基于Hogan理论的阶段性护理干预方案对乳腺癌患者术后的康复效果

张欢; 洪珈; 姜春云; 邵苏

doi:10.16766/j.cnki.issn.1674-4152.004436

基于Hogan理论的阶段性护理干预方案对乳腺癌患者术后的康复效果

doi: 10.16766/j.cnki.issn.1674-4152.004436

张欢¹,
洪珈^2, ,,
姜春云²,
邵苏¹

1.
淳安县第一人民医院(浙江省人民医院淳安分院)普外科, 浙江杭州 311700
2.
淳安县第一人民医院(浙江省人民医院淳安分院)科教科

基金项目:

浙江省医药卫生科技计划项目 2025KY1246

淳安县医药卫生科技计划项目 2024CAYY009

详细信息

通讯作者:
洪珈，E-mail：hjhj317237801@163.com

中图分类号: R473.73 R737.9
计量
- 文章访问数: 14
- HTML全文浏览量: 6
- PDF下载量: 2
- 被引次数: 0
出版历程
- 收稿日期: 2025-03-31
- 网络出版日期: 2026-06-02

Rehabilitative effects of a stage-based nursing intervention program based on Hogan's theory in postoperative breast cancer patients

1.
Department of General Surgery, Chun'an Branch of Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 311700, China

摘要

摘要: 目的改良根治术(MRM)是乳腺癌治疗的首选术式，但术后并发症发生风险高，康复训练可降低并发症发生率，但常规护理干预效果欠佳。为此，本研究将Hogan理论应用于乳腺癌术后康复领域中，并探讨其在乳腺癌术后患者中的康复效果。方法选取2023年10月—2024年10月于浙江省人民医院淳安分院拟行MRM的62例乳腺癌患者，按照计算机生成的随机数字表进行序列排队分组，单数纳入观察组(31例)，双数纳入对照组(31例)。对照组实施常规护理，观察组实施常规护理+基于Hogan理论的阶段性护理干预方案。干预后，对比组间的疼痛程度、上肢功能障碍、功能锻炼依从性、并发症及生活质量。结果术后2周、术后1个月及术后4个月，观察组疼痛数字等级量表(NRS)评分、上肢功能障碍评定(DASH)简表评分低于对照组(P＜0.05)；观察组依从性量表评分高于对照组(P＜0.05)；观察组术后并发症发生率为6.45%(2/31)，低于对照组的29.03%(9/31，χ²=5.415，P=0.020)。干预后，观察组乳腺癌患者生活质量测定量表(FACT-B)评分高于对照组(P＜0.05)。结论基于Hogan理论的阶段性护理干预方案可有效缓解乳腺癌患者术后疼痛程度，减轻上肢功能障碍，提高功能锻炼依从性，降低术后并发症发生率，提高生活质量。
- 阶段性护理 /
- 乳腺肿瘤 /
- 康复 /
- 疼痛 /
- Hogan理论 /
- 生活质量
Abstract: Objective Modified radical mastectomy (MRM) is the preferred surgical procedure for the treatment of breast cancer, but it is associated with a high risk of postoperative complications. Rehabilitation training can reduce the incidence of complications; however, the effects of conventional nursing interventions are often suboptimal. Therefore, this study applied Hogan's theory to the field of postoperative rehabilitation in breast cancer patients and explored its rehabilitative effects. Methods A total of 62 breast cancer patients scheduled for MRM at the Chun'an Branch of Zhejiang Provincial People's Hospital from October 2023 to October 2024 were enrolled. Patients were grouped according to queueing sequences generated by computerized random numbers: odd numbers were assigned to the observation group (n=31), and even numbers to the control group (n=31). The control group received conventional nursing care, while the observation group received conventional nursing combined with a stage-based nursing intervention program based on Hogan's theory. After intervention, intergroup comparisons were conducted for pain intensity, upper limb dysfunction, functional exercise compliance, complications, and quality of life. Results At 2 weeks, 1 month, and 4 months postoperatively, the observation group showed lower scores on the Numerical Rating Scale (NRS) for pain and the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire for upper limb dysfunction compared to the control group (P < 0.05). The observation group also had higher compliance scale scores than the control group (P < 0.05). The complication rate in the observation group was 6.45% (2/31), which was lower than in the control group 29.03% (9/31), P < 0.05. After the intervention, the Functional Assessment of Cancer Therapy-Breast (FACT-B) score for quality of life was higher in the observation group than in the control group (P < 0.05). Conclusion The stage-based nursing intervention program based on Hogan's theory can effectively alleviate the postoperative pain degree in breast cancer patients, reduce upper limb dysfunction, improve the compliance of functional exercise, decrease the incidence of postoperative complications, and enhance the quality of life.
- Phased nursing /
- Breast tumor /
- Rehabilitation /
- Pain /
- Hogan theory /
- Quality of life

