杜俊芳 溫雅
【摘 要】目的:以行胸腔鏡肺癌根治術(shù)患者為例,探究開展循證護(hù)理干預(yù)的作用效果。方法:選取2020年1月至2021年6月時(shí)段我院接收的72例行胸腔鏡肺癌根治術(shù)患者為對(duì)象,以數(shù)字號(hào)(1~72)形式隨機(jī)分設(shè)組別,即對(duì)照組、觀察組,各組例數(shù)36例。選擇行常規(guī)護(hù)理干預(yù)對(duì)照組患者,選擇行循證護(hù)理干預(yù)觀察組患者。以肺功能指標(biāo)、VAS評(píng)分、生存質(zhì)量評(píng)分、術(shù)后并發(fā)癥率為判定指標(biāo),對(duì)不同護(hù)理干預(yù)后取得效果分析。結(jié)果:干預(yù)后,對(duì)照組的肺功能指標(biāo)低于觀察組(P<0.05);對(duì)照組的VAS評(píng)分高于觀察組(P<0.05);對(duì)照組術(shù)后并發(fā)癥率22.22%,高于觀察組的5.56%(P<0.05);對(duì)照組生存質(zhì)量評(píng)分低于觀察組(P<0.05)。結(jié)論 對(duì)行胸腔鏡肺癌根治術(shù)患者開展循證護(hù)理干預(yù),效果佳,降低患者疼痛感,肺功能指標(biāo)改善,減少術(shù)后并發(fā)癥,提高生存質(zhì)量。
【關(guān)鍵詞】胸腔鏡肺癌根治術(shù);循證護(hù)理;生活質(zhì)量
Application of evidence-based nursing in patients undergoing thoracoscopic radical resection of lung cancer and its influence on their quality of life
DU Junfang, WEN Ya
Shanxi Cancer Hospital, Shanxi, Taiyuan 030013, China
【Abstract】Objective:To explore the effect of evidence-based nursing intervention in patients undergoing thoracoscopic radical resection of lung cancer. Methods:From January 2020 to June 2021, 72 patients who underwent thoracoscopic radical resection of lung cancer in our hospital were randomly divided into control group and observation group, with 36 cases in each group. Patients in the control group who received routine nursing intervention and patients in the observation group who received evidence-based nursing intervention were selected. Taking pulmonary function index, VAS score, quality of life score and postoperative complication rate as the judging indexes, the effect of different nursing interventions was analyzed. Results:After the intervention, the pulmonary function index of the control group was lower than that of the observation group(P<0.05). The VAS score of the control group was higher than that of the observation group(P<0.05). The postoperative complication rate of the control group was 22.22%, which was higher than that of the observation group (5.56%,P<0.05). The quality of life score of the control group was lower than that of the observation group(P<0.05). Conclusion:Evidence-based nursing intervention for patients undergoing thoracoscopic radical resection of lung cancer has a good effect, reducing pain, improving lung function index, reducing postoperative complications and improving quality of life.
