【摘要】：[目的]了解乳腺癌術(shù)后化療患者的家庭功能狀況及自我感受負擔水平,探討同期家庭護理對乳腺癌患者自我感受負擔的影響,為乳腺癌術(shù)后化療患者的家庭護理提供參考依據(jù)。[方法]本研究將2016年2月至2016年10月到昆明醫(yī)科大學(xué)第三附屬醫(yī)院(云南省腫瘤醫(yī)院)乳腺中心就診并接受乳腺癌改良根治術(shù)加術(shù)后輔助化療的100例患者隨機分為實驗組和對照組,每組各50例。對照組采用常規(guī)護理干預(yù)方法;實驗組除常規(guī)護理干預(yù)外,行以醫(yī)務(wù)工作者、淋巴水腫治療師、心理咨詢師、營養(yǎng)師、志愿者及研究者為干預(yù)團隊的家庭護理(包括:疾病指導(dǎo)、認知干預(yù)、應(yīng)對技巧訓(xùn)練、知識講座、患教活動、APP平臺信息推送及名醫(yī)熱線、放松訓(xùn)練、家屬同步健康教育、家屬同步肢體功能鍛煉指導(dǎo)、成立家屬聯(lián)盟等)。分別在干預(yù)前和干預(yù)18周結(jié)束時應(yīng)用家庭功能評定量表及乳腺癌患者自我感受負擔問卷,比較兩組患者干預(yù)前后家庭功能狀況及自我感受負擔水平,評估家庭護理在乳腺癌術(shù)后化療護理中的作用。[結(jié)果]干預(yù)前兩組患者基本情況、家庭功能狀況及自我感受負擔水平的統(tǒng)計分析結(jié)果如下:(1)實驗組和對照組基本情況:年齡、民族構(gòu)成、居住地分布、文化程度、婚姻狀況、家庭關(guān)系、宗教信仰、職業(yè)、工作狀況、家庭人均月收入、醫(yī)療費用支付形式方面差異無統(tǒng)計學(xué)意義(P0.05)。實驗組和對照組疾病認知情況:患者對疾病的認識、疾病主要認知途徑、腫瘤分期及有無轉(zhuǎn)移進行比較后差異無統(tǒng)計學(xué)意義(P0.05)。實驗組和對照組家庭護理者情況:主要照顧者、照顧者性別、年齡、身體健康狀況及照顧時間進行比較后差異無統(tǒng)計學(xué)意義(P0.05)。(2)干預(yù)前現(xiàn)況分析:①乳腺癌患者SPB評分總分為118.88±11.94,處于中度負擔水平,其中低度負擔患者達(26/100,26%),中度負擔患者達(51/100,51%),高度負擔患者達(23/100,23%);對SPBS-BC的5個維度進行評分,其中情感和經(jīng)濟負擔維度評分最高(為35.61±4.36)。實驗組SPB評分為118.46±10.83,對照組SPB評分為119.30±13.05,兩組干預(yù)前SPB評分結(jié)果差異無統(tǒng)計學(xué)意義(P0.05)。②家庭功能評分總分為133.29±8.98,其中僅有6% (6/100)患者家庭功能處于良好狀態(tài)。實驗組FAD評分為133.00±9.00,對照組SPB評分為133.58±9.01,兩組干預(yù)前FAD評分結(jié)果差異無統(tǒng)計學(xué)意義(P0.05)。干預(yù)18周后兩組患者家庭功能狀況及自我感受負擔水平統(tǒng)計分析結(jié)果如下:(1)患者自我感受負擔的干預(yù)效果評價:干預(yù)18周后,實驗組SPB評分總分為86.83±6.23,對照組為117.27±13.46,對兩組患者的SPB評分進行比較,結(jié)果顯示:生活負擔、情感和經(jīng)濟負擔、社會負擔、家庭結(jié)構(gòu)、疾病和治療所致的負擔均有緩解,且緩解有統(tǒng)計學(xué)差異(P0.001)。對兩組患者干預(yù)前后的自我感受負擔評分進行組內(nèi)比較,結(jié)果顯示:實驗組在生活負擔、情感和經(jīng)濟負擔、社會負擔、家庭結(jié)構(gòu)、疾病和治療所致的負擔均有緩解,且緩解有統(tǒng)計學(xué)差異(P0.001);對照組除家庭結(jié)構(gòu)負擔這一維度外,其他生活負擔、情感和經(jīng)濟負擔、社會負擔、疾病和治療所致的負擔均有緩解,但緩解無統(tǒng)計學(xué)差異(P0.05)。(2)家庭功能的干預(yù)效果評價:干預(yù)18周后進行家庭功能的比較,實驗組家庭功能評分總分為123.43±7.41,對照組為129.92±8.30,兩組患者的家庭功能除角色這一維度的評分結(jié)果無統(tǒng)計學(xué)意義(P0.05)外,其他維度:問題解決、溝通、情感反應(yīng)、情感介入、行為控制和總的功能評分結(jié)果均有統(tǒng)計學(xué)意義(P0.05)。對兩組患者干預(yù)前后的家庭功能進行組內(nèi)比較,結(jié)果顯示:實驗組除溝通這一維度的評分無統(tǒng)計學(xué)意義(P0.05)外,其他維度:問題解決、角色、情感反應(yīng)、情感介入、行為控制和總的功能評分結(jié)果均有統(tǒng)計學(xué)意義(P0.05);對照組在問題解決、情感介入、行為控制和總的功能評分結(jié)果上有統(tǒng)計學(xué)意義(P0.05),其余角色、溝通及情感反應(yīng)評分結(jié)果均無統(tǒng)計學(xué)意義(P0.05)。[結(jié)論]同期家庭護理干預(yù)能有效提高乳腺癌患者的家庭功能,明顯降低乳腺癌患者自我感受負擔體驗,在乳腺癌術(shù)后化療患者的臨床護理工作中有推廣應(yīng)用價值。
[Abstract]:[Objective] To study the family function and self-perceived burden of patients with breast cancer after operation, and to explore the effect of home care on the self-feeling burden of breast cancer patients. [Methods] The present study randomly divided into experimental group and control group, and 50 cases of each group were randomly divided into experimental group and control group, from Feb.2016 to October,2016 to the breast center of the Third Affiliated Hospital of Kunming Medical University (Yunnan Cancer Hospital) and received the modified radical operation of breast cancer. The control group adopts the conventional nursing intervention method; in addition to the routine nursing intervention, the experimental group is a medical worker, a lymphedema therapist, a psychological consultant, a nutritionist, a volunteer and a home care for the intervention team (including disease guidance, cognitive intervention, coping skill training, Knowledge lecture, affected teaching activity, APP platform information push and name medical hotline, relaxation training, family synchronous health education, family synchronization limb function exercise guidance, establishment of family union, etc.). The status of home function and self-perceived burden were compared between the two groups before and after the intervention, and the role of home care in the postoperative chemotherapy of breast cancer was evaluated. [Results] The results of the statistical analysis of the basic conditions, family function and self-perceived burden of the two groups before intervention were as follows: (1) Basic conditions of the experimental group and the control group: age, ethnic composition, distribution of place of residence, degree of culture, marital status, family relationship, religious belief, There was no significant difference in the form of occupational, work and