FMEA模式在乳腺癌患者癌性伤口和术后恢复中的应用

周玉; 童宗培; 王莉; 周均凤; 李青

doi:10.16766/j.cnki.issn.1674-4152.003398

FMEA模式在乳腺癌患者癌性伤口和术后恢复中的应用

doi: 10.16766/j.cnki.issn.1674-4152.003398

周玉^1, ,,
童宗培¹,
王莉¹,
周均凤¹,
李青²

1.
滁州市中西医结合医院普外一科，安徽滁州 239000
2.
滁州市中西医结合医院普外二科

基金项目:

安徽省卫生健康科研项目 AHWJ2022c052

详细信息

通讯作者:
周玉，E-mail：Czzy0914@163.com

中图分类号: R737.9
计量
- 文章访问数: 36
- HTML全文浏览量: 19
- PDF下载量: 1
- 被引次数: 0
出版历程
- 收稿日期: 2023-10-20
- 网络出版日期: 2024-03-27

Application of FMEA model prevention in cancer wound and postoperative recovery in patients with breast cancer

1.
Department of General Surgery, Chuzhou Combined Hospital of Traditional Chinese and Western Medicine, Chuzhou, Anhui 239000, China

摘要

摘要: 目的探究失效模式和效果分析(FMEA)模式在乳腺癌患者中的应用效果，及对患者癌性伤口和术后恢复的影响。方法选取2021年1月—2023年8月滁州市中西医结合医院收治的乳腺癌患者86例纳入研究，按照随机数字表将患者分为对照组(43例，采用常规护理干预)及FMEA组(43例，采用FMEA预防性护理干预)。比较2组干预前后癌性伤口恢复情况、疼痛、患肢功能恢复、焦虑状况及护理满意度。结果干预后，FMEA组渗液颜色正常例数显著多于对照组(χ²=4.674，P=0.031)，渗液气味显著低于对照组[(2.14±0.67)级vs. (2.58±0.74)级，t=2.890，P=0.005]，渗液量差异无统计学意义(P>0.05)。干预第1、3、7天，2组VAS评分均逐渐降低(P < 0.05)，且FMEA组各时间点评分均显著低于对照组(P < 0.05)；干预后，2组患肢活动角度均显著提高(P < 0.05)，且FMEA组显著高于对照组(P < 0.05)；干预后，2组状态焦虑量表(SAI)评分、特质焦虑量表(TAI)评分均显著降低(P < 0.05)，且FMEA组显著低于对照组(P < 0.05)。FMEA组护理满意度显著高于对照组[93.02%(40/43) vs. 76.74%(33/43)，χ²=4.440，P=0.035]。结论 FMEA模式预防可有效促进乳腺癌患者术后癌性伤口与上肢功能恢复，缓解疼痛及焦虑。
- 乳腺癌 /
- 失效模式和效果分析 /
- 癌性伤口 /
- 术后恢复
Abstract: Objective To explore the preventive effect of failure mode and effect analysis (FMEA) model in breast cancer patients, and its impact on cancerous wounds and postoperative recovery. Methods A total of 86 patients with breast cancer treated at Chuzhou Integrated Traditional and Western Medicine Hospital from January 2021 to August 2023 were selected and included as study subjects. According to the random number table method, the patients were simply randomly divided into control group (n=43, routine care intervention) and FMEA group (n=43, FMEA model preventive care intervention). The two groups were compared before and after the intervention in terms of cancer wound healing, pain status, functional recovery of the affected limb, anxiety status and nursing satisfaction. Results After intervention, the colour normality of exudate in the FMEA group was significantly higher than that in the control group (χ²=4.674, P=0.031), while the odour of exudate was significantly lower than that in the control group [(2.14±0.67) grade vs. (2.58±0.74) grade, t=2.890, P=0.005], but the exudate volume had no significant difference (P>0.05). On the 1st, 3rd, 7th day after intervention, the VAS scores in both groups were gradually decreased (P < 0.05), and the above scores in the FMEA group at different time points were significantly lower than those in the control group (P < 0.05). After intervention, the angle of movement of the affected limb was significantly increased in both groups (P < 0.05), and the above indicators were significantly higher in the FMEA group (P < 0.05). The state anxiety inventory (SAI) score and trait anxiety inventory (TAI) score in both groups were declined significantly after intervention (P < 0.05), and the two scores were significantly lower in the FMEA group compared to control group (P < 0.05). Nursing satisfaction in the FMEA group was significantly higher than in the control group [93.02% (40/43) vs. 76.74% (33/43), χ²=4.440, P=0.035]. Conclusion FMEA model prevention can effectively promote the recovery of post operative cancer wound and upper limb function, relieve the pain status and anxiety status of patients.
- Breast cancer /
- Failure mode and effect analysis /
- Cancerous wound /
- Postoperative recovery

