Prospective study on effect of dual-subject three-step method on postoperative recovery in patients with intradural tumors
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摘要:目的
探讨双主体三步法在椎管内肿瘤患者围术期的应用效果。
方法选取椎管内肿瘤患者86例行前瞻性研究，随机分为对照组和观察组，每组43例，对照组围术期行常规护理，观察组行双主体三步法干预。观察2组康复进程、围术期不同时点心理状态[患者健康问卷抑郁量表(PHQ-9)、广泛性焦虑量表(GAD-7)]、日本骨科协会腰椎功能(JOA)评分及并发症发生情况。
结果观察组首次排气、首次下床活动、恢复排便及住院时间均短于对照组，差异有统计学意义(P < 0.05); 术前1 d、术后1 d、出院1个月后，观察组PHQ-9、GAD-7评分均低于对照组，差异有统计学意义(P < 0.05); 出院时、出院1个月后、随访6个月时，观察组JOA评分均高于对照组，观察组并发症发生率为6.98%, 低于对照组的25.58%, 差异均有统计学意义(P < 0.05)。
结论双主体三步法应用于椎管内肿瘤患者能有效改善身心应激状态，减少并发症，改善腰椎功能，促进术后早期康复。
Abstract:ObjectiveTo investigate the effects of the dual-subject three-step method on perioperative outcomes in patients with intradural tumors.
MethodsA total of 86 patients with intradural tumors were enrolled in a prospective study and were randomly divided into control group and observation group, with 43 patients per group. The control group received routine perioperative care, while the observation group underwent intervention of the dual-subject three-step method. The recovery process, psychological state [Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7)] at different perioperative time points, lumbar spine function scores of Japanese Orthopaedic Association (JOA), and occurrence of complication were observed.
ResultsThe observation group exhibited shorter durations for first flatus, first ambulation, recovery of bowel movements, and hospital stay compared with the control group (P < 0.05). The PHQ-9 and GAD-7 scores in the observation group were lower than those in the control group at 1 day preoperatively, 1 day postoperatively, and 1 month after discharge (P < 0.05). At discharge, 1 month after discharge, and 6 months during follow-up, the JOA scores in the observation group were higher than those in the control group (P < 0.05). The complication rate in the observation group was lower than that in the control group (6.98% versus 25.58%, P < 0.05).
ConclusionApplication of the dual-subject three-step method in patients with intradural tumors can effectively improve psychophysical stress, reduce complications, improve lumbar spine function, and promote early postoperative recovery.
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Keywords:
- dual-subject /
- three-step method /
- intradural tumor /
- psychophysical stress /
- lumbar spine function
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表 1 2组一般资料比较(x±s)
组别 n 性别 年龄/岁 体质量/kg 合并症 临床分期 文化程度 男 女 高血压 糖尿病 高脂血症 Ⅰ期 Ⅱ期 初中及以下 高中/中专 大专及以上 对照组 43 25 18 61.32±11.85 61.34±11.18 11 6 14 23 20 18 16 9 观察组 43 23 20 59.68±10.62 60.18±12.22 10 8 13 26 17 20 13 10 
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表 2 2组康复进程比较(x±s)
组别 n 首次排气时间/h 首次下床活动时间/d 恢复排便时间/d 住院时间/d 对照组 43 21.47±4.32 3.57±0.74 3.41±0.56 12.32±2.11 观察组 43 16.28±3.12* 2.48±0.56* 2.36±0.38* 9.58±1.37* 与对照组比较, * P < 0.05。
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表 3 2组心理状态比较(x±s)
分 组别 n 时点 PHQ-9评分 GAD-7评分 对照组 43 入院时 15.96±3.00 12.83±2.34 术前1 d 22.40±2.32* 17.48±1.02* 术后1 d 17.11±2.10 12.58±1.46 出院1个月后 13.24±1.85* 9.57±1.45* 观察组 43 入院时 16.48±2.48 13.12±2.58 术前1 d 18.12±1.45# 15.00±1.18# 术后1 d 13.25±1.32*# 9.78±1.22*# 出院1个月后 10.20±1.10*# 7.28±1.12*# 与入院时比较, * P < 0.05; 与对照组比较, #P < 0.05。
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表 4 2组日本骨科协会腰椎功能评分比较(x±s)
分 组别 n 入院时 出院时 出院1个月后 随访6个月时 对照组 43 16.98±2.96 14.00±2.62* 19.27±2.87* 21.86±2.32* 观察组 43 18.25±3.10 16.12±2.30*# 23.35±3.12*# 25.89±1.36*# 与入院时比较, * P < 0.05; 与对照组比较，#P < 0.05。
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表 5 2组并发症情况比较[n(%)]
组别 n 腹胀伴便秘 肺部感染 关节活动受限 尿潴留 合计 对照组 43 4(9.30) 2(4.65) 2(4.65) 3(6.98) 11(25.58) 观察组 43 0 1(2.33) 1(2.33) 1(2.33) 3(6.98)* 与对照组比较, * P < 0.05。
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