【摘要】：目的1.評(píng)價(jià)姑息照護(hù)對(duì)淋巴瘤患者生命質(zhì)量、癥狀改善、焦慮抑郁的效果2.評(píng)價(jià)姑息照護(hù)對(duì)淋巴瘤患者家庭照顧者的生命質(zhì)量、照顧負(fù)擔(dān)、焦慮抑郁的效果方法1.本研究以2015年10月~2016年3月河南省兩所省級(jí)醫(yī)院的104對(duì)淋巴瘤患者及照顧者為研究對(duì)象,將兩所醫(yī)院分別作為對(duì)照組和干預(yù)組。對(duì)照組僅接受醫(yī)院常規(guī)標(biāo)準(zhǔn)腫瘤護(hù)理,主要包括癥狀管理、心理支持、健康教育。干預(yù)組在接受醫(yī)院常規(guī)標(biāo)準(zhǔn)腫瘤護(hù)理的同時(shí)接受姑息照護(hù),組建姑息照護(hù)團(tuán)隊(duì),依照制定的姑息照護(hù)流程,主要從癥狀管理、信息需求和共同決策、心理社會(huì)支持和人文關(guān)懷3方面為患者及照顧者提供服務(wù)。2.干預(yù)前對(duì)患者及照顧者進(jìn)行一般情況調(diào)查,采用淋巴瘤患者生命質(zhì)量測(cè)定量表、埃德蒙頓評(píng)估量表和醫(yī)院焦慮抑郁量表測(cè)量患者的臨床結(jié)局,采用簡(jiǎn)明健康狀況量表、Zarit照顧者負(fù)擔(dān)量表、醫(yī)院焦慮抑郁量表測(cè)量照顧角色對(duì)照顧者生理及精神健康的影響。資料分別在干預(yù)前、干預(yù)12周、24周進(jìn)行收集。采用SPSS 21.0統(tǒng)計(jì)軟件數(shù)據(jù)處理。一般資料分析,定量資料采用兩獨(dú)立樣本t檢驗(yàn);定性資料采用卡方檢驗(yàn),等級(jí)資料采用秩和檢驗(yàn)。生命質(zhì)量、照顧負(fù)擔(dān)、焦慮抑郁量表得分采用重復(fù)測(cè)量方差分析,癥狀評(píng)估得分采用廣義估計(jì)方程分析。結(jié)果1.兩組淋巴瘤患者及照顧者一般資料比較差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.在不同時(shí)間點(diǎn)兩組淋巴瘤患者生命質(zhì)量、焦慮抑郁各維度得分及總分隨時(shí)間變化而變化,組間差異有統(tǒng)計(jì)學(xué)意義(P0.05);兩組患者的癥狀得分,均隨時(shí)間的變化而變化,兩組患者的惡心、氣短癥狀得分差異無統(tǒng)計(jì)學(xué)意義,而對(duì)照組疼痛、疲乏、抑郁、焦慮、食欲、瞌睡、健康狀態(tài)的得分高于干預(yù)組(P0.05)。3.在不同時(shí)間點(diǎn)兩組照顧者的生理功能、生理職能、軀體疼痛、精神健康隨時(shí)間變化無明顯差異,而干預(yù)組的照顧者在總體健康、活力、社會(huì)功能、情感功能得分均高于對(duì)照組(P0.05);干預(yù)組照顧者在干預(yù)12周、24周后的照顧負(fù)擔(dān)均小于對(duì)照組(P0.05);干預(yù)組照顧者的焦慮水平在干預(yù)12周、24周后要明顯低于對(duì)照組(P0.05),而兩組抑郁水平得分無明顯差異。結(jié)論本研究通過建立姑息照護(hù)團(tuán)隊(duì),采用多學(xué)科合作的模式,將姑息照護(hù)應(yīng)用于有準(zhǔn)備、知情、受激勵(lì)的患者和照顧者,有效提高患者和照顧者的生命質(zhì)量,降低患者治療過程中疼痛、疲乏、嗜睡等不良癥狀及焦慮抑郁,同時(shí)也減輕了照顧者的照顧負(fù)擔(dān),緩解照顧者不良情緒,可以作為慢性病管理實(shí)踐中的參考。
[Abstract]:Objective 1. To evaluate the effect of palliative care on quality of life, symptom improvement, anxiety and depression in lymphoma patients. To evaluate the effect of palliative care on the quality of life care burden anxiety and depression in patients with lymphoma. From October 2015 to March 2016, 104 cases of lymphoma patients and caregivers in two provincial hospitals in Henan Province were selected as control group and intervention group. The control group only received standard tumor nursing care, including symptom management, psychological support, health education. The intervention group received palliative care at the same time as the standard tumor nursing in hospital, and set up palliative care team. According to the established palliative care process, the intervention group mainly made decisions on symptom management, information demand and common decision. Psychological and social support and humanistic care for patients and caregivers 3 aspects of services. 2. The patients and caregivers were investigated before intervention. The quality of life (QOL) of lymphoma patients, Edmonton evaluation scale and hospital anxiety and depression scale were used to measure the clinical outcome of the patients, and the concise health status scale was used to measure the clinical outcome of the patients. The effects of care role on the caregivers' physical and mental health were measured by the Zarit caregivers burden scale and the Hospital anxiety and Depression scale. Data were collected before, 12 and 24 weeks after intervention. SPSS 21 1.0 statistical software was used to process the data. General data analysis, quantitative data using two independent samples t test, qualitative data using chi-square test, grade data using rank test. Quality of life, care burden, anxiety and depression scale scores were measured repeatedly by ANOVA, and symptom assessment scores were analyzed by generalized estimation equation. Result 1. There was no significant difference between the two groups in general data of lymphoma patients and caregivers (P0.05). At different time points, the quality of life, the scores of anxiety and depression and the total scores of lymphoma patients in two groups changed with time, and the difference was statistically significant (P0.05). There was no significant difference in the scores of nausea and shortness of breath between the two groups, while the control group had pain, fatigue, depression, anxiety, appetite, drowsiness. The score of health status was higher than that of intervention group (P0.05). At different time points, there was no significant difference in physiological function, body pain, mental health between the two groups, while in the intervention group, the overall health, vitality and social function of the caregivers were not significantly different. The scores of affective function were higher than those of the control group (P0.05). The care burden of the carers in the intervention group was lower than that in the control group after 12 weeks and 24 weeks (P0.05). The anxiety level of carers in the intervention group was significantly lower than that in the control group after 12 weeks and 24 weeks (P0.05), but there was no significant difference in depression level between the two groups. Conclusion through establishing palliative care team and adopting multi-disciplinary cooperation model, palliative care can be applied to patients and caregivers who are prepared, informed and motivated, so as to improve the quality of life of patients and caregivers. It can reduce the adverse symptoms such as pain, fatigue, drowsiness and anxiety and depression in the course of treatment, at the same time, it also lightens the care burden of the caregivers and relieves the bad mood of the carers, which can be used as a reference in the practice of chronic disease management.
【學(xué)位授予單位】：鄭州大學(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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本文編號(hào)：2362737