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表 1 2组乳腺癌患者癌性伤口恢复情况比较

Table 1. Comparison of cancer wound recovery between the two groups of breast cancer patients

组别	例数	渗液量[例(%)]			渗液颜色[例(%)]		渗液气味 (x±s, 级)
组别	例数	少量	中量	大量	正常	非正常	渗液气味 (x±s, 级)
对照组	43	15(34.88)	15(34.88)	13(30.23)	18(41.86)	25(58.14)	2.58±0.74
FMEA组	43	21(48.84)	15(34.88)	7(16.28)	28(65.12)	15(34.88)	2.14±0.67
统计量		1.605^a			4.674^b		2.890^c
P值		0.108			0.031		0.005
注：^a为Z值，^b为χ²值，^c为t值。

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表 2 2组乳腺癌患者疼痛情况比较(x±s, 分)

Table 2. Comparison of pain between the two groups of breast cancer patients (x±s, points)

组别	例数	干预第1天	干预第3天	干预第7天
对照组	43	4.94±0.87	3.92±0.66^a	2.64±0.43^ab
FMEA组	43	4.36±0.81	3.37±0.59^a	2.19±0.37^ab
t值		3.200	4.074	5.202
P值		0.002	< 0.001	< 0.001
注：F_组间=3.284，P < 0.001；F_时间=9.860，P < 0.001；F_交互=4.224，P < 0.001。与干预第1天比较，^aP < 0.05；与干预第3天比较，^bP < 0.05。

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表 3 2组乳腺癌患者患肢功能恢复情况比较(x±s, °)

Table 3. Comparison of functional recovery of the affected limb between the two groups of breast cancer patients (x±s, °)

组别	例数	上举		内旋		外旋		水平屈曲		水平伸展
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	43	82.14±8.34	148.51±16.36^a	42.16±4.28	57.27±5.19^a	55.61±5.38	69.82±7.14^a	87.43±6.17	121.06±8.12^a	15.17±2.23	21.37±3.55^a
FMEA组	43	83.27±9.42	162.57±15.62^ab	41.29±4.73	61.57±5.28^ab	56.48±5.12	77.51±7.57^ab	89.18±6.46	125.57±7.66^ab	14.61±2.35	23.38±3.58^ab
注：与干预前比较，^aP < 0.05；与对照组比较，^bP < 0.05。

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表 4 2组乳腺癌患者焦虑状况比较(x±s, 分)

Table 4. Comparison of anxiety status of breast cancer patients in two groups (x±s, points)

组别	例数	SAI		TAI
组别	例数	干预前	干预后	干预前	干预后
对照组	43	54.15±7.64	44.88±3.76^a	53.76±6.67	42.15±4.34^a
FMEA组	43	55.23±8.17	42.69±3.68^a	52.36±7.23	39.86±4.47^a
t值		0.809	2.730	0.933	2.410
P值		0.421	0.008	0.353	0.018
注：与干预前比较，^aP < 0.05。

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表 5 2组乳腺癌患者护理满意度比较[例(%)]

Table 5. Comparison of nursing satisfaction of breast cancer patients in two groups [cases (%)]

组别	例数	非常满意	满意	不满意	总满意
对照组	43	18(41.86)	15(34.88)	10(23.26)	33(76.74)
FMEA组	43	26(60.47)	14(32.56)	3(6.98)	40(93.02)
注：2组护理总满意度比较，χ²=4.440，P=0.035。

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参考文献(20)

