前瞻性靶向护理对老年脑胶质瘤患者术后血清创伤标记物及精神心理状态的影响  

Effects of prospective targeted nursing on postoperative serum trauma markers and mental and psychological state in elderly patients with glioma

作　　者：张颖蓓[1] 倪芳芳[1] 陈家伟 张瑶瑾[1] 唐琦[1] Zhang Yingbei;Ni Fangfang;Chen Jiawei;Zhang Yaojin;Tang Qi(Department of Intensive Care Medicine of Center Hospital of Jing an District,Shanghai,200040,P.R.China)

机构地区：[1]上海市静安区中心医院重症医学科,上海200040

出　　处：《老年医学与保健》2024年第1期128-133,共6页Geriatrics & Health Care

基　　金：复旦大学—复星护理科研基金项目(FNF202238)。

摘　　要：目的探究前瞻性靶向护理干预措施对老年脑胶质瘤患者术后血清创伤性标记物及术后精神心理状态的影响。方法采用随机对照研究方法,选取2021年11月—2023年11月于上海市静安区中心医院重症医学科进行治疗的94例老年脑胶质瘤术后患者,根据入院编号单双号,采用随机信封抽签原则将纳入对象分为观察组(n=47)与对照组(n=47)。患者均在全麻下行手术治疗,观察组予前瞻性靶向护理干预措施,对照组予以神经外科围手术期常规护理,2组干预观察时间均为14 d。分别于干预前后检测并比较2组患者血清应激反应指标[促肾上腺皮质激素(ACTH)、皮质醇(Cs)]水平、氧化损伤指标[肌红蛋白(MYo)、缺血修饰清蛋白(IMA)、八廓环磷酰胺(TAC)]水平、血清疼痛指标[皮质醇(Cor)、白细胞介素-6(IL-6)、前列腺素E2(PGE2)]水平;同时采用美国国立卫生研究院卒中量表(NIHSS)、世界卫生组织生活质量简表(QOL-BREF)量表、汉密尔顿抑郁量表(HAMD)和汉密尔顿焦虑量表(HAMA)评估并比较2组患者神经功能缺损程度、生活质量情况、抑郁及焦虑程度。结果干预14 d,2组患者血清Cor、IL-6、PGE2、IMA、MYo、Cs、ACTH均明显低于同组干预前(P<0.01),且观察组较对照组更低(P<0.01);而2组患者血清TAC均明显高于同组干预前,且观察组较对照组更高(P<0.01);2组HAMA、HAMD、NIHSS评分均明显低于同组干预前(P<0.01),且观察组较对照组更低(P<0.01);而2组QOL-BREF评分均明显高于同组干预前(P<0.01),且观察组较对照组更高(P<0.01)。结论前瞻性靶向护理干预措施可能有效改善老年脑胶质瘤患者术后的心理应激反应,缓解其术后精神心理状态,同时可明显减轻手术创伤对患者的疼痛程度,减轻氧化应激损伤,有助于促进患者提高生活质量。Objective To investigate the effects of prospective targeted nursing on postoperative serum trauma markers and mental and psychological state in elderly patients with glioma.Methods A randomized controlled study was used to select 94 elderly patients with glioma who underwent surgery in the Department of Intensive Care Medicine of Central Hospital of Jing an District from November 2021 to November 2023.They were randomly divided into observation group(47 cases)and control group(47 cases)according to their admission numbers(odd or even).All patients underwent surgical treatment under general anesthesia.The observation group received prospective targeted nursing interventions,while the control group received routine perioperative neurosurgery nursing.The intervention observation time of both groups was 14 days.The levels of serum stress response indexes[adrenocorticotropic hormone(ACTH),cortisol(Cs)],oxidative damage indexes[myoglobin(MYo),ischemic modified albumin(IMA),oct-acyclophosphamide(TAC)],pain indexes[cortisol(Cor),interleukin-6(IL-6),prostaglandin E2(PGE2)]were detected and compared before and after intervention.At the same time,the National Institutes of Health Stroke Scale(NIHSS),World Health Organization Quality of Life Brief(QOL-BREF)scale,Depression Rating Scale(HAMD)and Hamilton Anxiety Rating Scale(HAMA)were used to evaluate the degree of neurological deficits,quality of life,depression and anxiety,respectively,and the scores were compared between the two groups.Results After 14 days of intervention,the levels of serum Cor,IL-6,PGE2,IMA,MYo,Cs and ACTH of the two groups were significantly lower than those of the same group before intervention(P<0.01),and the observation group was lower than the control group(P<0.01),while the level of serum TAC of the two groups was significantly higher than that of the same group before intervention,and the observation group was higher than the control group(P<0.01).The scores of HAMA,HAMD and NIHSS of the two groups were significantly lower than those of the same

关 键 词：老年 胶质瘤 前瞻性靶向性护理 血清创伤性标记物 术后精神心理状态 

分 类 号：R473.73[医药卫生—护理学]