基于多学科协作的临床路径护理联合术后早期功能锻炼对甲状腺腺瘤切除术患者应用价值探讨  

Application value of clinical pathway nursing based on multi-disciplinary team combined with early postoperative functional exercise in patients with thyroid adenoma resection

作　　者：董艳杰 张慧丽[1] 陈方 陈彩云 王青青[2] DONG Yanjie;ZHANG Huili;CHEN Fang;CHEN Caiyun;WANG Qingqing(Zhengzhou Seventh People's Hospital,Zhengzhou,Henan450000,China)

机构地区：[1]郑州市第七人民医院内分泌老年病科,河南郑州450000 [2]郑州市第七人民医院普外科,河南郑州450000

出　　处：《社区医学杂志》2024年第9期301-305,311,共6页Journal Of Community Medicine

摘　　要：目的对甲状腺腺瘤切除术患者手术前后采用基于多学科协作(MDT)的临床路径护理联合术后早期功能锻炼模式,探讨其应用价值。方法选取郑州市第七人民医院2020-07-01-2022-08-31收治的108例甲状腺腺瘤患者作为研究对象,采用随机数字表法分为常规护理组(54例)和联合护理组(54例),2组患者均接受手术治疗,常规护理组予以常规护理干预,联合护理组在常规护理基础上采用基于MDT的临床路径护理联合术后早期功能锻炼。干预后,比较2组患者颈部功能〔颈椎功能障碍指数(NDI)〕、颈部僵硬和瘢痕挛缩发生率、心境状态〔简明心境量表(POMS)〕、自护能力〔自护能力测定量表(ESCA)评分〕和生活质量〔甲状腺癌特异性生活质量量表(THYCA-QoL)评分〕。结果根据干预前基线数据调整,干预8周后,2组患者积极心境评分、ESCA评分、NDI和THYCA-QoL评分均提高,消极心境评分均降低,其中联合护理组积极心境评分为(35.26±3.73)分,高于常规护理组(29.70±4.16)分,F=26.782,P<0.001;消极心境评分为(32.67±4.29)分,低于常规护理组(40.74±4.07)分,F=49.887,P<0.001;ESCA评分为(132.06±10.29)分,高于常规护理组(103.24±9.82)分,F=110.388,P<0.001;NDI为(25.78±2.87)%,低于常规护理组(36.85±3.37)%,F=177.223,P<0.001;THYCA-QoL评分为(42.61±3.72)分,低于常规护理组(50.37±3.66)分,F=59.128,P<0.001。干预8周后,联合护理组颈部僵硬发生率为9.26%,低于常规护理组的25.93%,χ^(2)=5.173,P=0.023;瘢痕挛缩发生率为5.56%,低于常规护理组的18.52%,χ^(2)=4.285,P=0.039。结论基于MDT的临床路径护理联合术后早期功能锻炼能调节甲状腺腺瘤患者心境状态,降低颈部僵硬及瘢痕挛缩发生率,有助于促进颈部功能恢复,提高患者生活质量。Objective To explore the application value of multi-disciplinary team(MDT)based clinical pathway nursing combined with early postoperative functional exercise in patients with thyroid adenoma resection before and after surgery.Methods All 108patients with thyroid adenoma admitted to the Seventh People's Hospital of Zhengzhou from July 1,2020,to August 31,2022were selected as the study objects,and they were divided into routine nursing group(54cases)and combined nursing group(54cases)using random number table method.Both groups received surgical treatment,and routine nursing group received conventional nursing intervention.The combined nursing group received MDT based clinical pathway nursing combined with early postoperative functional exercise on the basis of routine nursing.After intervention,neck function[neck disability index(NDI)],incidence of neck stiffness and cicatricial contracture,mood status[profile of mood states(POMS)],self-care ability[exercise of self care agency(ESCA)]and quality of life[thyroid cancer-specific quality of life(THYCA-QoL)]were compared between the two groups.Results After adjusting for baseline data before intervention,8weeks after intervention,both groups of patients showed increased positive mood scores,ESCA scores,NDI,and THYCA-QoL scores,and decreased negative mood scores.Positive mood score of patients in combined nursing group was(35.26±3.73)points,which was higher than that in routine nursing group(29.70±4.16)points,F=26.782,P<0.001;the negative mood score was(32.67±4.29)points,which was lower than that in routine nursing group(40.74±4.07)points,F=49.887,P<0.001;the ESCA score was(132.06±10.29)points,which was higher than that that in routine nursing group(103.24±9.82)points,F=110.388,P<0.001;NDI was(25.78±2.87)%,which was lower than that in routine nursing group(36.85±3.37)%,F=177.223,P<0.001;THYCA-QoL score was(42.61±3.72)points,which was lower than that in routine nursing group(50.37±3.66)points,F=59.128,P<0.001.After 8weeks of intervention,the incidence of neck

关 键 词：甲状腺腺瘤 早期功能锻炼 多学科协作 临床路径护理 颈部功能 

分 类 号：R736.1[医药卫生—肿瘤]