[1]	刘平贤, 张浩, 李伟汉, 等. 乳腺癌根治术后手术部位感染对肿瘤标志物与纤溶凝血功能及上肢淋巴水肿的影响[J]. 中华医院感染学杂志, 2021, 31(23): 3571-3575. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202123011.htm LIU P X, ZHANG H, LI W H, et al. Influences of surgical site infection on tumor markers, fibrinolysis and coagulation functions and lymphedema after radical mastectomy[J]. Chinese Journal of Nosocomiology, 2021, 31(23): 3571-3575. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHYY202123011.htm
[2]	邹云艳, 马燕, 马波, 等. 基于亲情疏导的心理护理对乳腺癌改良根治术后患者心理状态的影响[J]. 中华全科医学, 2020, 18(12): 2140-2143. doi: 10.16766/j.cnki.issn.1674-4152.001708 ZOU Y Y, MA Y, MA B, et al. Effect of psychological nursing based on family counseling on psychological status of patients with breast cancer after modified radical mastectomy[J]. Chinese Journal of General Practice, 2020, 18(12): 2140-2143. doi: 10.16766/j.cnki.issn.1674-4152.001708
[3]	周丽华, 高洁, 黄燕华, 等. 延续性护理对乳腺癌患者术后负情绪及生活质量的影响[J]. 广东医学, 2020, 41(9): 921-924. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX202009014.htm ZHOU L H, GAO J, HUANG Y H, et al. The influence of continuous nursing on negative emotion and quality of life of breast cancer patients after operation[J]. Guangdong Medical Journal, 2020, 41(9): 921-924. https://www.cnki.com.cn/Article/CJFDTOTAL-GAYX202009014.htm
[4]	陈鸣霞, 严敏, 付白娣. 失效模式与效应分析在过敏性哮喘舌下脱敏治疗患儿中的应用价值[J]. 川北医学院学报, 2021, 36(5): 673-676. doi: 10.3969/j.issn.1005-3697.2021.05.033 CHEN M X, YAN M, FU B D. Application value of failure mode and effect analysis in sublingual desensitization treatment of children with allergic asthma[J]. Journal of North Sichuan Medical College, 2021, 36(5): 673-676. doi: 10.3969/j.issn.1005-3697.2021.05.033
[5]	蒋文婷, 陈丽君. 乳腺癌病人乳腺癌相关淋巴水肿发生风险及其与发病情况的关联效应分析[J]. 护理研究, 2022, 36(18): 3338-3343. doi: 10.12102/j.issn.1009-6493.2022.18.027 JIANG W T, CHEN L J. Risk of breast cancer-related lymphedema of patients with breast cancer and its correlation with incidence[J]. Chinese Nursing Research, 2022, 36(18): 3338-3343. doi: 10.12102/j.issn.1009-6493.2022.18.027
[6]	中国抗癌协会乳腺癌专业委员会. 中国抗癌协会乳腺癌诊治指南与规范(2019年版)[J]. 中国癌症杂志, 2019, 29(8): 609-680. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ202312004.htm Chinese Anti-Cancer Association, Committee of Breast Cancer Society. Chinese anti-cancer association guidelines and standards for the diagnosis and treatment of breast cancer (2019)[J]. China Oncology, 2019, 29(8): 609-680. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGAZ202312004.htm
[7]	蒋琪霞, 李晓华, 胡素琴, 等. 伤口评估流程及内容和记录方式的设计与应用评价[J]. 实用临床医药杂志, 2008, 4(4): 1-4. doi: 10.3969/j.issn.1672-2353.2008.04.001 JIANG Q X, LI X H, HU S Q, et al. The design and application evaluation of the wound evaluation process and content and record method[J]. Journal of Clinical Medicine in Practice, 2008, 4(4): 1-4. doi: 10.3969/j.issn.1672-2353.2008.04.001
[8]	纪久雨, 鲁学文, 刘月江. 超声引导下竖脊肌平面阻滞和胸椎旁阻滞对行乳腺癌根治术患者术后恢复的影响[J]. 东南大学学报(医学版), 2020, 39(4): 440-444. doi: 10.3969/j.issn.1671-6264.2020.04.007 JI J Y, LU X W, LIU Y J. Effects of ultrasound-guided erector spinae block and thoracic paravertebral block on postoperative recovery in patients undergoing radical mastectomy[J]. Journal of Southeast University: Medical Science Edition, 2020, 39(4): 440-444. doi: 10.3969/j.issn.1671-6264.2020.04.007
[9]	曹湾, 黄小蓓, 邹全庆, 等. 围手术期渐进式综合康复干预对乳腺癌患者上肢功能及心理的影响[J]. 中国康复医学杂志, 2021, 36(6): 731-734. doi: 10.3969/j.issn.1001-1242.2021.06.018 CAO W, HUANG X B, ZOU Q Q, et al. The impact of the gradual comprehensive rehabilitation intervention during the surgery period on the upper limb function and psychological of breast cancer patients[J]. Chinese Journal of Rehabilitation Medicine, 2021, 36(6): 731-734. doi: 10.3969/j.issn.1001-1242.2021.06.018
