基于循证的精准护理模式对肝癌介入患者围术期心理应激及术后并发症的影响

刘丽霞; 毛剑婷; 黄旭芳; 吴巧红

doi:10.16766/j.cnki.issn.1674-4152.002393

基于循证的精准护理模式对肝癌介入患者围术期心理应激及术后并发症的影响

doi: 10.16766/j.cnki.issn.1674-4152.002393

丽水市中心医院32病区介入诊疗中心，浙江丽水 323000

基金项目:

浙江省医药卫生科技计划项目 2020KY1086

详细信息

通讯作者:
刘丽霞, E-mail: 18957066667@189.cn

中图分类号: R473.73 R735.7
计量
- 文章访问数: 426
- HTML全文浏览量: 128
- PDF下载量: 12
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-12
- 网络出版日期: 2022-08-13

Effect of evidence-based precision nursing model on perioperative psychological stress and postoperative complications in patients with liver cancer undergoing interventional therapy

Interventional Treatment Center in the 32th Ward, Lishui Central Hospital, Lishui, Zhejiang 323000, China

摘要

摘要: 目的探究基于循证的精准护理模式对肝癌介入患者围术期心理应激及术后并发症的影响。方法丽水市中心医院介入诊疗中心自2020年开始实施基于循证的精准护理模式，实施前将2019年4—12月的50例患者纳入对照组，2020年1—8月实施后的46例患者纳入观察组，2组患者均给予肝动脉化疗栓塞术，对照组采用常规围术期护理，观察组采用基于循证的精准护理。比较2组心理应激反应评分、心理状态、依从性、术后并发症及护理满意度情况。结果术后3 d，观察组医学应对问卷(MCMQ)中屈服、回避状态得分[(7.18±1.77)分、(11.87±2.38)分]均显著低于对照组[(10.48±1.89)分、(13.29±2.33)分]，应对状态得分[(20.64±2.72)分]显著高于对照组[(18.85±2.93)分，均P＜0.05]。出院前，观察组汉密尔顿抑郁自评量表(HAMD)、汉密尔顿焦虑自评量表(HAMA)评分均显著低于对照组(均P＜0.05)。观察组低蛋白血症、胃肠道反应的发生率显著低于对照组(均P＜0.05)。观察组术后适当运动、饮食控制的遵医行为人数显著高于对照组(均P＜0.05)。观察组护理人员沟通能力、操作技能和医护配合度3个方面的护理满意度得分高于对照组(均P＜0.05)。结论基于循证的精准护理模式有助于改善肝癌介入治疗患者心理应激状态和不良情绪，减少术后并发症，护理满意度更高。
- 精准护理 /
- 肝癌 /
- 介入治疗 /
- 心理应激
Abstract: Objective To explore the effects of evidence-based precision nursing mode on peri-operative psychological stress and post-operative complications in patients undergoing liver cancer undergoing intervention therapy. Methods Before the implementation, 50 patients from April to December 2019 were included in the control group, and 46 patients after the implementation from January to August 2020 were included in the observation group. Both groups received hepatic arterial chemoembolization, and the control group received conventional perioperative surgery. The observation group adopted evidence-based precision nursing. The scores of psychological stress response, psychological status, compliance, post-operative complications and nursing satisfaction were compared between the two groups. Results At 3 days after surgery, the scores of yielding and avoiding status in the medical coping modes questionnaire of the observation group were (7.18±1.77) points and (11.87±2.38) points, which are significantly lower than the (10.48±1.89) points and (13.29±2.33) points of the control group, whereas the score of coping status was (20.64±2.72) points, which is significantly higher than the (18.85±2.93) points of the control group (all P < 0.05). Before discharge, scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were significantly lower in the observation group than in the control group (all P < 0.05). The incidence of hypoproteinaemia and gastrointestinal reactions was significantly lower in the observation group than in the control group (all P < 0.05). After surgery, the number of cases with proper exercise and diet control in the observation group was significantly greater than that in the control group (all P < 0.05). The scores of satisfactions with communication ability, operating skills and medical-nursing cooperation of nursing staff in the observation group were higher than those in the control group (all P < 0.05). Conclusion The evidence-based precision nursing mode is beneficial to improve psychological stress status and negative emotions of patients undergoing liver cancer intervention therapy and reduce post-operative complications, with high nursing satisfaction.
- Precision nursing /
- Liver cancer /
- Intervention therapy /
- Psychological stress

HTML全文

表 1 2组肝癌患者心理应激反应评分(x±s，分)

Table 1. Scores of psychological stress response in the two groups (x±s, points)

组别	例数	屈服	回避	应对
观察组	46	7.18±1.77	11.87±2.38	20.64±2.72
对照组	50	10.48±1.89	13.29±2.33	18.85±2.93
t值		8.810	2.953	3.094
P值		＜0.001	0.004	0.003

下载: 导出CSV

表 2 2组肝癌患者心理状态评分(x±s，分)

Table 2. Scores of psychological state in the two groups (x±s, points)

