预见性护理在腹腔镜结直肠癌根治自然腔道取标本术围术期的应用

The application effect of predictive nursing in the perioperative period of laparoscopic radical colorectal cancer surgery with natural orifice specimen extraction

摘要:

目的探讨预见性护理在腹腔镜结直肠癌根治自然腔道取标本术（natural orifice specimen extraction surgery，NOSES）围术期中的应用效果。方法选取2020 年1 月至2021 年12 月于濮阳市油田总医院行腹腔镜NOSES 结直肠癌根治术患者90 例作为研究对象，采用随机数字表法将其分为对照组（44 例）和观察组（46 例），两组入院后均行腹腔镜结直肠癌根治NOSES 术治疗，对照组给予常规护理干预，观察组在此基础上给予基于快速康复理念的预见性护理，共干预7 d，比较两组患者干预后的临床指标以及干预前后炎症因子水平、疼痛及干预后并发症发生情况。结果干预后，观察组下床活动时间、首次排气时间、住院时间均明显短于对照组（P < 0.05），术中出血量明显少于对照组（P <0.05）；干预3、7 d 后观察组血清C-反应蛋白、肿瘤坏死因子-α水平均明显低于对照组（P < 0.05）；干预1、3、7 d 后观察组疼痛评分均低于对照组（P < 0.05）；观察组并发症发生率低于对照组（P < 0.05）。结论预见性护理可有效改善腹腔镜结直肠癌根治NOSES 患者围手术期临床指标，降低其炎症因子水平，减轻其疼痛感，安全性较高，可在临床推广应用。

Abstract:

Objective This study aims to investigate the application effect of predictive nursing in the perioperative period of natural origin specific extraction surgery (natural orifice specimen extraction surgery，NOSES) for laparoscopic radical resection of colorectal cancer. Methods A total of 90 patients who underwent laparoscopic NOSES radical surgery for colorectal cancer at Puyang Oilfield General Hospital from January 2020 to December 2021 were selected as the research subjects. They were randomly divided into a control group (44 cases) and an observation group (46 cases) based on different intervention methods. Both groups underwent laparo? scopic radical resection of colorectal cancer (NOSES) surgery after admission. The control group received routine nursing intervention， and on this basis，the observation group received predictive nursing based on the concept of rapid recovery for a total of 7 days of inter? vention. Compare the clinical indicators of the two groups of patients after intervention，as well as the levels of inflammatory factors， pain，and complications before and after intervention. Results After intervention，the observation group had significantly shorter time to get out of bed，first exhaust time，and hospitalization time compared to the control group，and the intraoperative bleeding volume was sig? nificantly lower than the control group (P < 0.05). Furthermore，the observation group had significantly lower levels of serum C-reactive protein and tumor necrosis factor-α after 3 and 7 days of intervention compared to the control group (P < 0.05). After 1 day，3 days，and 7 days of intervention，the pain scores of the observation group were lower than those of the control group (P < 0.05). Additionally，the incidence of complications in the observation group was lower than that in the control group (P < 0.05). Conclusion Predictive care could effectively improve perioperative clinical indicators，reduce inflammatory factor levels，and alleviate pain in patients undergoing laparoscopic NOSES radical resection of colorectal cancer. It had a high level of safety and should be promoted in clinical practice.