术中神经监测联合循证护理对甲状腺癌全甲状腺切除术后患者声带功能、情绪状态、疼痛及生活质量的影响：一项综合性研究
The impact of intraoperative neuromonitoring combined with evidence-based nursing on vocal cord function, emotional state, pain, and quality of Life in patients after total thyroidectomy for thyroid cancer: a comprehensive study.
作者信息
Chen Dandan, Shang Kun
机构信息
Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
出版信息
Front Oncol. 2025 Jul 15;15:1611729. doi: 10.3389/fonc.2025.1611729. eCollection 2025.
OBJECTIVE
To evaluate the impact of intraoperative neuromonitoring (IONM) combined with evidence-based nursing on vocal function, emotional status, pain levels, and quality of life (QoL) in patients undergoing total thyroidectomy for thyroid cancer.
METHODS
A single-center randomized controlled trial was conducted. The intervention group received IONM with evidence-based nursing, while the control group underwent IONM with conventional nursing. Outcomes were assessed using the Hospital Anxiety and Depression Scale (HADS), Numerical Rating Scale (NRS) for pain, EORTC QLQ-C30 for 1-month postoperative QoL, and Voice Handicap Index simplified Chinese version (VHI-10) combined with laryngoscopy for vocal recovery and complications.
RESULTS
Compared to controls, the intervention group exhibited significantly lower postoperative VHI-10 scores (5 (2, 8) vs 7 (4, 11), <0.001), reduced HADS anxiety scores (5 (2, 8) vs 10 (4, 12), <0.001), and lower 24-hour NRS pain scores (3 (1, 4) vs 4 (2.75, 4.25), <0.001). The intervention group also demonstrated marked improvements in QLQ-C30 global health status (83 (73.75, 86) vs 77 (72.75, 80), =0.001), shorter operative duration (92.467 ± 16.916 vs 107.93 ± 24.26 min, <0.001), reduced intraoperative blood loss (16.5 (9.75, 24) vs 23.5 (11.75, 32) mL, =0.005), and lower postoperative drainage (59 (30, 77.25) vs 82 (46.5, 110.25) mL, =0.001).
CONCLUSION
The integration of IONM with evidence-based nursing significantly enhanced postoperative recovery and QoL in thyroid cancer patients. Future studies should prioritize larger cohorts, long-term follow-up, and comparisons across surgical techniques to strengthen clinical recommendations. This multimodal approach demonstrates significant potential for optimizing patient-centered outcomes in thyroid surgery.
目的
评估术中神经监测（IONM）联合循证护理对甲状腺癌全甲状腺切除患者嗓音功能、情绪状态、疼痛程度及生活质量（QoL）的影响。
方法
进行一项单中心随机对照试验。干预组接受IONM联合循证护理，而对照组接受IONM联合传统护理。使用医院焦虑抑郁量表（HADS）、疼痛数字评定量表（NRS）、术后1个月生活质量的欧洲癌症研究与治疗组织核心问卷（EORTC QLQ-C30）以及简化中文版嗓音障碍指数（VHI-10）并结合喉镜检查来评估嗓音恢复情况和并发症，以此评估结局。
结果
与对照组相比，干预组术后VHI-10评分显著更低（5（2，8）对7（4，11），<0.001），HADS焦虑评分降低（5（2，8）对10（4，12），<0.001），24小时NRS疼痛评分更低（3（1，4）对4（2.75，4.25），<0.001）。干预组在QLQ-C30总体健康状况方面也有显著改善（83（73.75，86）对77（72.75，80），=0.001），手术时间更短（92.467±16.916对107.93±24.26分钟，<0.001），术中失血量减少（16.5（9.75，24）对23.5（11.75，32）毫升，=0.005），术后引流量更低（59（30，77.25）对82（46.5，110.25）毫升，=0.001）。
结论
IONM与循证护理相结合显著提高了甲状腺癌患者的术后恢复情况和生活质量。未来的研究应优先考虑更大的队列、长期随访以及不同手术技术之间的比较，以强化临床建议。这种多模式方法在优化甲状腺手术以患者为中心的结局方面显示出巨大潜力。
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