正念减压式心理干预结合ERAS理念在腰椎管狭窄症患者PTED围手术期中的应用

程君; 李曼林; 路遥; 卞冰洁; 祝尚颖; 佟茂琦; 巩陈; 邹明

doi:10.16766/j.cnki.issn.1674-4152.003654

正念减压式心理干预结合ERAS理念在腰椎管狭窄症患者PTED围手术期中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003654

程君¹,
李曼林¹,
路遥¹,
卞冰洁¹,
祝尚颖²,
佟茂琦¹,
巩陈²,
邹明^2, ,

1.
亳州市人民医院手术室，安徽亳州 236800
2.
亳州市人民医院脊柱外科

基金项目:

安徽省重点研究与开发计划项目 202104j07020053

详细信息

通讯作者:
邹明，E-mail：17705678527@163.com

中图分类号: R473.6 R681.5
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- 文章访问数: 2
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- 被引次数: 0
出版历程
- 收稿日期: 2024-03-15
- 网络出版日期: 2024-11-19

The application of mindfulness-based stress reduction intervention combined with ERAS concept in PTED perioperative period for lumbar spinal stenosis patients

1.
Operating Room, Bozhou People ' s Hospital, Bozhou, Anhui 236800, China

摘要

摘要: 目的探讨正念减压式心理干预结合加速康复外科(ERAS)理念应用于经皮椎间孔镜椎间盘切除术(PTED)患者围手术期中的效果。方法选择2021年6月—2023年5月在亳州市人民医院行经皮椎间孔镜椎间盘切除术的患者134例，采用随机数字表法分为对照组(67例)和观察组(67例)。对照组采用常规围手术期护理, 观察组在对照组的基础上实施正念减压和快速康复理念护理干预。比较2组手术相关指标、心理状态、疼痛程度、腰椎功能恢复情况及并发症发生情况，运用SPSS 25.0统计学软件分析数据。结果观察组患者住院时间较对照组短[(1.77±0.37)d vs. (1.96±0.46)d, P＜0.05]；干预后，观察组患者简明心境状态中消极情绪评分较对照组低(P＜0.05)，积极情绪评分较对照组高(P＜0.05)；术后1 d、干预后，观察组患者疼痛评分较对照组低(P＜0.05)；干预后，观察组患者腰椎功能评分较对照组高(P＜0.05)；干预后，观察组患者并发症发生率较对照组低[2(2.99%) vs. 11(16.42%), χ²=6.900，P＜0.05]。结论将正念减压式心理干预与加速康复外科理念结合用于经皮椎间孔镜椎间盘切除术患者围手术期护理中，可明显改善患者心理状态、促进其腰椎功能恢复，同时减轻疼痛、减少并发症的发生。
- 正念减压式心理干预 /
- 加速康复外科理念 /
- 腰椎管狭窄症 /
- 经皮椎间孔镜椎间盘切除术
Abstract: Objective To investigate the effect of mind-based decompression psychological intervention combined with enhanced recovery after surgery (ERAS) in perioperative period of percutaneous transforaminal endoscopic discectomy (PTED) patients. Methods A total of one hundred and thirty-four patients who underwent percutaneous foraminoscopic discectomy at Bozhou People ' s Hospital from June 2021 to May 2023 were selected and divided into a control group (n=67) and an observation group (n=67) by random number table method. The control group was treated with routine perioperative nursing, while the observation group was treated with mindfulness-based decompression and rapid rehabilitation. Surgical indicators, mental state, pain levels, lumbar function recovery, and complication rates were compared between the two groups. SPSS 25.0 software was used for statistical analysis. Results The hospitalization time was shorter in the observation group [(1.77±0.37) d vs. (1.96±0.46) d, P < 0.05]. After the intervention, the observation group had lower negative emotion score and higher positive emotion score (P < 0.05). Pain scores was lower in the observation group one day after operation and after the intervention (P < 0.05). After intervention, lumbar function was high in the observation group (P < 0.05). After intervention, the complication rate was lower in the observation group [2 (2.99%) vs. 11 (16.42%), χ²=6.900, P < 0.05]. Conclusion The combination of mindfulness-based decompression psychological intervention and accelerated department of surgery rehabilitation concept in the perioperative nursing of patients with percutaneous foraminoscopic discectomy can significantly improve psychological state, promote the recovery of lumbar function, relieve pain, and reduce complications.

