Intervention effect of nutritional-psychological dual-wheel-driven ERAS nursing on patients in hepatobiliary surgery

doi:10.3760/cma.j.issn.1007-1245.2024.20.027

Abstract

Abstract:

Objective　To investigate the intervention effects of nutritional-psychological dual-wheel-driven enhanced recovery after surgery (ERAS) nursing on nutritional status and psychological stress in patients from hepatobiliary surgery. Methods　A total of 206 patients admitted to Hepatobiliary Surgery, Xianyang Central Hospital from July 2019 to June 2022 were selected as the study objects, and were divided into a control group and an observation group with 103 patients in each group by the random number table method. In the control group, there were 75 males and 28 females, aged 18-65 (45.25±6.30) years, and there were 16 cases of pancreatic cancer, 20 cases of gallbladder cancer, 53 cases of hepatocellular carcinoma, and 14 cases of intrahepatic bile duct carcinoma. There were 73 males and 30 females in the observation group, aged 18-65 (46.04±6.78) years, and there were 17 cases of pancreatic cancer, 20 cases of gallbladder cancer, 54 cases of hepatocellular carcinoma, and 12 cases of intrahepatic bile duct carcinoma. The control group adopted the conventional perioperative accelerated nursing program, while the observation group adopted the nutritional-psychological dual-wheel-driven ERAS nursing program (constructing a multidisciplinary team, carrying out simultaneous nutritional and psychological assessment and intervention) until 72 h after surgery. The differences in terms of demographic data, clinical data, wound healing, body weight, length of hospital stay, gastrointestinal function recovery, Nutritional Risk Screening 2002 (NRS2002) score, Self-rating Anxiety Scale (SAS) score, and comprehensive line length of appetite Visual Analogue Scale (VAS) were compared between the two groups. t test, ANOVA, and χ² test were used. Results　The postoperative first exhaust time, first feeding time, first defecation time, length of hospital stay, and wound healing time in the observation group were shorter than those in the control group [(14.84±4.36) h vs. (16.47±5.08) h, (11.20±2.19) h vs. (12.65±2.50) h, (48.48±6.43) h vs. (54.16±7.38) h, (9.37±2.09) d vs. (10.26±2.47) d, (6.38±2.05) d vs. (8.76±3.14) d] (all P<0.05). There was no statistically significant difference in the NRS2002 score between the two groups at admission (P>0.05). The NRS2002 score of the observation group was lower than that of the control group 24 h before surgery and on the next day after surgery (t=2.487 and 3.481, both P<0.05). Overall comparison: the differences among groups, time, and interactions were statistically significant (all P<0.001). There was no statistically significant difference in the SAS score or comprehensive line length of appetite VAS between the two groups at admission (both P>0.05). The SAS score of the observation group on the next day after surgery was lower than that of the control group at the same time point and that of the observation group at admission (both P<0.001). The comprehensive line length of appetite VAS in the observation group on the next day after surgery was longer than that in the control group at the same time point and that of the observation group at admission (both P<0.001). There was no statistically significant difference in the body weight of the observation group between on the next day after surgery and at admission (P>0.05), while the body weight of the control group on the next day after surgery was lower than that at admission (t=2.205, P=0.030), and the body weight of the observation group was higher than that of the control group on the next day after surgery (t=2.197, P=0.029). Conclusion　Nutritional-psychological dual-wheel-driven ERAS nursing program can effectively shorten the postoperative recovery time of gastrointestinal function in patients from hepatobiliary surgery, promote the improvement of patients' nutritional status, reduce the postoperative anxiety, promote the recovery of appetite, and avoid the postoperative weight loss, which contributes to the rapid recovery of the disease.

