目的:探讨快速康复外科护理对甲状腺癌根治术患者疼痛程度及应激反应的影响。
方法:在这项回顾性研究中,分析2020年11月至2022年10月在平矿总医院接受甲状腺癌根治术的100例患者的临床资料.在患者中,56例接受快速康复外科护理的患者被分配到研究组,另外44例接受常规护理的患者被分配到对照组。比较两组甲状腺激素水平,疼痛程度,应激反应,恢复时间,住院时间,焦虑和抑郁,护理满意度,以及并发症的发生率。
结果:疼痛评分,恢复时间,研究组住院时间和住院时间均低于对照组(均P<0.05)。术后48小时,两组促甲状腺激素(TSH)水平均显著升高,研究组高于对照组。三碘甲状腺原氨酸(T3)和甲状腺素(T4)显著降低,研究组低于对照组(均P<0.05)。手术后一天,两组的血浆皮质醇(Cor)和血管紧张素II(AngII)水平均升高,研究组水平显著低于对照组(均P<0.05)。手术后,焦虑自评量表(SAS)和抑郁自评量表(SDS)评分均降低(P<0.05),研究组SAS、SDS评分明显低于对照组(均P<0.05)。此外,研究组护理满意度高于对照组(P<0.05),研究组术后并发症发生率低于对照组(P<0.05)。年龄,性别,病程,病理类型,护理方法是影响预后的危险因素。Logistic回归分析显示病理类型和护理方法是影响预后的独立危险因素。
结论:对于接受根治性甲状腺切除术的患者,快速康复外科护理能有效减轻术后疼痛和焦虑,缩短恢复时间和住院时间,减少并发症和应激反应的发生率,但是促进手术后更快的恢复,提高生活质量。
OBJECTIVE: To determine the effect of rapid rehabilitation surgery nursing on degree of pain and stress response in patients undergoing radical thyroidectomy for thyroid carcinoma.
METHODS: In this retrospective study, the clinical data of 100 patients who received radical thyroidectomy for thyroid carcinoma in Pingkuang General Hospital between November 2020 and October 2022 were analyzed. Among the patients, 56 who received rapid rehabilitation surgery nursing were assigned to the research group, and the other 44 patients who received routine nursing were assigned to the control group. The two groups were compared for thyroid hormone level, degree of pain, stress response, recovery time, hospitalization time, anxiety and depression, nursing satisfaction, and the incidence of complications.
RESULTS: The pain score, recovery time, and hospitalization time in the research group were all lower than those of the control group (all P < 0.05). 48 hours after operation, the thyroid stimulating hormone (TSH) level of the two groups was significantly increased, and was higher in the research group than the control group. Triodothyronine (T3) and thyroxine (T4) were significantly decreased, and was lower in the research group than the control group (all P < 0.05). One day after operation, the levels of plasma cortisol (Cor) and angiotensin II (Ang II) in both groups were increased, with significantly lower levels in the research group than the control group (all P < 0.05). After surgery, the self-rating anxiety scale (SAS) and self-rating depression scale (SDS) scores in both groups decreased (P < 0.05), with significantly lower SAS and SDS scores in the research group than the control group (all P < 0.05). Additionally, the research group expressed higher nursing satisfaction than the control group (P < 0.05), and the research group showed a lower incidence of postoperative complications than the control group (P < 0.05). Age, gender, course of disease, pathologic type, and nursing method were risk factors affecting the prognosis. Logistic regression analysis showed that pathologic type and nursing method were independent risk factors affecting prognosis.
CONCLUSIONS: For patients undergoing radical thyroidectomy, rapid rehabilitation surgical nursing can effectively reduce postoperative pain and anxiety, shorten recovery time and hospitalization time, decrease incidence of complications and stress response, but promote a fasterrecovery after operation, and improve the quality of life.