手术室程序化护理在腹腔镜下结直肠癌根治术中的应用及对患者免疫功能、疼痛和预后的影响

【摘要】 目的 :探讨手术室程序化护理在腹腔镜下结直肠癌根治术中的应用及对患者免疫功能、疼痛和预后的影响。方法：选取80例腹腔镜下结直肠癌根治术患者为研究对象，按照随机数字表法将其分为程序化组和对照组各40例。对照组采用常规围术期护理，程序化组在常规护理的基础上进行手术室程序化护理。比较术前及术后3d,两组患者免疫功能（CD3~+、CD4~+、CD8~+、CD4~+/CD8~+）变化，观察术后6h、12h、24h、48h疼痛度[视觉模拟量表（VAS）]变化，分析两组患者预后康复情况（首次肛门排气时间、首次排便时间、下床康复时间）。结果：两组患者在手术期前，CD3~+、CD4~+、CD8~+、CD4~+/CD8~+差异均不明显（P> 0.05），术后3d时，程序化组CD3~+、CD4~+、CD8~+、CD4~+/CD8~+水平与术前比较均无统计学意义（P> 0.05），程序化组CD3~+、CD4~+水平均明显高于对照组，而CD8~+明显低于对照组（P <0.05）；两组CD4~+/CD8~+水平比较无统计学意义（P> 0.05）。两组患者术后6h、12h、24h、48hVAS均快速下降，且程序化组明显低于对照组（P <0.05）；干预3d里，程序化组首次肛门排气时间、首次排便时间、下床康复时间明显早于对照组（P <0.05）。结论 :手术室程序化护理在腹腔镜下结直肠癌根治术中可有效提高患者免疫功能，并减缓患者疼痛度，有利于帮助患者实现预后快速康复。更多还原

【Abstract】 Objective to explore the application of programmed nursing care in operation room in laparoscopic radical resection of colorectal cancer and the influence on immune function, pain and prognosis of patients. Methods Eighty patients undergoing laparoscopic colorectal cancer radical resection were selected as the research object and divided into a programmed group and a control group according to the random number table, 40 cases in each group. The control group received routine perioperative care, while the programmed group received programmed care in the operating room on the basis of routine care. The changes of immunologic functions(CD3~+, CD4~+, CD8~+, CD4~+/CD8~+) of patients between the two groups before operation and 3d after operation were compared. The changes of pain severity [visual analogue scale(VAS)] at 6h, 12h, 24h and 48h after operation were observed, and the prognosis and rehabilitation situations of patients in the two groups were analyzed(first anal exhaust time, first defecation time and recovery time from bed). Results Before operation, the levels of CD3~+, CD4~+, CD8~+ and CD4~+/CD8~+ in the two groups were not significantly different(P >0.05). On day 3 after operation, the levels of CD3~+, CD4~+, CD8~+ and CD4~+/CD8~+ in the programmed group were not significantly different from those before operation(P > 0.05). The levels of CD3~+ and CD4~+ in the programmed group were significantly higher than those in the control group, while CD8~+ was significantly lower than that in the control group(P < 0.05). There was no significant difference in CD4~+/CD8~+ levels between the two groups(P > 0.05). The 48hVAS of patients in the two groups decreased rapidly at 6h, 12h, 24h and 48 h after operation, and it was significantly lower in the programmed group than in the control group(P < 0.05). On day 3 of intervention, the first flatus time, first defecation time and recovery time under the bed in the programmed group were significantly earlier than those in the control group(P <0.05). Conclusion The programmed nursing in operation room can effectively improve immune function and relieve pain of patients in laparoscopic colorectal cancer radical surgery, which is conducive to achieving rapid recovery from prognosis.更多还原