Key words:

Enhanced recovery after surgery, Hepatobiliary surgery, Nutrition, Psychological stress

摘要：

目的　探讨营养心理双轮驱动的加速康复外科（enhanced recovery after surgery，ERAS）护理对肝胆外科患者的营养与心理应激的干预效果。方法　选取2019年7月至2022年6月就诊于咸阳市中心医院肝胆外科的206例患者作为研究对象，采用随机数字表法将患者分为对照组和观察组各103例。对照组中男75例、女28例；年龄18～65（45.25±6.30）岁；胰腺癌16例、胆囊癌20例、肝细胞癌53例、肝内胆管癌14例。观察组中男73例、女30例；年龄18～65（46.04±6.78）岁；胰腺癌17例、胆囊癌20例、肝细胞癌54例、肝内胆管癌12例。对照组采用常规围手术期加速护理方案，观察组采用营养心理双轮驱动的ERAS护理方案（构建多学科团队、进行营养与心理的同步评估及干预），干预至术后72 h结束。比较两组患者人口学资料、临床资料、伤口愈合情况、体重、住院天数、胃肠功能恢复情况、营养风险筛查2002（Nutritional Risk Screening 2002，NRS2002）评分、焦虑自评量表（SAS）评分、食欲视觉模拟评分法（VAS）综合线段长度。采用t检验、方差分析、χ²检验。结果　观察组患者术后首次排气时间、首次进食时间、首次排便时间、住院天数、伤口愈合时间均短于对照组［（14.84±4.36）h比（16.47±5.08）h、（11.20±2.19）h比（12.65±2.50）h、（48.48±6.43）h比（54.16±7.38）h、（9.37±2.09）d比（10.26±2.47）d、（6.38±2.05）d比（8.76±3.14）d］（均P<0.05）。两组患者入院时NRS2002评分比较，差异无统计学意义（P>0.05）；观察组患者术前24 h、术后次日的NRS2002评分均低于对照组同期（t=2.487、3.481，均P<0.05）；整体比较：组间、时间、交互差异均有统计学意义（均P<0.001）。两组患者入院时SAS评分、食欲VAS综合线段长度比较，差异均无统计学意义（均P>0.05）；观察组患者术后次日的SAS评分低于对照组同期及本组入院时（均P<0.001）；观察组患者术后次日的食欲VAS综合线段长度长于对照组同期及本组入院时（均P<0.001）。观察组术后次日体重与本组入院时比较差异无统计学意义（P>0.05），对照组术后次日体重较入院时有所下降（t=2.205，P=0.030），且观察组术后次日体重大于对照组（t=2.197，P=0.029）。结论　营养心理双轮驱动的ERAS护理方案能够有效缩短肝胆外科患者术后胃肠功能恢复时间，促进患者营养状态改善，减轻术后焦虑情绪，促进食欲恢复，避免术后体重下降，有利于疾病的快速康复。

关键词:

加速康复外科, 肝胆外科, 营养, 心理应激

Li Hongmei, Cui Liping, Si Ying.

Intervention effect of nutritional-psychological dual-wheel-driven ERAS nursing on patients in hepatobiliary surgery [J]. International Medicine and Health Guidance News, 2024, 30(20): 3481-3486.

李红梅崔利萍司莹.

营养心理双轮驱动的ERAS护理对肝胆外科患者的干预效果 [J]. 国际医药卫生导报, 2024, 30(20): 3481-3486.