【Key Words】Thoracoscopic radical resection of lung cancer; Evidence-based nursing; quality of life
胸腔鏡肺癌根治術(shù)是目前臨床治療肺癌疾病的常用方法之一,因其具有術(shù)中出血量小、手術(shù)切口小等優(yōu)勢(shì),深受患者青睞。然而,雖然該術(shù)式應(yīng)用給患者帶來的傷害小,但其仍屬于有創(chuàng)操作,能對(duì)患者肺部換氣功能帶來一定程度影響,所以,在行手術(shù)治療時(shí),護(hù)理干預(yù)的開展非常重要。循證護(hù)理是一種新型護(hù)理方法,通過有效結(jié)合肺癌患者自身特點(diǎn)和翻找的研究結(jié)果,并開展有效科學(xué)護(hù)理措施,對(duì)患者術(shù)后恢復(fù)有重要作用[1]。故而,本文以我院接收的72例行胸腔鏡肺癌根治術(shù)患者為對(duì)象,就開展循證護(hù)理的效果價(jià)值做分析研究。
1.1 一般資料
選取2020年1月至2021年6月時(shí)段我院接收的72例行胸腔鏡肺癌根治術(shù)患者為對(duì)象,以數(shù)字號(hào)(1~72)形式隨機(jī)劃分兩組,即對(duì)照組、觀察組,每組例數(shù)36例。對(duì)照組,男21例,女15例,年齡35歲~71歲,平均年齡(54.71±2.13)歲,腺癌19例、鱗癌17例;觀察組,男20例,女16例,年齡35歲~71歲,平均年齡(54.69±2.21)歲,腺癌18例,鱗癌18例。病例差異?。≒>0.05)。
1.2 入選與剔除標(biāo)準(zhǔn)
1.2.1 入選標(biāo)準(zhǔn) 研究所選對(duì)象經(jīng)影像學(xué)檢查、病理學(xué)檢查均確診為肺癌;所選對(duì)象年齡均不低于35歲,但未超過71歲;選取患者均知曉同意研究進(jìn)行。
1.2.2 剔除標(biāo)準(zhǔn) 伴心腦血管病癥者;伴關(guān)鍵器官功能障礙者;伴認(rèn)知能力低下、言語(yǔ)溝通障礙者;對(duì)研究進(jìn)行不配合者。
1.3 方法
選擇行常規(guī)護(hù)理干預(yù)對(duì)照組患者,對(duì)患者生命體征情況密切觀察,并將相關(guān)注意事項(xiàng)及時(shí)告知患者;患者服藥前,并叮囑其遵醫(yī)囑按時(shí)按量用藥,并保持引流暢通。
選擇行循證護(hù)理干預(yù)觀察組患者,(1)問題提出:在期刊數(shù)據(jù)庫(kù)內(nèi)以“臨床護(hù)理、胸腔鏡肺癌根治術(shù)”為關(guān)鍵詞進(jìn)行檢索發(fā)現(xiàn),研究主要集中于治療效果促進(jìn)、生存質(zhì)量改善等方面。(2)問題成因明確:①并發(fā)癥多發(fā),原因有護(hù)理人員缺少防控意識(shí),護(hù)理全面性、規(guī)范性差。②生存質(zhì)量不佳,原因有缺少對(duì)患者情緒狀況的重視,缺少疼痛護(hù)理的開展。(3)循證護(hù)理實(shí)施:①護(hù)理人員應(yīng)積極主動(dòng)和患者對(duì)話溝通,從治療和病情兩方面著手,對(duì)胸腔鏡肺癌根治術(shù)效果明確。②對(duì)于疼痛不耐受者,護(hù)理人員可根據(jù)患者喜好引導(dǎo)其手工制作、看視頻等,將注意力轉(zhuǎn)移,從心理角度使疼痛感改善。③訓(xùn)練患者排痰,指導(dǎo)患者前傾身體,引導(dǎo)其深呼吸至最大程度,隨后進(jìn)行2~4s屏息,對(duì)患者背部拍打,引導(dǎo)患者連續(xù)請(qǐng)客,隨后將咳嗽力度加大,從而有效排除痰液。④呼吸功能訓(xùn)練,指導(dǎo)患者平臥,頭部適當(dāng)抬高,交叉雙臂疊放于起步,用鼻緩慢吸氣,隆起腹部,隨后緩慢呼氣,排出全部氣體,2~4次每日,20~40min/次。
1.4 評(píng)價(jià)標(biāo)準(zhǔn)
干預(yù)前后,評(píng)估患者疼痛情況,選用VAS(視覺模擬評(píng)分法)進(jìn)行,分值0分(無痛)至10分(劇烈疼痛),評(píng)分越高說明患者疼痛感越明顯[2]。
