围术期预见性护理对肝癌射频消融术患者的影响

doi:10.3760/cma.j.issn.1007-1245.2023.05.027

摘要/Abstract

摘要：

目的　观察围术期预见性护理对肝癌射频消融术患者自我护理能力、不良情绪及并发症的影响。方法　收集2021年1月至2022年8月在河南省中医院行射频消融术的肝癌患者92例，按护理方式不同随机平均分为两组。对照组46例，男32例，女14例，年龄（52.71±5.68）岁，采用围术期常规护理；观察组46例，男30例，女16例，年龄（52.68±5.72）岁，在围术期常规护理基础上采用围术期预见性护理。观察护理前后患者自我护理能力（健康知识掌握、自护能力、自护责任感、自我概念），抑郁自评量表（SDS）、焦虑自评量表（SAS）评分。比较患者术后肛门首次排气时间、肠鸣音恢复时间和首次排便时间，术后6 h、12 h、24 h、48 h患者疼痛强度，术后并发症。计量资料采用t检验，计数资料采用χ²检验。结果　观察组护理后健康知识掌握、自护技能、自护责任感、自我概念评分分别为（56.26±6.75）分、（39.15±4.31）分、（22.64±3.62）分、（25.69±4.19）分，均高于同期对照组［（50.42±6.03）分、（32.19±4.02）分、（18.62±3.45）分、（22.61±4.05）分］，两组比较差异均有统计学意义（t=-4.736、-5.643、-4.183、-6.582，均P<0.001）。观察组护理后SDS和SAS评分分别为（39.42±4.21）分、（34.62±3.71）分，均低于同期对照组［（45.26±5.23）分、（40.29±4.65）分］，两组比较差异均有统计学意义（t=5.899、6.465，均P<0.001）。观察组护理后肛门首次排气时间、肠鸣音恢复时间和首次排便时间分别为（21.54±2.03）h、（31.28±2.76）h、（28.19±2.18）h，均短于同期对照组［（28.36±2.25）h、（46.26±3.15）h、（37.71±2.64）h］，两组比较差异均有统计学意义（t=15.826、17.526、14.625，均P<0.001）。观察组术后6 h、12 h、24 h、48 h视觉模拟评分量表（VAS）评分分别为（7.05±0.49）分、（5.18±0.43）分、（4.19±0.39）分、（3.52±0.34）分，均低于同期对照组［（7.56±0.51）分、（6.85±0.48）分、（4.96±0.41）分、（4.05±0.39）分］，两组比较差异均有统计学意义（t=4.891、9.182、6.426、13.462，均P<0.001）。观察组术后并发症发生率13.0%（6/46），低于对照组的54.3%（25/46）（χ²=17.563，P<0.001）。结论　围术期预见性护理可提高肝癌患者射频消融术后的自我护理能力，减轻患者抑郁焦虑和疼痛，降低并发症的发生率。

关键词:

肝癌, 射频消融术, 自我护理能力, 不良情绪, 并发症, 围术期, 预见性护理

Abstract:

Objective　To observe the effects of perioperative predictive nursing on self-care ability, adverse emotions, and complications in patients with liver cancer undergoing radiofrequency ablation. Methods　A total of 92 patients with liver cancer who underwent radiofrequency ablation in Henan Provincial Hospital of Traditional Chinese Medicine from January 2021 to August 2022 were collected. They were randomly divided into 2 groups according to different nursing methods. In the control group, 46 patients [32 males and 14 females, aged (52.71±5.68) years] received routine nursing during the perioperative period. In the observation group, 46 patients [30 males and 16 females, aged (52.68±5.72) years] received predictive nursing on the basis of routine nursing during the perioperative period. The self-care ability (health knowledge mastery, self-care ability, self-care responsibility, and self-concept) and scores of Self-Rating Depression Scale (SDS) and Self-Rating Anxiety Scale (SAS) were observed before and after nursing. The first anal exhaust time, bowel sound recovery time, first defecation time, pain intensity 6 h, 12 h, 24 h, and 48 h after surgery, postoperative complications were compared. t test was used for the measurement data, and χ² test was used for the count data. Results　The scores of health knowledge mastery, self-care ability, self-care responsibility, and self-concept in the observation group after nursing were (56.26±6.75) points, (39.15±4.31) points, (22.64±3.62) points, and (25.69±4.19) points, respectively, which were higher than those in the control group [(50.42±6.03) points, (32.19±4.02) points, (18.62±3.45) points, and (22.61±4.05) points], with statistically significant differences between the two groups (t=-4.736, -5.643, -4.183, and -6.582; all P<0.001). The SDS and SAS scores of the observation group after nursing were (39.42±4.21) points and (34.62±3.71) points, respectively, which were lower than those of the control group [(45.26±5.23) points and (40.29±4.65) points], with statistically significant differences between the two groups (t=5.899 and 6.465; both P<0.001). The first anal exhaust time, bowel sound recovery time, and first defecation time in the observation group after nursing were (21.54±2.03) h, (31.28±2.76) h, and (28.19±2.18) h, respectively, which were shorter than those in the control group [(28.36±2.25) h, (46.26±3.15) h, and (37.71±2.64) h], with statistically significant differences between the two groups (t=15.826, 17.526, and 14.625; all P<0.001). The Visual Analogue Scale (VAS) scores of the observation group 6 h, 12 h, 24 h, and 48 h after surgery were (7.05±0.49) points, (5.18±0.43) points, (4.19±0.39) points, and (3.52±0.34) points, respectively, which were lower than those of the control group [(7.56±0.51) points, (6.85±0.48) points, (4.96±0.41) points, and (4.05±0.39) points], with statistically significant differences between the two groups (t=4.891, 9.182, 6.426, and 13.462; all P<0.001). The incidence of postoperative complications in the observation group was 13.0% (6/46), which was lower than that in the control group [54.3% (25/46)] (χ²=17.563, P<0.001). Conclusion　Perioperative predictive nursing can improve the self-care ability in patients with liver cancer after radiofrequency ablation, reduce their depression, anxiety, and pain, and reduce the occurrence of complications.