References

[1] O'Dowd DN, Bostock EL, Smith D, et al. Psychological parameters impact health-related quality of life in mental and physical domains in adults with muscular dystrophy[J]. Neuromuscul Disord, 2021, 31(4):328-335. DOI: 10.1016/j.nmd.2021.01.007.
[2] Rocinholi LF, Landeira-Fernandez J. Anxiety-like behavior in weanling and young adult male and female malnourished rats[J]. Physiol Behav, 2011, 102(1):13-16. DOI: 10.1016/j.physbeh.2010.09.017.
[3] Sun YM, Wang Y, Mao YX, et al. The safety and feasibility of enhanced recovery after surgery in patients undergoing pancreaticoduodenectomy: an updated meta-analysis[J]. Biomed Res Int, 2020, 2020:7401276. DOI: 10.1155/2020/7401276.
[4] 中华医学会外科学分会,中华医学会麻醉学分会.加速康复外科中国专家共识及路径管理指南(2018版)[J].中国实用外科杂志,2018,38(1):1-20. DOI:10.19538/j.cjps.issn1005-2208.2018.01.01.
[5] 董敏,郭文巍,刘辉,等.加速康复外科理念下全麻电视辅助胸腔镜肺部切除术患者安全进食时间的探讨[J].国际医药卫生导报,2022,28(11):1610-1614. DOI:10.3760/cma.j.issn.1007-1245.2022.11.031.
[6] 叶志霞.加速康复外科理念在肝切除围手术期护理中的应用思考[J].上海护理,2022,22(10):1-5. DOI:10.3969/j.issn.1009-8399.2022.10.001.
[7] 陈亚进.ERAS理念与精准微创肝切除[J].中华医学信息导报,2021,36(22):15. DOI:10.3760/cma.j.issn.1000-8039. 2021.22.127.
[8] Chen X. A novel nomogram based on the nutritional risk screening 2002 score to predict survival in hepatocellular carcinoma treated with transarterial chemoembolization[J]. Nutr Hosp, 2022, 39(4):835-842. DOI: 10.20960/nh.03983.
[9] Silva DMD, Henz AC, Fernandes SA, et al. Nutritional diagnosis of patients with hepatocellular carcinoma: what is the best method?[J]. Nutr Hosp, 2019, 36(4):884-889. DOI: 10.20960/nh.02542.
[10] Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population[J]. Nutr Hosp, 2005, 20(1):38-45.
[11] 齐玉梅,李增宁,李晓玲,等.肿瘤患者食欲评价和调节的专家共识[J/CD].肿瘤代谢与营养电子杂志,2020,7(2):169-177. DOI:10.16689/j.cnki.cn11-9349/r.2020.02.007.
[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版)[J].中国实用外科杂志,2021,41(9):961-992. DOI:10.19538/j.cjps.issn1005- 2208.2021.09.01.
[13] 周康源,周涛.肝胆术后胃肠功能恢复策略的研究进展[J].医学综述,2021,27(7):1385-1389. DOI:10.3969/j.issn.1006-2084.2021.07.025.
[14] 汪洁,裴丽燕,芦亚男,等.基于证据临床应用的多学科协作加速康复外科模式在肝切除患者护理中的应用[J].中华现代护理杂志,2021,27(14):1883-1888. DOI:10.3760/cma.j.cn115682-20200924-05520.
[15] 孙彬,赵海平,张娜.肝癌病人营养不良管理的研究进展[J].循证护理,2022,8(16):2206-2208. DOI:10.12102/j.issn.2095-8668.2022.16.015.
[16] 尹腾飞.老年消化道肿瘤患者营养不良与焦虑抑郁现况及相关影响分析[D].济南:山东大学,2019.
[17] Grim-Stieger M, Keilani M, Mader RM, et al. Serum levels of tumour necrosis factor-alpha and interleukin-6 and their correlation with body mass index, weight loss, appetite and survival rate--preliminary data of Viennese outpatients with metastatic cancer during palliative chemotherapy[J]. Eur J Cancer Care (Engl), 2008, 17(5):454-462. DOI: 10.1111/j.1365-2354.2007.00874.x.
[18] 余恺涛,贾杰.全周期康复视角下的肝癌相关指南及专家共识解读[J].中国医刊,2022,57(1):18-21. DOI:10.3969/j.issn.1008-1070.2022.01.006.
[19] 陈莹,张雅敏.围手术期肠内、外营养治疗在肝切除术后患者快速康复中的作用[J].天津医科大学学报,2021,27(4):384-387.
[20] 陈颖君,卞晓洁,陈大宇,等.多学科联合营养测评在肝癌病人营养评估中的价值和护理体会[J].肠外与肠内营养,2020,27(2):94-99. DOI:10.16151/j.1007- 810x.2020.02.007.
[21] 周超军,陈磊,蔡斌斌,等.术前CONUT评分预测HBV相关的HCC患者术后生存率[J].肝胆胰外科杂志,2019,31(6):329-334. DOI:10.11952/j.issn.1007-1954.2019.06.003.
[22] Chen L, Zhao M, Tan L, et al. Effects of five-step nutritional interventions conducted by a multidisciplinary care team on gastroenteric cancer patients undergoing chemotherapy: a randomized clinical trial[J]. Nutr Cancer, 2023, 75(1):197-206. DOI: 10.1080/01635581.2022. 2104329.
[23] 中国抗癌协会肿瘤营养专业委员会,全国卫生产业企业管理协会医学营养产业分会,浙江省医学会肿瘤营养与治疗学分会.肿瘤患者食欲下降的营养诊疗专家共识[J/CD].肿瘤代谢与营养电子杂志,2022,9(3):312-319. DOI:10.16689/j.cnki.cn11-9349/r.2022.03.007.