【摘要】：目的了解化療期胃癌患者癌因性疲乏癥狀的特性,評(píng)價(jià)自我管理應(yīng)用于化療期胃癌患者癌因性疲乏癥狀管理的可行性及干預(yù)效果的研究。方法第一階段,橫斷面調(diào)查:采用便利抽樣法連續(xù)收集2014年1月至6月在安徽醫(yī)科大學(xué)第一附屬醫(yī)院腫瘤內(nèi)科住院的惡性腫瘤患者,反復(fù)入院者排除,于化療第一天向患者發(fā)放自行編制的一般人口統(tǒng)計(jì)學(xué)變量問(wèn)卷、疲乏數(shù)字等級(jí)量表、癌癥疲乏量表(CFS)和癌癥治療功能評(píng)價(jià)量表(FACT-G)。通過(guò)此次橫斷面調(diào)查,明確化療期癌癥患者癌因性疲乏狀況與生命質(zhì)量以及兩者之間的關(guān)系。第二階段,試驗(yàn)性研究:選擇2014年7月至2014年12月在安徽醫(yī)科大學(xué)第一附屬醫(yī)院腫瘤內(nèi)科住院的胃癌患者,排除重復(fù)入院,研究對(duì)象①納入標(biāo)準(zhǔn):臨床診斷或病理學(xué)檢查確診為惡性腫瘤;確定化療方案;小學(xué)及以上文化水平;年齡≥18周歲;知情同意并明確自身病情。②排除標(biāo)準(zhǔn):有精神疾病及認(rèn)知障礙者;語(yǔ)言溝通障礙者;疾病嚴(yán)重威脅生命者。最終將符合納入標(biāo)準(zhǔn)的67名患者作為研究對(duì)象,并將2014年7月-9月入院的32名患者列入干預(yù)組,2014年10月-12月入院的35名患者列入對(duì)照組。兩組患者均在化療第一天收集基線資料,干預(yù)組在常規(guī)護(hù)理的基礎(chǔ)上進(jìn)行自我管理癥狀干預(yù)模式:個(gè)性化問(wèn)題進(jìn)行個(gè)別解決,共性問(wèn)題利用小組會(huì)議2-4人/組(護(hù)士長(zhǎng)1名,在校研究生2名,醫(yī)生1名)的形式,借助PPT為媒介,結(jié)束后每人發(fā)放自我管理手冊(cè)。居家期間(出院第7天)電話干預(yù),并評(píng)價(jià)手冊(cè)使用情況,同時(shí)約定患者再次入院化療時(shí)間�；熤芷谠俅稳朐旱谝惶煸俅斡迷u(píng)估工具進(jìn)行測(cè)量。對(duì)照組給予常規(guī)護(hù)理,收集資料及評(píng)估工具測(cè)量的時(shí)間同干預(yù)組,在試驗(yàn)研究結(jié)束后給他們發(fā)放自我管理手冊(cè),但資料不用于試驗(yàn)性效果研究。兩組患者均用一般資料調(diào)查表、癌癥疲乏量表(CFS)及癌癥治療功能評(píng)價(jià)量表(FACT-G)進(jìn)行測(cè)量。采用SPSS10.0軟件進(jìn)行統(tǒng)計(jì)數(shù)據(jù)分析。采用一般統(tǒng)計(jì)描述量性研究的數(shù)據(jù),正態(tài)分布的計(jì)量資料使用均數(shù)和標(biāo)準(zhǔn)差進(jìn)行描述,非正態(tài)分布的用中位數(shù)和四分位數(shù)間距描述;使用單樣本K-S擬合優(yōu)度檢驗(yàn)癌因性疲乏和生命質(zhì)量量表各維度均服從正態(tài)分布,因此,干預(yù)組和對(duì)照組干預(yù)前后的癌因性疲乏和生命質(zhì)量差異性檢驗(yàn)使用兩獨(dú)立樣本的t檢驗(yàn)法;干預(yù)組自身干預(yù)前后、對(duì)照組自身干預(yù)前后的癌因性疲乏和生命質(zhì)量差異性檢驗(yàn)使用配對(duì)樣本的t檢驗(yàn)。結(jié)果本研究通過(guò)橫斷面調(diào)查顯示:化療期癌癥患者的癌因性疲乏的發(fā)生率為76.7%。各維度得分標(biāo)準(zhǔn)化后,大小依次是情感疲乏、認(rèn)知疲乏、軀體疲乏,說(shuō)明本次樣本群的患者在情感方面最為疲乏,在軀體方面較輕,化療期癌癥患者的癌因性疲乏管理措施應(yīng)重視情感疲乏。使用多元回歸分析癌因性疲乏對(duì)生命質(zhì)量的影響,結(jié)果顯示軀體疲乏、情感疲乏和認(rèn)知疲乏是導(dǎo)致患者生命質(zhì)量下降的預(yù)測(cè)因子,其中軀體疲乏的貢獻(xiàn)最大。試驗(yàn)性研究中顯示:干預(yù)前兩組患者人口學(xué)資料和疾病相關(guān)資料得分構(gòu)成差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。干預(yù)前兩組患者的癌因性疲乏各維度和總分以及生命質(zhì)量各維度和總分差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。干預(yù)后兩組患者的癌因性疲乏各維度和總分差異有統(tǒng)計(jì)學(xué)意義(P0.01),干預(yù)組癌因性疲乏的各維度和總分均小于對(duì)照組。干預(yù)后兩組患者的生命質(zhì)量各維度和總分差異有統(tǒng)計(jì)學(xué)意義(P0.01),干預(yù)組生命質(zhì)量的各維度和總分均大于對(duì)照組。干預(yù)組干預(yù)前后癌因性疲乏和生命質(zhì)量量表各維度和總分差異有統(tǒng)計(jì)學(xué)意義(P0.01),干預(yù)后干預(yù)組癌因性疲乏得分比干預(yù)前均降低,生命質(zhì)量得分均提高。與干預(yù)前相比,對(duì)照組干預(yù)后癌因性疲乏除情感疲乏差異無(wú)統(tǒng)計(jì)學(xué)意義外(P0.05),軀體疲乏、認(rèn)知疲乏和CFS總分下降有統(tǒng)計(jì)學(xué)意義(P0.01)。與干預(yù)前相比,對(duì)照組干預(yù)后社會(huì)維度得分升高有統(tǒng)計(jì)學(xué)意義(P0.05),其它維度和總分差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論本研究顯示,癌因性疲乏各個(gè)方面都會(huì)導(dǎo)致患者生活質(zhì)量的下降。以自我管理為主的干預(yù)模式,對(duì)于化療期胃癌患者癌因性疲乏癥狀可以有效地緩解,從而改善和提高了患者的生命質(zhì)量。常規(guī)護(hù)理措施對(duì)對(duì)照組化療期胃癌患者的癌因性疲乏和生命質(zhì)量起了一定的作用,但沒有干預(yù)組的效應(yīng)大。提示臨床醫(yī)務(wù)人員應(yīng)加強(qiáng)對(duì)化療期胃癌患者癌因性疲乏的全面評(píng)估,采用有效的針對(duì)性的干預(yù)措施,如認(rèn)知行為干預(yù)、延伸服務(wù)。健康教育等有效預(yù)防和控制癌因性疲乏,改善癌癥患者的生活質(zhì)量。
