2020, 14(1): 13-14, 17.
[4]	朱光亮, 沈俊, 李晓明, 等. 美洛昔康预处理联合超声引导下喉上神经阻滞在甲状腺癌手术患者围术期中的应用[J]. 中华全科医学, 2022, 20(3): 391-394. doi: 10.16766/j.cnki.issn.1674-4152.002360 ZHU G L, SHEN J, LI X M, et al. Application of meloxicam pretreatment combined with ultrasound-guided internal branch of superior laryngeal nerve block in perioperative period of radical thyroidectomy patients[J]. Chinese Journal of General Practice, 2022, 20(3): 391-394. doi: 10.16766/j.cnki.issn.1674-4152.002360
[5]	秦发伟, 刘美凤, 陈洪元. 经口腔前庭入路腔镜甲状腺手术患者护理方案的构建[J]. 中华护理杂志, 2021, 56(6): 873-879. doi: 10.3761/j.issn.0254-1769.2021.06.012 QIN F W, LIU M F, CHEN H Y. Construction of a perioperative nursing scheme for transoral endoscopic thyroidectomy vestibular approach[J]. Chinese Journal of Nursing, 2021, 56(6): 873-879. doi: 10.3761/j.issn.0254-1769.2021.06.012
[6]	张杨西贝, 柏彬, 马杰, 等. 基于加速康复外科理念的术前护理干预模式在老年腰椎管狭窄症手术患者中的应用研究[J]. 中华全科医学, 2021, 19(12): 2146-2148, 2157. doi: 10.16766/j.cnki.issn.1674-4152.002257 ZHANG Y X B, BO B, MA J, et al. Application of preoperative nursing intervention mode based on the concept of enhanced recovery after surgery in elderly patients with lumbar spinal stenosis[J]. Chinese Journal of General Practice, 2021, 19(12): 2146-2148, 2157. doi: 10.16766/j.cnki.issn.1674-4152.002257
[7]	文珂, 陈佩娟, 何玉. 成人鼻咽癌放疗病人张口锻炼依从性影响因素及与自我管理效能的关系[J]. 护理研究, 2021, 35(24): 4419-4423. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202124014.htm WEN K, CHEN P J, HE Y. Influencing factors of mouth-opening exercise compliance and its relationship with self-management efficacy in adult patients with nasopharyngeal carcinoma undergoing radiotherapy[J]. Chinese Nursing Research, 2021, 35(24): 4419-4423. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202124014.htm
[8]	高玉萍, 刘美凤, 于成娥, 等. 经口腔前庭入路腔镜甲状腺肿瘤切除术围手术期护理模式探讨[J]. 中华现代护理杂志, 2020, 26(26): 3673-3676. GAO Y P, LIU M F, YU C E, et al. Discussion on the perioperative nursing model of endoscopic thyroidectomy through oral vestibule[J]. Chinese Journal of Modern Nursing, 2020, 26(26): 3673-3676.
[9]	盖晓冬, 葛圣金. 术后慢性疼痛患病率调查及危险因素分析[J]. 中国临床医学, 2020, 27(3): 481-487. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202003031.htm GE X D, GE S J. Prevalence and risk factors of chronic postsurgical pain after surgery[J]. Chinese Journal Of Clinical Medicine, 2020, 27(3): 481-487. https://www.cnki.com.cn/Article/CJFDTOTAL-LCYX202003031.htm
[10]	马旻, 艾自胜, 石志道. 一般自我效能感量表在中老年2型糖尿病患者中的信度效度检验[J]. 同济大学学报(医学版), 2022, 43(4): 515-520. https://www.cnki.com.cn/Article/CJFDTOTAL-TJIY202204010.htm MA M, AI Z S, SHI Z D. Reliability and validity of General Self-Efficacy Scale(Chinese version)in middle-aged and elderly patients with type 2 diabetes[J]. Journal of Tongji University(Medical Science), 2022, 43(4): 515-520. https://www.cnki.com.cn/Article/CJFDTOTAL-TJIY202204010.htm
[11]	NEZLEK J B, RUSANOWSKA M, HOLAS P, et al. The factor structure of a Polish language version of the hospital anxiety depression scale (HADS)[J]. Current Psychology, 2021, 40(5): 2318-2326.
