Case nursing for enhanced recovery of patients with complex esophageal cancer based on the ACTED model
基于ACTED模式的复杂食管癌患者快速康复个案护理

摘要

目的 探讨基于ACTED模式（评估-以患者为中心-干预-评价-院外康复）的个案护理在复杂食管癌患者围手术期快速康复中的应用效果。方法 对1例既往有胃毕Ⅱ式吻合术史的60岁男性食管癌患者，采用ACTED全程护理模式，从术前优化、术后康复、出院管理及居家护理四个阶段实施多学科协作的个体化护理干预。结果 患者术前营养状况显著改善（体重增加1.4kg，BMI从17.9提升至18.4，血红蛋白从100g/L升至110g/L，白蛋白从35.0g/L升至37.1g/L），心肺功能明显提升（6分钟步行试验从454m提升至565m），术后未发生严重并发症，住院期间未发生误吸及肺部感染，术后第13天顺利出院。结论 ACTED模式可有效改善复杂食管癌患者的术前状态，降低术后并发症风险，加速术后康复进程，为复杂食管癌患者的围手术期护理提供参考。

Abstract

Objective To explore the application effect of case nursing based on the ACTED model (Assessment-Patient-centered-Intervention-Evaluation-Discharge rehabilitation) in the perioperative enhanced recovery of patients with complex esophageal cancer.
Methods A 60-year-old male patient with esophageal cancer and a history of Billroth II anastomosis was managed using the whole-process ACTED nursing model. Individualized nursing interventions with multidisciplinary collaboration were implemented across four stages: preoperative optimization, postoperative rehabilitation, discharge management, and home care.
Results The patient's preoperative nutritional status significantly improved (weight increased by 1.4 kg, BMI rose from 17.9 to 18.4, hemoglobin increased from 100 g/L to 110 g/L, and albumin increased from 35.0 g/L to 37.1 g/L). Cardiopulmonary function was notably enhanced (6-minute walk test distance increased from 454 m to 565 m). No severe postoperative complications occurred, and no aspiration or pulmonary infection was observed during hospitalization. The patient was discharged smoothly on the 13th day postoperatively.
Conclusion   The ACTED model can effectively improve the preoperative status of patients with complex esophageal cancer, reduce the risk of postoperative complications, and accelerate the postoperative recovery process, providing a reference for perioperative nursing care of such patients.