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表 1 2组乳腺癌患者一般资料比较

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

组别	例数	年龄(x±s, 岁)	病理分期[例(%)]				病理类型[例(%)]		患侧[例(%)]
组别	例数	年龄(x±s, 岁)	Ⅰ期	Ⅱ期	Ⅲ期	Ⅳ期	浸润性	其他	左侧	右侧
对照组	31	54.32±5.20	10(32.26)	14(45.16)	5(16.13)	2(6.45)	26(83.87)	5(16.13)	19(61.29)	12(38.71)
观察组	31	55.13±5.36	8(25.81)	15(48.39)	5(16.13)	3(9.68)	28(90.32)	3(9.68)	15(48.39)	16(51.61)
统计量		0.604^a	0.559^b				0.574^c		1.042^c
P值		0.548	0.576				0.449		0.307
注：^a为t值，^b为Z值，^c为χ²值。

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表 2 2组乳腺癌患者术后不同时间NRS评分比较(x±s，分)

Table 2. Comparison of NRS scores at different time points after surgery between the two groups of breast cancer patients

组别	例数	术后1 d	术后2周	术后1个月	术后4个月
对照组	31	5.30±1.63	3.22±1.04^a	2.43±0.67^ab	2.05±0.59^abc
观察组	31	5.25±1.58	2.69±0.85^a	1.75±0.49^ab	1.23±0.38^abc
F值		1.064	2.128	2.469	2.411
P值		0.866	0.043	0.016	0.019
注：与同组术后1 d比较，^aP＜0.05；与同组术后2周比较，^bP＜0.05；与同组术后1个月比较，^cP＜0.05。

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表 3 2组乳腺癌患者术后不同时间DASH简表评分比较(x±s，分)

Table 3. Comparison of DASH Short Form scores at different time points after surgery between the two groups of breast cancer patients (x±s, points)

组别	例数	术后1 d	术后2周	术后1个月	术后4个月
对照组	31	42.05±4.12	38.25±3.74^a	34.33±3.05^ab	28.76±2.45^abc
观察组	31	42.13±4.20	34.16±3.62^a	30.15±3.02^ab	20.13±2.21^abc
F值		1.039	2.203	2.270	2.395
P值		0.917	0.034	0.028	0.020
注：与同组术后1 d比较，^aP＜0.05；与同组术后2周比较，^bP＜0.05；与同组术后1个月比较，^cP＜0.05。

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表 4 2组乳腺癌患者术后不同时间依从性量表评分比较(x±s，分)

Table 4. Comparison of compliance scale scores at different time points after surgery between the two groups of breast cancer patients (x±s, points)

组别	例数	术后1 d	术后2周	术后1个月	术后4个月
对照组	31	56.20±5.34	52.01±5.23^a	48.45±4.76^ab	41.13±4.08^abc
观察组	31	56.75±5.41	57.32±6.07	55.47±5.62	52.34±5.53^abc
F值		1.026	2.269	2.234	3.224
P值		0.944	0.028	0.031	0.002
注：与同组术后1 d比较，^aP＜0.05；与同组术后2周比较，^bP＜0.05；与同组术后1个月比较，^cP＜0.05。

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表 5 2组乳腺癌患者并发症发生率比较[例(%)]

Table 5. Comparison of complication rates between the two groups of breast cancer patients [n(%)]

组别	例数	淋巴水肿	皮瓣坏死	皮下积液	营养不良	合计
对照组	31	2(6.45)	2(6.45)	3(9.68)	2(6.45)	9(29.03)
观察组	31	1(3.23)	0	1(3.23)	0	2(6.45)
注：2组并发症发生率比较，χ²=5.415，P=0.020。

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表 6 2组乳腺癌患者干预前后FACT-B评分比较(x±s，分)

Table 6. Comparison of FACT-B scores before and after intervention between the two groups of breast cancer patients (x±s, points)

组别	例数	情感状况		功能状况		生理状况
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	31	8.23±1.35	12.33±3.45^b	7.06±1.20	18.32±3.62^b	7.15±1.26	19.25±3.74^b
观察组	31	8.17±1.28	16.07±3.51^b	7.12±1.25	21.35±3.76^b	7.20±1.28	22.03±3.56^b
统计量		0.180^a	2.932^c	0.193^a	2.414^c	0.155^a	2.287^c
P值		0.858	0.004	0.848	0.018	0.877	0.027

组别	例数	社会/家庭状况		附加关注		总评分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后
对照组	31	10.02±2.65	20.36±3.06^b	12.03±2.14	25.66±4.05^b	44.49±4.25	75.92±8.02^b
观察组	31	10.08±2.61	23.12±3.11^b	12.15±2.18	30.23±4.12^b	44.72±4.35	112.80±9.85^b
统计量		0.090^a	2.279^c	0.219^a	2.090^c	0.211^a	2.677^c
P值		0.929	0.027	0.828	0.048	0.834	0.009
注：^a为t值，^c为F值；与同组干预前比较，^bP＜0.05。

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