[12]	中华医学会外科学分会, 中华医学会麻醉学分会. 中国加速康复外科临床实践指南(2021)(一)[J]. 协和医学杂志, 2021, 12(5): 624-631. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX202105006.htm Chinese Society of Surgery, Chinese Society of Anesthesiology. Clinical Practice Guidelines for ERAS in China(2021)(Ⅰ)[J]. Medical Journal Of Peking Union Medical College Hospital, 2021, 12(5): 624-631. https://www.cnki.com.cn/Article/CJFDTOTAL-XHYX202105006.htm
[13]	朱峰, 龚剑峰. 预康复在腹部外科中的价值[J]. 腹部外科, 2021, 34(1): 10-13, 17. https://www.cnki.com.cn/Article/CJFDTOTAL-FBWK202101004.htm ZHU F, GONG J. Value of prehabilitation in abdominal surgery[J]. Journal of Abdominal Surgery, 2021, 34(1): 10-13, 17. https://www.cnki.com.cn/Article/CJFDTOTAL-FBWK202101004.htm
[14]	ASSOULINE B, COOLS E, SCHORER R, et al. Preoperative exercise training to prevent postoperative pulmonary complications in adults undergoing major surgery. A systematic review and meta-analysis with trial sequential analysis[J]. Ann Am Thorac Soc, 2021, 18(4): 678-688.
[15]	刘宗超, 李哲轩, 张阳, 等. 2020全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2021, 7(2): 1-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLZD202102001.htm LIU Z C, LI Z X, ZHANG Y, et al. Interpretation on the report of Global Cancer Statistics 2020[J]. Journal of Multidisciplinary Cancer Management(Electronic Version), 2021, 7(2): 1-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLZD202102001.htm
[16]	朱宝燕, 李智林. 快速康复护理在甲状腺癌围术期护理中的应用[J]. 护理研究, 2020, 34(17): 3164-3167. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202017036.htm ZHU B Y, LI Z L. Application of fast-track nursing in perioperative period of thyroid cancer[J]. Chinese Nursing Research, 2020, 34(17): 3164-3167. https://www.cnki.com.cn/Article/CJFDTOTAL-SXHZ202017036.htm
[17]	ZEMŁA A J, NOWICKA-SAUER K, JARMOSZEWICZ K, et al. Measures of preoperative anxiety[J]. Anaesthesiol Intensive Ther, 2019, 51(1): 64-69.
[18]	蒲小金, 张有娣, 汪袁云子, 等. 加速康复外科理念在肝切除围术期中应用效果的meta分析[J]. 中国普外基础与临床杂志, 2020, 27(9): 1128-1138. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202009016.htm PU X J, ZHANG Y D, WANG Y Y Z, et al. Effect of fast track surgery in perioperative period of hepatectomy: A meta analysis[J]. Chinese Journal of Bases and Clinics In General Surgery, 2020, 27(9): 1128-1138. https://www.cnki.com.cn/Article/CJFDTOTAL-ZPWL202009016.htm
[19]	CUI Y, LI Y X. Effect of high-quality nursing on alleviating depression and anxiety in patients with thyroid cancer during perioperative period: a protocol for systematic review[J]. Medicine(Baltimore), 2020, 99(45): e23018. DOI: 10.1097/MD.0000000000023018.
[20]	HE J, XIA J Y. Effect of a WeChat-based perioperative nursing intervention on risk events and self-management efficacy in patients with thyroid cancer[J]. Am J Transl Res, 2021, 13(7): 8270-8277.