【摘要】：目的調(diào)查直腸癌結(jié)腸造口患者希望水平及生活質(zhì)量的現(xiàn)狀。探討ADOPT模式對(duì)結(jié)腸造口患者希望水平及生活質(zhì)量水平的影響。方法本研究選取萊蕪市某三級(jí)乙等醫(yī)院124例直腸癌術(shù)后結(jié)腸造口患者,將其隨機(jī)分為對(duì)照組和試驗(yàn)組,每組各62例。對(duì)照組患者給予常規(guī)的護(hù)理。試驗(yàn)組患者在常規(guī)護(hù)理基礎(chǔ)上,由從事本專業(yè)三年以上,經(jīng)過(guò)造口及心理咨詢培訓(xùn)的護(hù)士實(shí)施ADOPT模式干預(yù)。時(shí)間為6個(gè)月。該模式包括個(gè)性化指導(dǎo)、患者小組的干預(yù)、結(jié)腸造口自我護(hù)理手冊(cè)講解、電話隨訪、門診隨訪及家訪。在術(shù)后第1天、出院時(shí)及出院6個(gè)月時(shí)采用希望水平量表、生活質(zhì)量量表、造口適應(yīng)量表、造口并發(fā)癥評(píng)估表對(duì)兩組患者進(jìn)行評(píng)估。結(jié)果1.兩組患者在性別、年齡、文化程度、婚姻狀況、職業(yè)、家庭月收入、醫(yī)療支付、宗教信仰、家庭關(guān)系、居住類別、臨床分期、腫瘤轉(zhuǎn)移與否、因本病住院次數(shù)、病程、家族史方面差異均無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。2.在出院時(shí),對(duì)照組與試驗(yàn)組患者在造口皮膚并發(fā)癥、造口回縮和造口皮膚黏膜分離的評(píng)分方面無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。出院后6個(gè)月,對(duì)照組患者造口皮膚并發(fā)癥、造口狹窄和造口脫垂評(píng)分顯著高于試驗(yàn)組(P0.05)。3.兩組患者的身體適應(yīng)、心理適應(yīng)、社會(huì)適應(yīng)不同時(shí)間段,差異存在統(tǒng)計(jì)學(xué)意義(P0.05)。并且兩組患者造口適應(yīng)量表總分及三個(gè)適應(yīng)方面存在交互效應(yīng),差異也均具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.兩組患者在術(shù)后第1天時(shí),其希望水平差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)。在出院時(shí),兩組的希望水平均有所提高,但試驗(yàn)組高于對(duì)照組(P0.05)。在經(jīng)過(guò)6個(gè)月的干預(yù)后,試驗(yàn)組的希望水平評(píng)分有明顯的提高,并且顯著的高于對(duì)照組(P0.05)。5.出院前,兩組患者在生活質(zhì)量評(píng)價(jià)量表的15個(gè)大項(xiàng)中的比較均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05)。經(jīng)過(guò)6個(gè)月的護(hù)理干預(yù)后,我們發(fā)現(xiàn)試驗(yàn)組的14項(xiàng)生活質(zhì)量評(píng)分均有了顯著的改善,并且明顯優(yōu)于對(duì)照組(P0.05)。而經(jīng)濟(jì)困難評(píng)分兩組患者在干預(yù)前后并無(wú)明顯改變。結(jié)論1.ADOPT模式有利于提高結(jié)腸造口患者適應(yīng)水平及減少造口并發(fā)癥。2.ADOPT模式有利于提高結(jié)腸造口患者希望水平及生活質(zhì)量。
[Abstract]:Objective to investigate the level of hope and quality of life (QOL) of rectal cancer patients undergoing colostomy. To investigate the effect of ADOPT model on the level of hope and quality of life in patients with colostomy. Methods 124 patients with rectal cancer were randomly divided into control group (n = 62) and experimental group (n = 62). The patients in the control group were given routine nursing care. On the basis of routine nursing, the patients in the test group were treated with ADOPT mode by nurses who had been engaged in this major for more than three years and had undergone stomatology and psychological counseling training. The time is six months. The model includes individualized guidance, patient group intervention, colon colostomy self-care manual, telephone follow-up, outpatient follow-up and home visits. On the first day after operation, at the time of discharge and 6 months after discharge, the two groups were evaluated with the level of Hope scale, the quality of Life scale, the Osteotomy adaptation scale and the Evaluation of complications of Ostomy. Result 1. The patients in the two groups were divided into two groups: sex, age, education, marital status, occupation, family monthly income, medical payment, religious belief, family relationship, type of residence, clinical stage, tumor metastasis or not, number of hospitalizations due to the disease, course of disease. Family history differences were not statistically significant (P0.05). 2. At the time of discharge, there was no significant difference between the control group and the test group in the score of complications, retraction and mucosal separation (P0.05). At 6 months after discharge, the score of complications, stricture and prolapse of stoma in the control group was significantly higher than that in the experimental group (P0.05). 3. Two groups of patients' physical adaptation, psychological adaptation, social adaptation in different time periods, the difference was statistically significant (P0.05). And the two groups of patients with oral adaptation scale total score and three aspects of the interaction effect, the difference is also statistically significant (P0.05). 4. At the first day after operation, there was no significant difference in the level of hope between the two groups (P0.05). At the time of discharge, the level of hope increased in both groups, but higher in the trial group than in the control group (P0.05). After 6 months of intervention, the score of hope level in the experimental group was significantly improved, and significantly higher than that in the control group (P0.05). 5. Before discharge, there was no significant difference between the two groups in the 15 major items of the quality of life evaluation scale (P0.05). After 6 months of nursing intervention, we found that the 14 quality of life scores of the experimental group were significantly improved, and significantly better than the control group (P0.05). However, there was no significant change in the score of economic difficulty between the two groups before and after intervention. Conclusion the model of 1.ADOPT is helpful to improve the level of adaptation and reduce the complications of colostomy. 2.ADOPT is helpful to improve the level of hope and quality of life of patients with colostomy.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R473.73

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