Key words:

Liver cancer, Radiofrequency ablation, Self-care ability, Adverse emotions, Complications, Perioperative period, Predictive care

周亚丹.

围术期预见性护理对肝癌射频消融术患者的影响 [J]. 国际医药卫生导报, 2023, 29(5): 708-713.

Zhou Yadan.

Effect of perioperative predictive nursing on patients with liver cancer undergoing radiofrequency ablation [J]. International Medicine and Health Guidance News, 2023, 29(5): 708-713.

参考文献

[1] Huang DQ, Singal AG, Kono Y, et al. Changing global epidemiology of liver cancer from 2010 to 2019: NASH is the fastest growing cause of liver cancer[J]. Cell Metab, 2022, 34(7):969-977.e2. DOI: 10.1016/j.cmet.2022.05.003.
[2] 赫捷,陈万青,沈洪兵,等.中国人群肝癌筛查指南(2022,北京)[J].临床肝胆病杂志,2022,38(8):1739-1758. DOI:10.3969/j.issn.1001-5256.2022.08.007.
[3] 2019年肝癌中西医临床协作专家委员会.原发性肝癌中西医结合介入诊疗专家共识(试行第一版)[J].临床肝胆病杂志,2022,38(1):70-77. DOI:10.3969/j.issn.1001-5256. 2022.01.010.
[4] 王建美,张志洁,张晴.动态三维超声造影在肝癌射频消融术前病灶形态及术后疗效评估中的运用价值[J].国际医药卫生导报,2019,25(15):2513-2516. DOI:10.3760/cma.j.issn.1007-1245.2019.15.035.
[5] 霍传红,张淑红.T淋巴细胞亚群、VEGF、MMP-14检测对肝癌射频消融术后残癌临床评估的价值[J].国际医药卫生导报,2019,25(8):1186-1189. DOI:10.3760/cma.j.issn.1007-1245.2019.08.003.
[6] Zhang L, Qiao L, Zhang M, et al. Comparison of prognosis among patients with colorectal cancer liver metastases treated by surgical resection, radiofrequency ablation and HIFU: a protocol for network meta-analysis[J]. Medicine (Baltimore), 2022, 101(33):e27915. DOI: 10.1097/MD.0000000000027915.
[7] 韩春起.射频消融术治疗肝细胞癌研究进展[J].山西医药杂志,2020,49(9):1104-1106. DOI:10.3969/j.issn.0253- 9926.2020.09.015.
[8] 孙玉,张洪海,龙江,等.肝动脉栓塞联合射频消融间隔时间对小肝癌临床疗效的影响[J].临床肝胆病杂志,2022,38(10):2286-2289. DOI:10.3969/j.issn.1001-5256.2022. 10.016.
[9] Liu Y, Li Y, Gao F, et al. Comparison of transcatheter arterial chemoembolization-radiofrequency ablation and transcatheter arterial chemoembolization alone for advanced hepatocellular carcinoma with macrovascular invasion using propensity score analysis: a retrospective cohort study[J]. J Oncol, 2020, 2020:1341863. DOI: 10.1155/2020/1341863.
[10] 中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等.原发性肝癌规范化病理诊断指南(2015年版)[J].临床肝胆病杂志,2015,31(6):833-839. DOI:10.3969/j.issn.1001-5256.2015. 06.004.
