目的: 探讨快速康复外科（fast track surgery,FTS）理念指导的围手术期全程护理在肝癌经动脉化疗栓塞治疗（transcatheter arterial chemoembolization,TACE）中的应用效果。方法: 前瞻性纳入2022年1月—2024年6月行TACE治疗的肝癌患者103例,通过随机数字表的方法分为观察组51例、对照组52例。研究过程中,观察组、对照组分别有1例、2例因失访脱落,最终两组各纳入50例。对照组实施常规护理,观察组采用FTS全程护理。比较两组围术期肝功能指标[总胆红素（total bilirubin,TBIL）、白蛋白（albumin,ALB）、碱性磷酸酶（alkaline phosphatase,ALP）]水平、炎症应激指标[C反应蛋白（C-reactive protein,CRP）、肿瘤坏死因子-α（tumor necrosis factor-α,TNF-α）、白细胞介素-6（interleukin-6,IL-6）]、疼痛视觉模拟（via visual analogue scale,VAS）评分,干预前后焦虑自评量表（self-rating anxiety scale,SAS）评分和抑郁自评量表（self-rating depression scale,SDS）评分,术后恢复状况及并发症发生情况。结果: 观察组术后3d的TBIL、ALP水平低于对照组,ALB水平高于对照组;观察组术后首次进水时间、首次进食时间、首次排便时间均短于对照组;干预后,两组SAS、SDS评分均明显降低,且观察组低于对照组;术后1、2、3d,观察组VAS评分,CRP、TNF-α、IL-6水平均低于对照组;术后3d,观察组恶心呕吐、便秘腹胀的并发症发生率明显低于对照组。结论: FTS理念的全程护理可改善TACE患者肝功能,降低炎症应激反应,缓解焦虑抑郁情绪,促进术后康复并减少并发症。
Abstract
Objective To evaluate the efficacy of perioperative nursing based on the fast track surgery (FTS) concept in patients with liver cancer undergoing transcatheter arterial chemoembolization (TACE). Methods This prospective study included 103 liver cancer patients scheduled for TACE between January 2022 and June 2024. They were randomly assigned to an observation group (51 patients) and a control group (52 patients). During the study, one patient in the observation group and two in the control group were lost to follow-up, leaving 50 patients in each group for final analysis. The control group received standard care, while the observation group was managed with FTS-based nursing. Comparisons were made between the groups for perioperative liver function parameters [total bilirubin (TBIL), albumin (ALB), alkaline phosphatase (ALP)], inflammatory and stress markers [C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6)], pain intensity [via visual analogue scale (VAS)], and psychological status [using Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS)] before and after intervention. Postoperative recovery indicators and complication rates were also assessed. Results Three days postoperatively, the observation group exhibited lower TBIL and ALP levels and a higher ALB level compared to the control group. The observation group also showed shorter times to first water intake, eating, and defecation. Both groups demonstrated reduced SAS and SDS scores post-intervention, with the observation group having lower scores than the control group. For VAS scores and levels of CRP, TNF-α, and IL-6, the observation group had lower values than the control group on days 1, 2, and 3 after surgery. Three days after surgery, the incidence of complications such as nausea and vomiting, constipation and abdominal distension was significantly lower in the observation group than in the control group. Conclusion Perioperative nursing guided by the FTS concept can enhance liver function in TACE patients, mitigate inflammatory and stress responses, alleviate anxiety and depression, promote recovery, and reduce complications.
关键词
FTS理念 /
全程护理 /
肝细胞癌 /
动脉化疗栓塞治疗 /
围术期
Key words
fast track surgery concept /
comprehensive care /
hepatocellular carcinoma /
transcatheter arterial chemoembolization /
perioperative period
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参考文献
[1] HAO K, PAIK J A, HAN H L, et al.Yttrium-90 radioembolization treatment strategies for management of hepatocellular carcinoma[J]. World J Radiol, 2024, 16(10): 512-527.
[2] MA P K, FU X J, DUAN F, et al.Efficacy and predictive factors of transarterial chemoembolization combined with lenvatinib plus programmed cell death protein-1 inhibition for unresectable hepatocellular carcinoma[J]. World J Gastrointest Oncol, 2024, 16(4): 1236-1247.
[3] 吴易, 宋于生, 周通纲, 等. 改变肿瘤酸性微环境肝动脉化疗栓塞术治疗肝细胞癌的疗效与安全性[J]. 广东医学, 2024, 45(10): 1294-1299.
[4] GUAN Y, TIAN Y, FAN Y W.Pain management in patients with hepatocellular carcinoma after transcatheter arterial chemoembolisation: A retrospective study[J]. World J Gastrointest Surg, 2023, 15(3): 374-386.
[5] 宋奇锋, 胡玲, 林师佈, 等. 肝动脉灌注化疗与肝动脉灌注化疗栓塞术治疗Ⅱb-Ⅲa期肝细胞癌的近远期疗效比较[J]. 现代肿瘤医学, 2023, 31(08): 1476-1480.
[6] 马静, 汤玉梅, 侯梦晓. 快速康复理念在结直肠癌围术期的应用对患者术后胃肠功能恢复及应激反应的影响[J]. 中国肛肠病杂志, 2024, 44(05): 58-60.
