多学科治疗模式联合升降式移动胸车促进外科肺癌术后快速康复的效能及机制  

Efficacy and mechanism of multidisciplinary treatment combined with lifting mobile chest cart to promote rapid recovery after surgical lung cancer surgery

作　　者：李风 胡宏鸯[2] 徐秋丽 张凡 徐东良 Li Feng;Hu Hongyang;Xu Qiuli;Zhang Fan;Xu Dongliang(Zhejiang University,Hangzhou 310009,China;Shaw Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310020,China;Zhejiang Xin’an International Hospital,Jiaxing 314000,China)

机构地区：[1]浙江大学,杭州310009 [2]浙江大学医学院附属邵逸夫医院,杭州310020 [3]浙江新安国际医院,嘉兴314000

出　　处：《中华实验外科杂志》2024年第5期1064-1067,共4页Chinese Journal of Experimental Surgery

基　　金：浙江省医药卫生科技计划项目(2021KY1118)。

摘　　要：目的:观察多学科治疗模式联合升降式移动胸车对外科肺癌术后患者快速康复的应用价值及其对应激反应的影响。方法:选取2022年1月至2023年1月在浙江大学医学院附属邵逸夫医院接受外科肺癌术后的患者80例,根据治疗方法分为对照组和观察组,各40例,其中对照组患者选择传统的常规治疗方法;观察组患者采取基于多学科照护模式联合升降式移动胸车。比较两组患者的手术前后应激障碍程度评分、肺功能、身体活动能力、抑郁情绪评价、血清应激障碍标志物含量变化。结果:干预后,观察组IES-R各维度评分在侵扰、回避、唤醒中应激障碍程度评分均低于对照组(6.87±0.95、9.38±2.96、9.02±1.15比7.65±0.98、10.97±2.83、10.68±2.51),t=0.463、0.365、0.253,P<0.05)。术后28 d观察组患者的肺功能指标FEV1、FEV1/FVC、6 min身体活动能力均高于对照组[(2.20±0.35)L、(76.35±6.58)%、(452.00±22.18)m比(2.01±0.52)L、(72.55±6.14)%、(422±20.14)m,t=1.247、4.268、5.291,P<0.05]。术后观察组负面情绪HAMA和HAMD评分明显低于对照组(6.32±2.31、5.51±2.12比10.66±2.74、8.71±1.99,t=2.363、0.113,P<0.05);观察组患者肺癌术后皮质醇水平低于对照组[(541.72±91.51)nmol/L比(571.20±83.68)nmol/L,t=0.096,P<0.05];观察组患者肺癌术后PGE2水平显著低于对照组[(132.62±72.33)pg/ml比(152.48±69.98)pg/ml,t=0.082,P<0.05]。结论:肺癌手术患者应用基于多学科照护模式联合升降式移动胸车组,可以显著降低患者的创伤后应激障碍程度,改善患者肺功能,同时缓解负面情绪提高身体活动能力,改善患者预后。Objective To observe the application value of multidisciplinary treatment mode combined with lifting mobile chest carriage for rapid rehabilitation of postoperative lung cancer patients and its impact on stress response.Methods Eighty patients with lung cancer who underwent surgical resection in the Sir Run Run Shaw Hospital from January 2022 to 2023 January 2022 were divided into control group(n=40)and observation group(n=40).The patients in the control group were treated with conventional therapy,while the patients in the observation group were treated with the combination of multi-disciplinary care model and lifting mobile chest vehicle.The scores of stress disorder,pulmonary function,physical activity,depressive mood and serum stress disorder markers were compared between the two groups before and after operation.Results After intervention,the scores of impact of event scale-revised of the observation group were lower than those of the control group in the degree of stress disorder in intrusion,avoidance and arousal[(6.87±0.95,9.38±2.96,9.02±1.15 vs.7.65±0.98,10.97±2.83,10.68±2.51,t=0.463,0.365,0.253,P<0.05].Forced Expiratory Volume in one second(FEV1),forced expiratory volume in one second/forced vital capacity(FEV1/FVC),6 min physical activity in observation group were higher than those in control group 28 days after Operation[(2.20±0.35)L,(76.35±6.58)%,(452.00±22.18)m vs.(2.01±0.52)L,(72.55±6.14)%,(422.00±20.14)m,t=1.247,4.268,5.291,P<0.05].The scores of Hama and Hamd in the observation group were significantly lower than those in the control group(6.32±2.31,5.51±2.12 vs.10.66±2.74,8.71±1.99,t=2.363,0.113,P<0.05).The postoperative cortisol level in the observation group was lower than that in the control group[(541.72±91.51)nmol/L vs.(571.20±83.68)nmol/L,t=0.096,P<0.05].The postoperative prostaglandin E2(PGE2)level in the observation group was significantly lower than that in the control group[(132.62±72.33)pg/ml vs.(152.48±69.98)pg/ml,t=0.082,P<0.05].Conclusion The stress disorder scor

关 键 词：多学科照护模式 升降式移动胸车 应激理论 血清应激障碍标志物 

分 类 号：R734.2[医药卫生—肿瘤]