组别	例数	HAMD评分		t值	P值	HAMA评分		t值	P值
组别	例数	术前	护理后7 d	t值	P值	术前	护理后7 d	t值	P值
观察组	46	14.78±3.61	3.02±0.63	37.623	＜0.001	12.96±2.41	3.54±0.63	36.156	＜0.001
对照组	50	15.18±3.68	4.11±0.65	42.033	＜0.001	13.24±2.43	4.08±0.78	40.356	＜0.001
t值		0.537	8.330			0.566	3.712
P值		0.593	＜0.001			0.573	＜0.001

下载: 导出CSV

表 3 2组肝癌患者术后并发症情况[例(%)]

Table 3. Postoperative complications of liver cancer patients in the two groups [cases (%)]

组别	例数	低蛋白血症	感染	消化道出血	低钾低钠血症	胃肠道反应
观察组	46	23(50.00)	0	1(2.17)	0	26(56.52)
对照组	50	36(72.00)	2(4.00)	2(4.00)	1(2.00)	38(76.00)
χ²值		4.895	0.430	0.005	0.020	4.090
P值		0.027	0.512	0.941	0.967	0.043

下载: 导出CSV

表 4 2组肝癌患者依从性比较[例(%)]

Table 4. Compliance of liver cancer patients in the two groups [cases (%)]

组别	例数	服药	饮食控制	定期复查	适当运动
观察组	46	45(97.83)	43(93.48)	46(100.00)	41(89.13)
对照组	50	44(88.00)	39(78.00)	48(96.00)	35(70.00)
χ²值		3.422	4.608	1.879	5.316
P值		0.064	0.032	0.170	0.021

下载: 导出CSV

表 5 2组肝癌患者护理满意度评分(x±s，分)

Table 5. Scores of nursing satisfaction in the two groups (x±s, points)

组别	例数	病房环境	护理人员沟通能力	操作技能	医护配合度
观察组	46	98.76±2.99	98.11±2.75	98.07±3.09	98.65±2.97
对照组	50	97.65±2.64	95.72±3.13	95.79±3.23	95.70±2.56
t值		1.931	3.960	3.527	5.224
P值		0.056	＜0.001	0.001	＜0.001

下载: 导出CSV

参考文献(16)