干預(yù)前后,評(píng)估患者生存質(zhì)量情況,選用生存質(zhì)量評(píng)價(jià)量表進(jìn)行,項(xiàng)目包括呼吸狀況和疼痛狀況、營(yíng)養(yǎng)狀況和情緒狀態(tài),各項(xiàng)目分值25分,100分為總分,評(píng)分越高說明患者生存質(zhì)量越好[3]。
觀察分析治療前后對(duì)照組、觀察組的FEV1(1秒用力呼氣容積)、FVC(用力肺活量)和PEF(最高呼氣流速)指標(biāo)情況。
1.5 統(tǒng)計(jì)學(xué)分析
采用SPSS 25.0統(tǒng)計(jì)學(xué)軟件進(jìn)行數(shù)據(jù)分析。計(jì)數(shù)資料采用(%)表示,進(jìn)行χ2檢驗(yàn),計(jì)量資料采用(χ±s)表示,進(jìn)行t檢驗(yàn),P<0.05為差異具有統(tǒng)計(jì)學(xué)意義。
2.1 對(duì)比肺功能指標(biāo)
比較患者肺功能指標(biāo),干預(yù)前,對(duì)照組、觀察組數(shù)據(jù)評(píng)分結(jié)果比較,差異無統(tǒng)計(jì)意義(P>0.05);干預(yù)后,較對(duì)照組,觀察組數(shù)據(jù)結(jié)果更高(P<0.05),見表1。
2.2 對(duì)比VAS評(píng)分、術(shù)后并發(fā)癥率
比較患者VAS評(píng)分,干預(yù)前后,對(duì)照組、觀察組組間數(shù)據(jù)結(jié)果相比,干預(yù)前高于干預(yù)后(P<0.05);干預(yù)前,兩組數(shù)據(jù)結(jié)果比較,差異?。≒>0.05);干預(yù)后,較對(duì)照組,觀察組數(shù)據(jù)結(jié)果更低(P<0.05),見表2。術(shù)后,對(duì)照組并發(fā)癥率22.22%(8/36),心律失常3例、肺炎3例、肺不張2例;觀察組并發(fā)癥率5.56%(2/36),心律失常1例、肺炎1例。兩組比較,對(duì)照組高于觀察組(2χ=4.181,P=0.041<0.05)。
2.3 對(duì)比生存質(zhì)量評(píng)分
比較患者生存質(zhì)量評(píng)分,干預(yù)后,較對(duì)照組,觀察組數(shù)據(jù)評(píng)分結(jié)果更高(P<0.05),見表3。
肺癌是臨床常見腫瘤疾病,以肺部慢性炎癥、環(huán)境污染和吸煙等為主要發(fā)病機(jī)制,易誘發(fā)患者出現(xiàn)出現(xiàn)胸痛和咳痰、咳嗽和低熱等癥狀[4]。胸腔鏡肺癌根治術(shù)是臨床治療肺癌的的一種主要外科治療方法,具有術(shù)后恢復(fù)快、創(chuàng)傷小等優(yōu)勢(shì)。在此次研究中,予以行胸腔鏡肺癌根治術(shù)患者實(shí)施循證護(hù)理干預(yù)。經(jīng)對(duì)臨床護(hù)理總結(jié)與特點(diǎn)問題的研究,對(duì)臨床護(hù)理問題加以明確,從患、護(hù)層面出發(fā)對(duì)問題成因分析,對(duì)相應(yīng)護(hù)理干預(yù)措施確定,于臨床中開展。在本次研究中,以我院接收的72例行胸腔鏡肺癌根治術(shù)患者為對(duì)象,經(jīng)上述歸納總結(jié)可知,采取循證護(hù)理方法對(duì)患者進(jìn)行干預(yù),能使患者肺功能得到改善,疼痛感減輕,提高預(yù)后,有較好臨床應(yīng)用價(jià)值。
綜上,對(duì)行胸腔鏡肺癌根治術(shù)患者開展循證護(hù)理干預(yù),效果佳,降低患者疼痛感,肺功能指標(biāo)改善,減少術(shù)后并發(fā)癥,提高生存質(zhì)量,可推廣。
參考文獻(xiàn)
[1] 別愛玉.循證護(hù)理干預(yù)在胸外科行胸腔鏡手術(shù)患者中的應(yīng)用[J].中國(guó)醫(yī)藥指南,2020,18(6):1.
[2] 謝瑩,杜媛媛.胸外科行胸腔鏡手術(shù)患者中應(yīng)用循證護(hù)理干預(yù)措施的臨床效果觀察[J].臨床醫(yī)藥文獻(xiàn)電子雜志,2020,7(100):2.
[3] 孫立梅.胸腔鏡下行肺癌根治術(shù)患者圍手術(shù)期實(shí)施護(hù)理干預(yù)效果體會(huì)[J].中國(guó)保健營(yíng)養(yǎng),2019,29(13):191-192.
[4] 孫立梅.胸腔鏡下行肺癌根治術(shù)患者圍手術(shù)期實(shí)施護(hù)理干預(yù)效果體會(huì)[J].中國(guó)保健營(yíng)養(yǎng),2019,29(13):191-192.