【摘要】：目的從情緒、應(yīng)對方式和生活質(zhì)量三個方面對肺癌患者進行評估,闡述在肺癌患者化療過程中應(yīng)用綜合護理模式后其情緒、應(yīng)對方式和生活質(zhì)量等方面的變化,根據(jù)臨床護理反饋來評估綜合護理干預(yù)的實際療效和臨床價值。方法收集河南省某三級甲等醫(yī)院2014年12月至2015年2月肺癌化療4個病區(qū)首次確診為肺癌的患者132例,對這132例患者的臨床資料進行回歸性分析,以1、3病區(qū)為對照組,2、4病區(qū)作干預(yù)組。每組患者均為66例。對照組給予呼吸內(nèi)科常規(guī)護理,包括:(1)基礎(chǔ)護理(2)健康教育(3)心理護理(4)預(yù)防感染(5)飲食指導(dǎo)。干預(yù)組分為6個小組,每小組8-12人。干預(yù)組的研究對象需要在臨床常規(guī)護理的基礎(chǔ)上進行綜合護理干預(yù)措施,詳細的護理干預(yù)措施為:(1)患者入院確診后擬行化療時開始進行認知干預(yù)、漸進式肌肉放松訓(xùn)練、團體心理干預(yù)的綜合護理干預(yù)。每次干預(yù)時間30~60min,每周給予干預(yù)1次,共計6次,同時結(jié)合患者實際情況隨時調(diào)整。(2)患者化療間歇期出院后,電話跟蹤隨訪,每1周一次。主要以解決患者的實際問題為目的,繼續(xù)向患者提供心理學(xué)相關(guān)知識,鞏固治療效果。(3)應(yīng)用調(diào)查問卷收集研究對象的一般基線資料。應(yīng)用簡式心境量表(POMS-SF)、醫(yī)學(xué)應(yīng)對量表(MCMQ)、生活質(zhì)量調(diào)查表(QLQ-C30)分別在化療前調(diào)查研究開始時、接受綜合護理干預(yù)后化療結(jié)束一月內(nèi),評估兩組患者的情緒、應(yīng)對方式和生活質(zhì)量狀況。資料收集整理后錄入數(shù)據(jù)庫,采用SPSSl6.0進行統(tǒng)計分析。通過對比兩組研究對象在進行護理干預(yù)前后的情緒、應(yīng)對方式和生活質(zhì)量三個方面的變化進行分析討論,從而評價綜合護理干預(yù)的效果。結(jié)果1、簡式心境量表是測量患者的心境狀態(tài),主要得分經(jīng)t檢驗。干預(yù)前,干預(yù)組和對照組簡式心境量表調(diào)查表各分值經(jīng)t檢驗,得分差異不具有統(tǒng)計學(xué)意義(P㧐0.05);干預(yù)后,干預(yù)組和對照組相比,研究對象緊張-焦慮、抑郁-沮喪、疲乏-遲鈍、憤怒-敵意、迷惑-混亂,精力-活力的變化有統(tǒng)計學(xué)意義(P㩳0.05)。2、醫(yī)學(xué)應(yīng)對方式調(diào)查表主要測量患者的應(yīng)對方式,主要得分經(jīng)t檢驗。干預(yù)前,干預(yù)組合對照組醫(yī)學(xué)應(yīng)對方式調(diào)查表各分值經(jīng)t檢驗,兩組患者在面對、回避和屈服方面的得分差異不具有統(tǒng)計學(xué)意義(P㧐0.05),具有可比性;干預(yù)后,干預(yù)組與對照組相比,各項評估指標均有統(tǒng)計學(xué)意義(P0.05)。3、生活質(zhì)量調(diào)查表主要是調(diào)查患者的生活質(zhì)量,主要得分經(jīng)t檢驗。干預(yù)前,干預(yù)組和對照組生活質(zhì)量調(diào)查表各分值經(jīng)t檢驗,兩組患者在軀體、角色、情緒、認知、社會、疲勞、疼痛、惡心嘔吐以及總健康狀況等方面的得分不具有統(tǒng)計學(xué)意義(P㧐0.05);干預(yù)后,干預(yù)組患者在軀體功能、情緒功能、認知功能和總健康這四項出現(xiàn)了明顯的改善結(jié)果,而社會功能和角色功能與對照組相比并無明顯差異。干預(yù)組經(jīng)綜合護理后,干預(yù)組患者疲乏、疼痛、惡心嘔吐、呼吸困難、睡眠障礙、食欲障礙、腹瀉等癥狀得到了明顯的改善(P0.05)。而便秘和經(jīng)濟困難這兩個方面并無明顯差異。結(jié)論1、綜合護理干預(yù)可以改善患者的心理問題。2、綜合護理干預(yù)能夠幫助患者積極主動地面對疾病,使患者較多運用積極的應(yīng)對方式。3、綜合護理干預(yù)能部分改善患者的不良癥狀,提高患者的生活質(zhì)量。
[Abstract]:Objective To evaluate the patients with lung cancer from three aspects: emotion, coping style and quality of life, to expound the changes of emotion, coping style and quality of life after applying comprehensive nursing mode in the course of chemotherapy for lung cancer patients, and to evaluate the actual curative effect and clinical value of comprehensive nursing intervention according to clinical nursing feedback. From December 2014 to February 2015, 132 patients with lung cancer were diagnosed as lung cancer for the first time in four wards of lung cancer chemotherapy in a tertiary hospital of Nan Province. The clinical data of 132 patients were analyzed retrospectively. The control group was divided into 1,3 wards as control group and 2,4 wards as intervention group. (2) Health education (3) Psychological nursing (4) Prevention of infection (5) Dietary guidance. The intervention group was divided into six groups, each group of 8-12 people. The intervention group needs to carry out comprehensive nursing intervention measures on the basis of clinical routine nursing. Detailed nursing intervention measures are: (1) After the patients were admitted to hospital, they began to carry out cognitive intervention, gradually. The