[1]	CARUSO S, CALATAYUD A L, PILET J, et al. Analysis of liver cancer cell lines identifies agents with likely efficacy against hepatocellular carcinoma and markers of response[J]. Gastroenterology, 2019, 157(3): 760-776. doi: 10.1053/j.gastro.2019.05.001
[2]	ZHANG G Q, ZHONG L P, YANG N, et al. Screening of aptamers and their potential application in targeted diagnosis and therapy of liver cancer[J]. World J Gastroenterol, 2019, 25(26): 3359-3369. doi: 10.3748/wjg.v25.i26.3359
[3]	马颖, 马明, 张朝霞, 等. 血清恶性肿瘤特异性生长因子对原发性肝癌介入治疗的疗效评估价值[J]. 中华全科医学, 2018, 16(3): 343-345. doi: 10.16766/j.cnki.issn.1674-4152.000095 MA Y, MA M, ZHANG CX, et al. The efficacy prediction diagnostic value of tumor specific growth factor for primary hepatic carcinoma patients received transcatheter arterial chemoembolization[J]. Chinese Journal of General Practice, 2018, 16(3): 343-345. doi: 10.16766/j.cnki.issn.1674-4152.000095
[4]	ZHANG X, ZHOU J, ZHU D D, et al. CalliSpheres drug-eluting beads (DEB) transarterial chemoembolization (TACE) is equally efficient and safe in liver cancer patients with different times of previous conventional TACE treatments: A result from CTILC study[J]. Clin Transl Oncol, 2019, 21(2): 167-177. doi: 10.1007/s12094-018-1902-8
[5]	李玲, 苏丹, 曾祥娥. 中晚期肝癌介入治疗患者术后心理弹性水平及影响因素分析[J]. 齐鲁护理杂志, 2020, 26(11): 16-19. doi: 10.3969/j.issn.1006-7256.2020.11.005 LI L, SU D, ZENG X E. Analysis of postoperative psychological resilience and its influencing factors in patients with middle and advanced liver cancer after interventional therapy[J]. Journal of Qilu Nursing, 2020, 26(11): 16-19. doi: 10.3969/j.issn.1006-7256.2020.11.005
[6]	虞向. 原发性肝癌介入治疗依从性的影响因素分析与防护策略[J]. 护理实践与研究, 2020, 17(5): 22-24. doi: 10.3969/j.issn.1672-9676.2020.05.008 YU X. Analysis of factors influencing compliance with interventional therapy for primary liver cancer and its protective strategies[J]. Nursing Practice and Research, 2020, 17(5): 22-24. doi: 10.3969/j.issn.1672-9676.2020.05.008
[7]	李晓娇, 武琳琳. 精准护理在轻度妊娠期高血压患者中的应用及对妊娠结局的影响[J]. 贵州医药, 2019, 43(1): 156-158. doi: 10.3969/j.issn.1000-744X.2019.01.057 LI X J, WU L L. Application of precision nursing in patients with mild gestational hypertension and its effect on pregnancy outcomes[J]. Guizhou Medical Journal, 2019, 43(1): 156-158. doi: 10.3969/j.issn.1000-744X.2019.01.057
[8]	黄佳燕, 郭梦霞, 简杏清. 临床护理路径在肝癌介入治疗患者术后护理中的应用[J]. 护理实践与研究, 2019, 16(18): 83-85. doi: 10.3969/j.issn.1672-9676.2019.18.033 HUANG J Y, GUO M X, JIAN X Q. The application of clinical nursing pathway in the nursing of patients after operation of liver cancer interventional treatment[J]. Nursing Practice and Research, 2019, 16(18): 83-85. doi: 10.3969/j.issn.1672-9676.2019.18.033
[9]	林华蓉. 纽曼系统护理模式对中晚期肝癌介入治疗术后病人生活质量和不良情绪的影响[J]. 安徽医药, 2019, 23(9): 1834-1838. doi: 10.3969/j.issn.1009-6469.2019.09.035 LIN H R. Effect of Newman nursing on quality of life and bad mood of patients with liver cancer after interventional therapy[J]. Anhui Medical and Pharmaceutical Journal, 2019, 23(9): 1834-1838. doi: 10.3969/j.issn.1009-6469.2019.09.035
[10]	MOKKARALA M, NODA C, MALONE C, et al. Comparison of response and outcomes of drug-eluting bead chemoembolization (DEB-TACE) versus radioembolization (TARE) for patients with colorectal cancer liver metastases[J]. Anticancer Res, 2019, 39(6): 3071-3077. doi: 10.21873/anticanres.13442
[11]	姜娜. 肝癌放射性介入治疗消极应对方式的影响因素分析与预防对策[J]. 护理实践与研究, 2019, 16(16): 13-15. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ201916007.htm JIANG N. Analysis of influencing factors and preventive measures of liver cancer radioactivity interventional therapy for negative coping style[J]. Nursing Practice and Research, 2019, 16(16): 13-15. https://www.cnki.com.cn/Article/CJFDTOTAL-HLSJ201916007.htm
[12]	秦晓凤. 认知行为干预对肝癌介入术后患者不良情绪及心理应激反应的影响[J]. 国际护理学杂志, 2020, 39(5): 806-807, 809. doi: 10.3760/cma.j.issn.1673-4351.2020.05.014 QIN X F. Effects of cognitive behavioral intervention on adverse emotions and psychological stress in patients with liver cancer after intervention[J]. International Journal of Nursing, 2020, 39(5): 806-807, 809. doi: 10.3760/cma.j.issn.1673-4351.2020.05.014
[13]	郝院, 王玲, 古兰, 等. 精准化护理在特重度烧伤患者休克期的应用[J]. 中国美容医学, 2020, 29(6): 157-159. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202006050.htm HAO Y, WANG L, GU L, et al. Application of Precision Nursing in Shock Stage of Severe Burn Patients[J]. Chinese Journal of Aesthetic Medicine, 2020, 29(6): 157-159. https://www.cnki.com.cn/Article/CJFDTOTAL-MRYX202006050.htm
[14]	孙振, 查慧芳, 尤莹莹, 等. 多学科协助模式的精准护理在喉功能保全术后患者吞咽功能康复中的应用[J]. 中国中西医结合耳鼻咽喉科杂志, 2020, 28(4): 299-304. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH202004014.htm SUN Z, ZHA H F, YOU Y Y, et al. Application of multi-disciplinary precise nursing in swallowing function rehabilitation of patients after laryngeal function preservation operation[J]. Chinese Journal of Otorhinolaryngology in Integrative Medicine, 2020, 28(4): 299-304. https://www.cnki.com.cn/Article/CJFDTOTAL-XYJH202004014.htm
[15]	常喜霞. 循证护理干预对肝癌介入治疗患者术后不良反应发生率及护理满意度的影响[J]. 国际护理学杂志, 2020, 39(13): 2407-2409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYS202105022.htm CHANG X X. Influence of evidence-based nursing on the incidence of postoperative adverse reactions and nursing satisfaction in patients with liver cancer after interventional therapy[J]. International Journal of Nursing, 2020, 39(13): 2407-2409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYS202105022.htm
[16]	陈芳, 郑萍萍, 李龙倜. 以患者需求为导向的精准护理服务模式在老年慢性病患者中的应用与评价[J]. 护士进修杂志, 2017, 32(20): 1877-1880. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201720015.htm CHEN F, ZHENG P P, LI L T. Application and evaluation of patients'demand oriented accurate nursing service in elderly patients with chronic diseases[J]. Journal of Nurses Training, 2017, 32(20): 1877-1880. https://www.cnki.com.cn/Article/CJFDTOTAL-FSJX201720015.htm