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表 1 2组PTED患者一般资料比较

Table 1. Comparison of general data between the two groups of PTED patients

组别	例数	性别(例)		年龄(x±s, 岁)	病程(x±s, 月)
组别	例数	男性	女性	年龄(x±s, 岁)	病程(x±s, 月)
观察组	67	40	27	45.45±13.81	21.58±3.36
对照组	67	36	31	47.33±14.72	22.12±3.18
统计量		0.486^a		0.762^b	0.955^b
P值		0.486		0.447	0.341
注：^a为χ²值，^b为t值。

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表 2 2组PTED患者手术相关指标比较(x±s)

Table 2. Comparison of surgery-related indicators between the two groups of PTED patients (x±s)

组别	例数	手术时长(min)	初次离床时间(d)	住院时间(d)
观察组	67	95.89±12.37	1.03±0.24	1.77±0.37
对照组	67	98.46±14.28	1.07±0.18	1.96±0.46
t值		1.113	1.091	2.634
P值		0.268	0.277	0.009

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表 3 2组PTED患者心理状态比较(x±s，分)

Table 3. Comparison of psychological states between the two groups of PTED patients (x±s points)

组别	例数	紧张		愤怒		疲劳
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
观察组	67	18.03±2.21	10.64±2.07^b	22.27±2.52	12.86±2.03^b	15.07±1.89	8.15±0.83^b
对照组	67	17.52±2.37	12.39±2.18^b	21.68±2.64	14.62±2.15^b	14.74±1.96	9.02±0.96^b
统计量		1.288^a	4.765^c	1.323^a	4.872^c	0.992^a	5.611^c
P值		0.200	＜0.001	0.188	＜0.001	0.323	＜0.001

组别	例数	抑郁		慌乱		精力
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
观察组	67	17.58±3.16	10.07±2.42^b	15.04±1.76	7.51±1.42^b	13.47±2.25	19.16±1.68^b
对照组	67	16.94±3.31	12.27±2.31^b	14.67±1.89	9.04±1.38^b	12.93±2.37	17.83±1.59^b
统计量		1.145^a	5.383^c	1.173^a	6.325^c	1.353^a	4.706^c
P值	0.254	＜0.001		0.243	＜0.001	0.179	＜0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

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表 4 2组PTED患者术后疼痛程度比较(x±s，分)

Table 4. Comparison of postoperative pain degrees between the two groups of PTED patients (x±s, points)

组别	例数	干预前	术后即刻	术后1 d	干预后
观察组	67	7.33±0.86	5.72±0.69^a	4.34±1.02^ab	2.09±0.42^abc
对照组	67	7.18±0.73	5.83±0.71^a	4.93±0.87^ab	2.37±0.38^abc
F值		1.088	0.909	3.602	4.046
P值		0.278	0.365	＜0.001	＜0.001
注：F_时间=1 103.000，P＜0.001；F_组间=10.560，P＜0.001；F_交互=5.904，P＜0.001。与同组干预前比较，^aP＜0.05；与同组术后即刻比较，^bP＜0.05；与同组术后1 d比较，^cP＜0.05。

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表 5 2组PTED患者腰椎功能比较(x±s，分)

Table 5. Comparison of lumbar function between the two groups of PTED patients (x±s, points)

组别	例数	主观症状		临床体征		日常生活受限度
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
观察组	67	4.62±1.09	7.41±0.37^b	3.51±0.48	4.67±0.39^b	7.88±1.42	10.19±1.58^b
对照组	67	4.43±1.14	6.96±0.42^b	3.39±0.52	4.24±0.46^b	7.57±1.34	9.07±1.66^b
统计量		0.986^a	6.581^c	1.388^a	5.836^c	1.300^a	4.000^c
P值		0.326	＜0.001	0.167	＜0.001	0.196	＜0.001
注：^a为t值，^c为F值。与同组干预前比较，^bP＜0.05。

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表 6 2组PTED患者并发症总发生情况比较[例(%)]

Table 6. Comparison of total complications between the two groups of PTED patients [cases (%)]

组别	例数	血肿	感觉障碍	皮神经炎	硬脊膜撕裂	总发生
观察组	67	1(1.49)	0	1(1.49)	0	2(2.99)
对照组	67	3(4.48)	4(5.97)	3(4.48)	1(1.49)	11(16.42)
注：2组并发症总发生率比较，χ²=6.900，P=0.009。

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