[10]	程长, 何嘉悦, 余吟吟, 等. 中文版状态-特质焦虑量表的测量等值性研究[J]. 中国临床心理学杂志, 2021, 29(1): 68-73. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY202101014.htm CHENG C, HE J Y, YU Y Y, et al. Measurement Invariance of Chinese version of State-Trait Anxiety Inventory Form Y[J]. Chinese Journal of Clinical Psychology, 2021, 29(1): 68-73. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLCY202101014.htm
[11]	代璐莲, 饶莉, 唐毅, 等. H医院患者满意度调查问卷信效度分析[J]. 重庆医学, 2021, 50(24): 4287-4291. doi: 10.3969/j.issn.1671-8348.2021.24.030 DAI L L, RAO L, TANG Y, et al. Analysis of reliability and validity of patient satisfaction questionnaire in H Hospital[J]. Chongqing medicine, 2021, 50(24): 4287-4291. doi: 10.3969/j.issn.1671-8348.2021.24.030
[12]	HUANG J, YOU J X, LIU H C, et al. Failure mode and effect analysis improvement: a systematic literature review and future research agenda[J]. Rel Eng Sys Saf, 2020, 199: 106885. DOI: 10.1016/j.ress.2020.106885.
[13]	于洪梅, 谭智慧, 杨雪莲. 基于自我效能的护理对乳腺癌根治术患者病耻感及患肢水肿的影响[J]. 川北医学院学报, 2021, 36(6): 805-808. doi: 10.3969/j.issn.1005-3697.2021.06.032 YU H M, TAN Z H, YANG X L. Effect of self-efficacy nursing on stigma and limb edema in patients with radical mastectomy[J]. Journal of North Sichuan Medical College, 2021, 36(6): 805-808. doi: 10.3969/j.issn.1005-3697.2021.06.032
[14]	黎东梅, 王茹, 任盟, 等. 基于FMEA模型的预防性护理在乳腺癌植入输液港化疗患者中的应用[J]. 海南医学, 2022, 33(18): 2445-2448. doi: 10.3969/j.issn.1003-6350.2022.18.036 LI D M, WANG R, REN M, et al. Application of preventive care based on FMEA model in breast cancer patients implanted with infusion port for chemotherapy[J]. Hainan Medical Journal, 2022, 33(18): 2445-2448. doi: 10.3969/j.issn.1003-6350.2022.18.036
[15]	宋欣, 何乾峰, 张毳毳, 等. 基于FMEA模式护理在严重创伤患者急救中的应用效果[J]. 中国医药导报, 2021, 18(27): 170-173. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202127041.htm SONG X, HE Q F, ZHANG C C, et al. Application effect of nursing based on FMEA model in emergency cane of patients with severe trauma[J]. China Medical Herald, 2021, 18(27): 170-173. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202127041.htm
[16]	蔚静, 赵国艳, 张凤, 等. 基于FMEA的个体化教学对手术室实习医生的带教效果[J]. 中华医学教育探索杂志, 2022, 21(7): 886-890. doi: 10.3760/cma.j.cn116021-20200918-00926 WEI J, ZHAO G Y, ZHANG F, et al. Effect of individualized teaching method based on FMEA on operating room interns[J]. Chinese Journal of Medical Education Research, 2022, 21(7): 886-890. doi: 10.3760/cma.j.cn116021-20200918-00926
[17]	钟可琪, 冯岚, 马玥, 等. 脊柱外科手术后切口感染风险预测评估体系的构建[J]. 中华创伤骨科杂志, 2022, 24(2): 161-167. doi: 10.3760/cma.j.cn115530-20210702-00320 ZHONG K Q, FENG L, MA Y, et al. Construction of a risk prediction and evaluation system for postoperative incisional infection after spinal surgery[J]. Chinese Journal of Orthopaedic Trauma, 2022, 24(2): 161-167. doi: 10.3760/cma.j.cn115530-20210702-00320
[18]	张丽娟, 周谊霞, 李毅, 等. 基于FMEA的护理模式对脑梗死患者负性情绪及日常活动能力的影响[J]. 中国医药导报, 2021, 18(23): 156-159, 180. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202123038.htm ZHANG L J, ZHOU Y X, LI Y, et al. Effect of FMEA-based nursing model on negative emotion and daily activity ability in patients with cerebral infarction[J]. China Medical Herald, 2021, 18(23): 156-159, 180. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202123038.htm
[19]	来晓玲, 齐向飞. 基于FMEA模型的渐进性康复护理在股骨颈骨折术后患者中的应用[J]. 中华现代护理杂志, 2022, 28(15): 2062-2065. doi: 10.3760/cma.j.cn115682-20210706-02967 LAI X L, QI X F. Effects of progressive rehabilitation nursing based on FMEA in patients after femoral neck fracture[J]. Chinese Journal of Modern Nursing, 2022, 28(15): 2062-2065. doi: 10.3760/cma.j.cn115682-20210706-02967
[20]	赵碧茹, 木菁菁, 叶菁华, 等. 基于FMEA模式的全程连续护理在妊娠期宫颈环扎术患者中的应用[J]. 中国优生与遗传杂志, 2023, 31(2): 409-413. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYA202302036.htm ZHAO B R, MU J J, YE J H, et al. Effects of full-course continuous nursing based on FMEA model on psychological status and hope level of patients with cervical cerclage during pregnancy[J]. Chinese Journal of Birth Health & Heredity, 2023, 31(2): 409-413. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYA202302036.htm