[Abstract]:Objective To investigate the characteristics of cancer-related fatigue symptoms in patients with gastric cancer during chemotherapy, and to evaluate the feasibility and intervention effect of self-management in cancer-related fatigue symptoms management in patients with gastric cancer during chemotherapy. Patients with malignant tumors in the oncology department of our hospital were excluded from repeated admission. On the first day of chemotherapy, self-made general demographic variables questionnaire, fatigue rating scale, cancer fatigue scale (CFS) and cancer treatment function evaluation scale (FACT-G) were distributed to the patients. Through this cross-sectional survey, the causes of cancer in the chemotherapy period were identified. In the second stage, experimental study: Gastric cancer patients hospitalized in the Department of Oncology, the First Affiliated Hospital of Anhui Medical University from July 2014 to December 2014 were selected and excluded from repeated admission. (2) Exclusion criteria: those with mental illness and cognitive impairment; those with language communication impairment; those with serious life-threatening illness. Finally, 67 patients who met the inclusion criteria were selected as subjects and 32 patients admitted to hospital from July to September 2014 were included. Patients in the intervention group were enrolled in the control group from October to December 2014. The baseline data were collected on the first day of chemotherapy in both groups. The intervention group was given self-management symptom intervention mode on the basis of routine nursing. Individual problems were solved individually, and the common problems were solved by group meetings of 2-4 persons/group (head nurse, 2 postgraduates in school). In the form of PPT, each person issued a self-management manual at the end of the session. Telephone intervention was conducted during home (7 days after discharge) and the use of the manual was evaluated. Chemotherapy was scheduled to be re-hospitalized. Chemotherapy cycles were re-hospitalized on the first day of re-hospitalization. Routine care was given to the control group and funding was collected. Both groups were measured with the General Data Questionnaire, the Cancer Fatigue Scale (CFS) and the Cancer Therapeutic Function Assessment Scale (FACT-G). SPSS10.0 software was used for statistical analysis. Analysis. Data from general statistical descriptive studies were used. The measurements of normal distribution were described by means of mean and standard deviation, while non-normal distribution was described by median and quartile spacing. Cancer-related fatigue and