2022 年第 10 期 第 17 卷

加速康复外科在肺癌合并冠心病患者围手术期的应用研究

Perioperative application of enhanced recovery after surgery in lung cancer patients with coronary atherosclerotic heart disease

作者：任迎春郭琳龚玉媛韩薇王鑫彧区颂雷范谦

英文作者：Ren Yingchun Guo Lin Gong Yuyuan Han Wei Wang Xinyu Ou Songlei Fan Qian

单位：首都医科大学附属北京安贞医院胸外科，北京100029

英文单位：Department of Thoracic Surgery Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：肺癌；加速康复外科；冠心病（冠状动脉粥样硬化性心脏病）；围手术期

英文关键词：【Keywords】Lungcancer;Enhancedrecoveryaftersurgery;Coronaryatheroscleroticheartdisease; Perioperative

• 摘要：

• 目的 探究加速康复外科护理应用于肺癌合并冠心病（冠状动脉粥样硬化性心脏病）患者围手术期的临床价值。方法 选择2020年6月至2021年6月首都医科大学附属北京安贞医院收治的90例拟行手术的肺癌合并冠心病患者作为研究对象。根据随机数字表法分为观察组和对照组，各45例。对照组应用围手术期常规护理，观察组在对照组基础上进行加速康复外科干预。比较2组围手术期指标，术前及术后1、3 d的疼痛情况，术前、术后1个月心理状况，围手术期并发症发生情况。结果 观察组术后首次排便时间、拔除胸腔引流管时间、住院时间均明显低于对照组［（39±3）h比（48±5）h、（85±14）h比（114±17）h、（9.4±1.0）d比（13.8±1.2）d］（均P＜0.05）。观察组术后1、3 d的疼痛视觉模拟量表评分均明显低于对照组［（5.0±0.6）分比（6.5±0.6）分、（3.1±0.3）分比（4.0±0.4）分］（均P＜0.05）。2组术后1个月焦虑自评量表与抑郁自评量表评分均明显低于术前，且观察组明显低于对照组（均P＜0.05）。观察组围手术期并发症发生率低于对照组［6.7%（3/45）比22.2%（10/45）］（P=0.036）。结论 加速康复外科应用于肺癌合并冠心病患者围手术期护理可以有效减轻疼痛，缓解不良情绪，减少并发症，加快患者康复。

• Objective  To observe the application effect of enhanced recovery after surgery for lung cancer patients with coronary atherosclerotic heart disease in the perioperative period. Methods A total of 90 lung cancer patients with coronary atherosclerotic heart disease who were admitted to Beijing Anzhen Hospital, Capital Medical University from June 2020 to June 2021 were selected as the research objects, and the patients were divided into the observation group and the control group by random number table method, with 45 patients in each group. The control group received routine perioperative nursing, and the observation group received enhanced recovery after surgery on the basis of the control group. The indexes of perioperative period, the pain condition before and 1 and 3 d after operation, the psychological condition before and 1 month after operation, and the occurrence of perioperative complications were compared between the two groups. Results The time of the first defecation, the time of removing the thoracic drainage tube and the time of hospitalization in the observation group were significantly lower than those in the control group［（39±3）h vs （48±5）h, （85±14）h vs （114±17）h, （9.4±1.0）d vs （13.8±1.2）d］(all P＜0.05). The pain visual analogue scale scores of the observation group were significantly lower than those of the control group［（5.0±0.6） vs （6.5±0.6）, （3.1±0.3） vs （4.0±0.4）］ 1 and 3 d after operation(all P＜0.05). The scores of self-rated anxiety scale and self-rated depression scale in the two groups were significantly lower than those before operation, and the scores in the observation group were significantly lower than those in the control group 1 month after operation (all P＜0.05). The incidence of perioperative complications in the observation group was lower than that in the control group［6.7%（3/45） vs 22.2%（10/45）］(P=0.036). Conclusion The application of enhanced recovery after surgery in perioperative nursing of patients with lung cancer and coronary atherosclerotic heart disease can effectively ease the pain, relieve bad mood, reduce complications and accelerate the recovery of patients.