[11] 赵香菊,岳同云.肝癌射频消融术患者的临床护理路径研究[J].中国全科医学,2019,22(S2):219-221.
[12] 杨倩.自我管理导向型5A护理模式在肝癌射频消融术患者中的应用[J].国际护理学杂志,2022,41(13):2412-2416. DOI:10.3760/cma.j.cn221370-20200826-00619.
[13] 陈盈,陈惠敏,蔡汝珠.肝癌射频消融术后相关并发症的原因分析及护理[J].解放军护理杂志,2013,30(24):53-55. DOI:10.3969/j.issn.1008-9993.2013.24.017.
[14] 纪建红,郑群丽,陈思倩,等.TACE联合射频消融术治疗巨块型肝癌的护理[J].介入放射学杂志,2013,22(12):1052-1054. DOI:10.3969/j.issn.1008-794X.2013.12.023.
[15] 刘爽.基于聚焦解决模式的放松训练干预在肝癌射频消融术围术期护理中的应用效果评估[J].黑龙江医学,2022,46(1):76-78. DOI:10.3969/j.issn.1004-5775.2022.01.026.
[16] 安帅,孙文莉.临床护理路径在肝癌射频消融术患者中的应用[J].齐鲁护理杂志,2020,26(5):112-114. DOI:10.3969/j.issn.1006-7256.2020.05.035.
[17] 刘星怡,张艳,李承志.IMB模型在肝癌射频消融术患者护理中的应用[J].齐鲁护理杂志,2018,24(14):11-14. DOI:10.3969/j.issn.1006-7256.2018.14.004.
[18] 戴晓阳. 常用心理评估量表手册[M]. 北京: 人民军医出版社, 2010: 153-156.
[19] 王超,郑柏,桂茂崇,等.超声引导下射频消融术与微创切除术治疗小肝癌的远期预后比较[J].中国现代医学杂志,2021,31(16):7-11. DOI:10.3969/j.issn.1005-8982.2021. 16.002.
[20] 贾哲,张珂,黄容海,等.射频消融联合Hassab术治疗肝癌合并门静脉高压症的临床研究[J].中华肝胆外科杂志,2021,27(1):36-41. DOI:10.3760/cma.j.cn113884-20200627- 00341.
[21] 李旻骏,邓柱鉴,刘昊天,等.再次肝切除术与射频消融治疗亚洲复发性肝细胞癌患者效果比较的Meta分析[J].临床肝胆病杂志,2021,37(5):1103-1109. DOI:10.3969/j.issn.1001-5256.2021.05.025.
[22] 王宁,郑金利,蒋利.手术切除与射频消融治疗符合米兰标准的不同肝段多发肝癌的效果分析[J].临床肝胆病杂志,2020,36(4):792-797. DOI:10.3969/j.issn.1001-5256. 2020.04.017.
[23] 吕素珍,黄旭芳,毛剑婷,等.强化血糖管理在肝癌合并糖尿病患者射频消融围手术期的应用研究[J].介入放射学杂志,2019,28(6):582-585. DOI:10.3969/j.issn.1008- 794X.2019.06.018.
[24] 颜兵,尤锦,王玉群.肝动脉化疗栓塞联合CT引导下射频消融序贯治疗老年原发性肝癌的临床疗效[J].中国老年学杂志,2018,38(6):1348-1350. DOI:10.3969/j.issn.1005- 9202.2018.06.029.
[25] 张发鹏,袁荣发,张引,等.腹腔镜下射频消融治疗小肝癌的临床疗效分析[J].中国普通外科杂志,2018,27(1):35-41. DOI:10.3978/j.issn.1005-6947.2018.01.006.
[26] 魏矿荣,彭侠彪,梁智恒,等.全球肝癌流行概况[J].中国肿瘤,2015,24(8):621-630. DOI:10.11735/j.issn.1004-0242. 2015.08.A001.
[27] 李科,林国桢,李燕,等.广州市2004-2013年原发性肝癌流行现况和趋势分析[J].中华肿瘤防治杂志,2016,23(23):1527-1530. DOI:10.16073/j.cnki.cjcpt.2016.23.001.
[28] 中国抗癌协会肝癌专业委员会.中国肿瘤整合诊治指南-肝癌(2022精简版)[J].中国肿瘤临床,2022,49(17):865-873. DOI:10.12354/j.issn.1000-8179.2022.20220942.
[29] 施璐璐,陈旭霞,肖宁波,等.预见性护理在行射频消融术治疗的肝癌患者围术期中的应用研究[J].现代实用医学,2021,33(7):943-944. DOI:10.3969/j.issn.1671-0800. 2021.07.048.