family-per-month income and medical expenses (P0.05). The cognitive status of the disease in the experimental group and the control group: the patient's knowledge of the disease, the main cognitive way of the disease, the stage of the tumor and the presence or absence of metastasis were not statistically significant (P0.05). In the experimental group and the control group, there was no significant difference in the situation of home care in the experimental group and the control group (P0.05). (2) The pre-intervention status analysis: The total score of SPB in breast cancer patients was 118.88 and 11.94, which was in moderate burden, among which low-burden patients (26/100,26%), moderate-burden patients (51/100,51%), high-burden patients (23/100,23%), and 5 dimensions of SPBS-BC, Among them, the score of emotional and economic burden is the highest (35.61-4.36). The SPB scores of the experimental group were 118.46 and 10.83, and the SPB scores of the control group were 119.30 and 13.05, and the difference of SPB scores between the two groups was not statistically significant (P0.05). The total score of the family function was 133.29-8.98, of which only 6% (6/100) of the patients had a good family function. The score of FAD in the experimental group was 133.00-9.00, the SPB score of the control group was 133.58-9.01, and the difference of the FAD scores between the two groups was not statistically significant (P0.05). After 18 weeks of intervention, the results of the statistical analysis of the family function and self-perceived burden of the two groups were as follows: (1) Evaluation of the intervention effect of the self-feeling burden of the patient: after 18 weeks of intervention, the SPB score of the experimental group was divided into 86.83 and 6.23, and the control group was 117.27-13.46. The results showed that the burden of life, the emotional and economic burden, the social burden, the family structure, the disease and the burden of treatment were relieved and the statistical difference was relieved (P 0.001). The results showed that the burden of life, emotional and economic burden, social burden, family structure, disease and treatment of the experimental group were relieved and the statistical difference was relieved (P 0.001). The burden of other living, emotional and economic burden, social burden, disease and treatment were relieved in the control group, except for the family structure burden, but there was no statistical difference (P0.05). (2) The evaluation of the intervention effect of the family function: compared with the family function after 18 weeks of intervention, the score of the family function in the experimental group was 123.43-7.41, the control group was 129.92-8.30, and the scores of the family function of the two groups were not statistically significant (P0.05). Other dimensions: problem solving, communication, emotional reaction, emotional intervention, behavior control and overall functional scoring results are of statistical significance (P0.05). The family function before and after the intervention of the two groups of patients was compared, and the results showed that, in the experimental group, the score of the dimension was not statistically significant (P0.05), and the other dimensions were: problem resolution, role, emotional response, emotional intervention, The results of behavior control and total functional score were of statistical significance (P0.05); the control group had statistical significance in the results of problem resolution, emotional intervention, behavior control and overall functional score (P0.05), and the other characters, communication and emotional response scores were not statistically significant (P0.05). [Conclusion] The home-care intervention in the same period can effectively improve the family function of the breast cancer patients, and obviously reduce the self-feeling burden experience of the breast cancer patients, and has the popularization and application value in the clinical nursing work of the chemotherapy patients after the breast cancer operation.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R473.73

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