池千勉

【摘要】 目的：探讨超前镇痛管理理念联合聚焦解决模式干预在肺癌根治术中的应用效果。方法：将2022年3月—2023年9月中山大学肿瘤防治中心收治的90例行肺癌根治术的患者参照随机数字表法分为两组，每组45例。对照组给予常规疼痛管理及心理干预，观察组在对照组基础上加用超前镇痛管理理念联合聚焦解决模式干预。比较两组疼痛水平、炎症水平及病耻感水平。结果：观察组术后6、12、24、48 h的视觉模拟评分法（VAS）评分均低于对照组，差异均有统计学意义（P<0.05）。术后72 h，两组的白细胞介素-8（IL-8）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（TNF-α）、血清肺表面活性蛋白A（SP-A）水平均较术前升高，但观察组均低于对照组，差异均有统计学意义（P<0.05）。术后72 h，两组的中文版肺癌患者病耻感评估量表（CLCSS）耻辱与羞愧、社会隔离、歧视、吸烟评分均低于术前，观察组均低于对照组，差异均有统计学意义（P<0.05）。结论：超前镇痛管理理念联合聚焦解决模式干预能够有效减轻肺癌根治术后患者术后疼痛反应，降低其应激性炎症反应，改善其病耻感。

【关键词】 超前镇痛管理理念 聚焦解决模式 肺癌 疼痛 病耻感

Research on the Application of Advanced Analgesic Management Concept Combined with Focused Solution Model Intervention in Radical Surgery for Lung Cancer/CHI Qianmian. //Medical Innovation of China， 2024， 21（13）： 0-083

[Abstract] Objective： To explore the application effect of advanced analgesic management concept combined with focused solution model intervention in radical surgery for lung cancer. Method： A total of 90 patients who underwent radical surgery for lung cancer admitted to the Intensive Care Unit of Sun Yat-Sen University Cancer Center from March 2022 to September 2023 were divided into two groups by random number table method， with 45 cases in each group. The control group received routine pain management and psychological intervention， while the observation group received advanced analgesic management concept combined with focused solution model intervention on the basis of the control group. The pain level， inflammation level， and stigma level of the two groups were compared. Result： The visual analogue scale （VAS） scores of the observation group at 6 hours， 12 hours， 24 hours and 48 hours after surgery were lower than those of the control group， the differences were statistically significant （P<0.05）. 72 hours after surgery， interleukin-8 （IL-8）， interleukin-6 （IL-6）， tumor necrosis factor-α （TNF-α）， serum pulmonary surfactant protein A （SP-A） in the two groups were increased compared to those before surgery， those in the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. 72 hours after surgery， Cataldo lung cancer stigma scale （CLCSS） （shame and shame， social isolation， discrimination， smoking） of the two groups were lower than those before surgery and those in the observation group were lower than those in the control group， the differences were statistically significant （P<0.05）. Conclusion： The combination of advanced analgesic management concept and focused solution model intervention can effectively alleviate postoperative pain response， reduce stress inflammatory response， and improve the shame of lung cancer patients after radical surgery.

[Key words] Advanced analgesic management concept Focused solution model Lung cancer Pain Stigma

First-author's address： Intensive Care Unit， Sun Yat-Sen University Cancer Center， Guangzhou 510060， China

doi：10.3969/j.issn.1674-4985.2024.13.018

肺癌是全球癌症死亡的主要原因，2020年全球新增的肺癌病例有220多万例，其发生率占所有癌症的11.1%，严重威胁全球人类健康[1]。肺癌根治术是肺癌的主要治疗技术，虽然此技术能够有效切除患者肿瘤和区域淋巴结，尽可能保留患者的肺部功能，从而降低患者死亡率，但手术毕竟属于创伤性操作，术后疼痛的发生依然不容忽视，若镇痛不充分，极易加重患者心理应激反应，并阻碍患者术后康复[2-3]。因此，加强肺癌手术患者的疼痛及心理干预至关重要。超前镇痛理念是一种新型外科理念，主要在机体尚未受到手术创伤影响前就给予预防性镇痛，从而减轻手术所致的机体应激及炎症反应，提高术后镇痛效果[4]。氟比洛芬酯是一种非甾体类抗炎镇痛药物，具有解热、镇痛及抗炎等作用，常用于外科手术超前镇痛中[5]。聚焦解决模式是一种新型心理疗法，主要以积极心理学理论为基础，以问题为着眼点，以目标为导向，最大限度挖掘患者潜在力量，从而解决患者相关问题[6]。……