[7] 王永泽, 付西峰, 李孝敏. 加速康复外科理念在肝癌肝切除术围手术期中的应用[J]. 中国医药科学, 2022, 12(22): 12-15.
[8] 邓伟. 临床试验设计与统计分析[M]. 北京: 人民卫生出版社, 2012.
[9] NI C, YANG Y, CHANG Y, et al.Fast-track surgery improves postoperative recovery in patients undergoing partial hepatectomy for primary liver cancer: A prospective randomized controlled trial[J]. Eur J Surg Oncol, 2013, 39(6): 542-547.
[10] 黄俊风, 邓显智, 李小波, 等. 舒芬太尼复合多拉司琼用于肝细胞癌微波消融术的镇痛分析[J]. 中外医疗, 2023, 42(19): 14-19.
[11] MANISHA V, M J P, ISSAH Y, et al. The impact of hepatocellular carcinoma diagnosis on patients' health-related quality of life[J]. Cancer Med, 2021, 10(18): 6273-6281.
[12] 李小银, 卢海婷, 王玛丽, 等. 舒缓护理联合心情日记对晚期肝癌患者心理痛苦和负性情绪的影响[J]. 现代临床护理, 2023, 22(8): 42-47.
[13] I D T, YUTAKA E, FRANCESCA R, et al. Perioperative lymphopenia is associated with increased risk of recurrence and worse survival following hepatectomy for hepatocellular carcinoma[J]. Ann Surg Oncol, 2024, 31(4): 2568-2578.
[14] 陈蓉蓉. 快速康复外科理念在腹腔镜肝癌切除术患者围手术期护理中的应用效果评价[J]. 中国医药指南, 2023, 21(29): 19-22.
[15] 姜晓燕. 肝癌切除术患者围手术期护理中快速康复外科理念的应用[J]. 中国医药指南, 2020, 18(07): 239-240.
[16] WARNER S J, KINSEY M C, BATES T H J, et al. Intratumoral chemotherapy: the effects of drug concentration and dose aportioning on tumor cell injury[J]. Bioengineering, 2024, 11(8): 809-819.
[17] 沈进进, 陶明明. 快速康复外科手术室管理对肝癌切除术患者的应用研究[J]. 河北医药, 2024, 46(21): 3299-3302.
[18] 曹冬凌, 郭宝宁, 李冬梅, 等. 快速康复理论联合医疗失效模式与效应分析干预在肝癌经导管动脉栓塞化疗患者中的应用效果[J]. 癌症进展, 2024, 22(14): 1581-1584.
[19] 杨岩岩. 快速康复外科理念对肺癌术后肺部感染的预防及血清炎性因子变化[J]. 中国老年学杂志, 2020, 40(08): 1622-1624.
[20] 闫会, 马翠真. 加速康复外科新理念在肝癌围手术期护理中的应用效果分析[J]. 中外医疗, 2021, 40(07): 132-134.
[21] 马文祥, 张静, 王麒麟, 等. 基于FTS理念建立围术期疼痛管理模式在四肢骨折中的应用效果探讨[J]. 中国实用医药, 2024, 19(04): 169-172.
[22] 陈新桂, 郑埕斌, 谢奋生, 等. 快速康复外科理念在腹腔镜全胃切除术中的应用[J]. 中国医药科学, 2024, 14(16): 136-140.
[23] 何宇文, 郭晨宁, 黄小萍. 基于FTS理念下多模式护理在经皮肾镜碎石取石术围术期中的应用[J]. 实用中西医结合临床, 2023, 23(19): 113-116.
[24] 蒋锐沅, 满婷婷, 覃艳春, 等. 敷和备化方联合TACE术对原发性肝癌患者血清炎性因子及临床疗效观察[J]. 中国中医基础医学杂志, 2021, 27(1): 102-106.
[25] 漆苏媛, 黄媛媛, 高冉冉, 等. FTS理念下护理对泌尿系结石手术患者炎性因子水平及术后恢复的影响[J]. 护理实践与研究, 2023, 20(17): 2539-2543.
[26] REINHARD J, SCHIEGL S J, PAGANO S, et al.Favourable mid-term isokinetic strength after primary THA combined with a modified enhanced recovery after surgery concept (ERAS) in a single blinded randomized controlled trial[J]. Arch Orthop Trauma Surg, 2024, 144(8): 1-14.
[27] 徐文婷, 唐迎迎, 曹秀珠, 等. 中等长度静脉导管穿刺点渗血现状及影响因素分析[J]. 全科医学临床与教育, 2024, 22(3): 273-275.
[28] 黄海林, 梁勇升, 唐培佳, 等. 快速康复外科理念麻醉管理在小儿先天性心脏病经胸介入手术治疗中的作用及安全性[J]. 中国临床研究, 2021, 34(4): 482-485.
[29] 冯锐, 冯競, 邹宗望, 等. 快速康复外科在早期非小细胞肺癌微创手术中临床应用[J]. 中华肿瘤防治杂志, 2020, 27(8): 653-657.
[30] 尹媛媛, 李燕, 葛静萍. 改良医用砂袋的设计及应用[J]. 医学信息, 2020, 33(23): 166-168.
基金
安徽省高等学校科学研究项目“基于数字孪生（DigitalTwin）技术在临床外科诊疗及教学培训中的创新应用”（2022AH040161）
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