quality-of-life differences before and after intervention in the control group were examined by two independent samples t-test; before and after intervention in the intervention group, cancer-related fatigue and quality-of-life differences before and after intervention in the control group were tested by paired samples t-test. The incidence of cancer-related fatigue was 76.7%. After standardization, the dimensions were emotional fatigue, cognitive fatigue and physical fatigue in turn, indicating that the patients in this sample group were the most emotional fatigue and the patients in the body were the lighter. The results showed that physical fatigue, emotional fatigue and cognitive fatigue were the predictors of the quality of life, and physical fatigue contributed the most to the quality of life. There was no significant difference in the dimensions and total scores of cancer-related fatigue and quality of life between the two groups before and after intervention (P 0.05). There was significant difference in the dimensions and total scores of cancer-related fatigue between the two groups after intervention (P 0.01). The dimensions and total scores of cancer-related fatigue in the intervention group were less than those in the control group. There was significant difference in each dimension and total score of QOL between the intervention group and the control group (P 0.01). The scores of QOL in the intervention group were higher than those in the control group. Compared with the control group, there was no significant difference in the scores of cancer-related fatigue except emotional fatigue (P 0.05), physical fatigue, cognitive fatigue and CFS (P 0.01). There was no significant difference in the degree and total score (P 0.05). Conclusion The study showed that all aspects of cancer-related fatigue would lead to the decline of patients'quality of life. It is suggested that clinical medical staff should strengthen the comprehensive evaluation of cancer-related fatigue in patients with gastric cancer during chemotherapy and adopt effective and targeted interventions, such as cognitive behavioral intervention and extended service. Education can effectively prevent and control cancer-related fatigue and improve the quality of life of cancer patients.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R473.73

【參考文獻(xiàn)】

相關(guān)期刊論文 前6條

1 吳婉英;癌因性疲乏的研究進(jìn)展[J];護(hù)理與康復(fù);2004年05期

2 談學(xué)靈;劉素珍;;癌因性疲乏評(píng)估研究進(jìn)展[J];護(hù)理研究;2008年05期

3 萬(wàn)崇華;孟瓊;湯學(xué)良;張燦珍;羅家洪;張曉磐;;癌癥患者生命質(zhì)量測(cè)定量表FACT-G中文版評(píng)介[J];實(shí)用腫瘤雜志;2006年01期

4 張鳳玲;韓麗沙;;癌因性疲乏的護(hù)理研究進(jìn)展[J];中華護(hù)理雜志;2008年03期

5 許虹波;姜麗萍;尹志勤;金玉愛;李萍;涂海霞;;肺癌化療患者癌因性疲乏狀況的調(diào)查[J];中華護(hù)理雜志;2010年04期

6 申存珍;孫小琴;;自我效能干預(yù)對(duì)結(jié)直腸癌術(shù)后化療患者癌因性疲乏的影響[J];實(shí)用臨床醫(yī)藥雜志;2013年18期

，

本文編號(hào)：2213988