Li Min, Jiang Zhiwei, Xu Rui, Shao Mingyue, Mao Juexia, Zeng Yue, Zhu Tingting
Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Provincial Hospital of Chinese Medicine, Nanjing 210029, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2023 Jul;54(4):746-751. doi: 10.12182/20230760505.
To examine the effect of perioperative precision nursing care of enhanced recovery after surgery (ERAS) on the postoperative recovery, stress response, and psychological state of colorectal cancer patients.
A total of 100 patients undergoing elective laparoscopic colorectal cancer surgery were randomly assigned to an experimental group and a control group, with 50 patients in each group. The experimental group received systematic, standardized, and specialized precision nursing care in three stages, the preoperative, intraoperative, and postoperative stages, while the control group received routine nursing care. The main outcome indicators compared between the two groups included the time of the first postoperative passage of flatus and stool, ambulation, liquid-diet meal, postoperative length-of-stay, and C-reactive protein (CRP), interleukin-6 (IL-6), and homeostatic model assessment of insulin resistance (HOMR-IR) measured 1 day before surgery and 1, 3, and 5 days after surgery. Secondary outcome indicators included the anxiety and depression levels of patients measured upon admission to the hospital and 48 h after surgery by Self-rating Anxiety Scale (SAS) and Self-rating Sepression Scale (SDS), respectively.
In the experimental group, the time of the first postoperative passage of flatus and stool, ambulation, and liquid-diet meal and the postoperative length-of-stay were all lower than those in the control group. The postoperative CRP and IL-6 levels of the two groups were significantly higher than the preoperative levels, and the control group had higher CRP and IL-6 levels than the experimental group did, all showing significant difference ( <0.05). The two groups presented different stress states at different points of time after surgery, with the CRP and IL-6 levels reaching the highest 3 days after surgery and then dropping to some degree afterwards. The HOMR-IR of the patients in the experimental group was significantly lower than that of the control group and the difference was significant at both 1 d and 3 d after surgery ( <0.05). Comparison of the difference in the anxiety and the depression scores in the two groups showed significant difference ( <0.05). Before discharge, patient satisfaction of the experimental group was significantly higher than that of the control group ( <0.05).
The implementation of ERAS precision nursing care can effectively promote the postoperative recovery of colorectal cancer patients, reduce the perioperative stress response, alleviate anxiety and depression, improve patient satisfaction, and hence should be extensively applied in clinical practice.
探讨围手术期精准护理对结肠癌患者术后恢复、应激反应及心理状态的影响。
选取100例行择期腹腔镜结肠癌手术患者，随机分为实验组和对照组，每组50例。实验组在术前、术中和术后三个阶段接受系统、规范、专业的精准护理，对照组接受常规护理。比较两组的主要结局指标包括术后首次排气排便时间、下床活动时间、进流食时间、术后住院时间，以及术前1天、术后1天、3天和5天测定的C反应蛋白（CRP）、白细胞介素-6（IL-6）和胰岛素抵抗稳态模型评估（HOMR-IR）。次要结局指标包括分别采用焦虑自评量表（SAS）和抑郁自评量表（SDS）在入院时和术后48小时测定的患者焦虑和抑郁水平。
实验组术后首次排气排便时间、下床活动时间、进流食时间和术后住院时间均低于对照组。两组术后CRP和IL-6水平均显著高于术前，且对照组高于实验组，差异均有统计学意义（<0.05）。两组术后不同时间点呈现不同应激状态，CRP和IL-6水平术后3天最高，随后有所下降。实验组患者的HOMR-IR显著低于对照组，术后1天和3天差异均有统计学意义（<0.05）。两组焦虑和抑郁评分差异比较有统计学意义（<0.05）。出院前，实验组患者满意度显著高于对照组（<0.05）。
实施精准护理可有效促进结肠癌患者术后恢复，降低围手术期应激反应，缓解焦虑和抑郁，提高患者满意度，应在临床实践中广泛应用。