intervening time was 30-60 minutes, once a week, totally 6 times, and adjusted according to the actual situation of the patients. (2) After discharging from the hospital during the chemotherapy interval, the patients were followed up by telephone every week, mainly to solve the actual problems of the patients. (3) General baseline data were collected by questionnaires. Simple Mood State Scale (POMS-SF), Medical Coping Scale (MCMQ) and Quality of Life Questionnaire (QLQ-C30) were used to evaluate the two groups at the beginning of the pre-chemotherapy investigation and one month after the end of chemotherapy after comprehensive nursing intervention. After collecting and sorting out the data, the patients'mood, coping style and quality of life were recorded in the database and analyzed by SPSSl6.0. The effects of comprehensive nursing intervention were evaluated by comparing the changes of mood, coping style and quality of life before and after nursing intervention between the two groups. Results 1. Simple mood scale was used to measure patients'mood state, and the main score was tested by t test. Before intervention, the scores of the intervention group and the control group were not statistically significant (P? 0.05). After intervention, compared with the control group, the subjects in the intervention group were nervous-anxiety, depression-depression, fatigue-retardation, anger-anger. Hostility, confusion-confusion, energy-vitality changes were statistically significant (P?0.05). 2. Medical Coping Style Questionnaire mainly measured the coping style of patients, the main score was tested by t test. Before intervention, the intervention group control group medical coping style questionnaire scores by t test, two groups of patients in the face, avoidance and surrender score differences were not significant. There was statistical significance (P? 0.05), comparable; after intervention, the intervention group compared with the control group, the evaluation indicators were statistically significant (P 0.05). 3, the quality of life questionnaire is mainly to investigate the quality of life of patients, the main score by t test. The scores of body, role, emotion, cognition, society, fatigue, pain, nausea and vomiting, and general health status were not statistically significant (P?0.05). After intervention, the intervention group showed significant improvement in physical function, emotional function, cognitive function and general health, while the social function and role function were compared with the control group. After comprehensive nursing, the symptoms of fatigue, pain, nausea and vomiting, dyspnea, sleep disorders, appetite disorders, diarrhea and other symptoms were significantly improved in the intervention group (P Combined nursing intervention can help patients to actively face the disease, so that patients more use positive coping style. 3, comprehensive nursing intervention can partly improve the adverse symptoms of patients, improve the quality of life of patients.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2016
【分類號】：R473.73

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