李艷操

(汕頭大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院心內(nèi)科，廣東汕頭 515000)

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過(guò)渡期護(hù)理對(duì)胰腺癌術(shù)后患者依從性及生活質(zhì)量的影響

李艷操

(汕頭大學(xué)醫(yī)學(xué)院附屬第一醫(yī)院心內(nèi)科，廣東汕頭 515000)

目的：探討過(guò)渡期護(hù)理對(duì)胰腺切除手術(shù)患者相關(guān)并發(fā)癥及生活質(zhì)量的影響。方法：選取我院收治的胰腺癌患者130例，手術(shù)后隨機(jī)分為過(guò)渡組和對(duì)照組，每組65例。對(duì)照組患者給予常規(guī)護(hù)理，過(guò)渡組在常規(guī)護(hù)理基礎(chǔ)上實(shí)施過(guò)渡期護(hù)理。比較兩組患者干預(yù)前后治療依從性、并發(fā)癥及再入院率差異，并對(duì)患者的生活質(zhì)量和對(duì)護(hù)理滿意度進(jìn)行調(diào)查。結(jié)果：治療依從性、并發(fā)癥及再入院率方面，過(guò)渡組的各項(xiàng)指標(biāo)均顯著優(yōu)于對(duì)照組(P<0.05)，過(guò)渡組患者的生活質(zhì)量和對(duì)護(hù)理工作的滿意度也明顯高于對(duì)照組，差異具有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論：胰腺癌患者手術(shù)后實(shí)施過(guò)渡期護(hù)理可明顯降低患者并發(fā)癥的發(fā)生率，改善患者的生活質(zhì)量，提高患者的護(hù)理滿意度。

胰腺癌；過(guò)渡期護(hù)理；滿意度；生活質(zhì)量

胰腺癌是腫瘤科常見(jiàn)的疾病之一，對(duì)人們的正常生活有較大影響。近年隨著胰腺癌手術(shù)的不斷改進(jìn)，術(shù)中并發(fā)癥和死亡率均明顯降低[1]。但患者行腫瘤切除手術(shù)之后多數(shù)在病情平穩(wěn)后出院，因此，在家進(jìn)行過(guò)渡期康復(fù)顯得尤為重要。國(guó)外研究表明過(guò)渡期護(hù)理模式可以拓展護(hù)理服務(wù)領(lǐng)域，使護(hù)理服務(wù)延伸到社區(qū)和家庭，更加注重了患者護(hù)理和康復(fù)的延續(xù)性[2]。我國(guó)過(guò)渡期護(hù)理模式的開(kāi)展尚處于起步階段，有關(guān)胰腺癌患者實(shí)行過(guò)渡期護(hù)理后對(duì)并發(fā)癥和生活質(zhì)量影響的報(bào)道亦較少。我們對(duì)2011年10月至2014年10月的130例胰腺癌患者出院后實(shí)施精心的過(guò)渡期護(hù)理，效果滿意?，F(xiàn)報(bào)告如下。

1 對(duì)象與方法

1.1 對(duì)象 選取2011年10月至2014年10月在我院腫瘤科進(jìn)行外科手術(shù)治療的胰腺癌患者130例。全部患者均經(jīng)過(guò)病理、生化、影像檢查確診為胰腺癌。排除合并嚴(yán)重臟器疾病、血液系統(tǒng)疾病、感染患者。手術(shù)后將患者隨機(jī)分為過(guò)渡組或?qū)φ战M，每組65例。其中過(guò)渡組男22例，女43例，年齡28～79歲，平均年齡47.4歲；對(duì)照組男26例，女39例，年齡31～82歲，平均年齡46.1歲。兩組患者在性別、年齡、腫瘤分型等方面比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)，具有可比性。

1.2 方法 對(duì)照組給予常規(guī)住院護(hù)理措施，過(guò)渡組在此基礎(chǔ)上給予術(shù)前普及胰腺癌手術(shù)相關(guān)知識(shí)，術(shù)后給予康復(fù)教育指導(dǎo)，包括戒煙、飲食、運(yùn)動(dòng)、減肥的控制等。出院后1個(gè)月、3個(gè)月進(jìn)行隨訪，對(duì)照組僅收集數(shù)據(jù)，過(guò)渡組則給予電話督導(dǎo)藥物服用及改善生活方式的指導(dǎo)，并隨時(shí)為患者提供相關(guān)問(wèn)題的咨詢。比較隨訪期間兩組患者生活方式的改變、出院后主要不良事件的發(fā)生情況。

1.3 觀察指標(biāo) 依從性問(wèn)卷觀察指標(biāo)為：術(shù)后1個(gè)月服藥、3個(gè)月服藥、復(fù)查、生活方式等方面的依從性。采用生活質(zhì)量綜合評(píng)估問(wèn)卷(generic quality of life inventory-74,GQOL-74)評(píng)估患者生活質(zhì)量，包括社會(huì)功能、心理功能、軀體功能和角色功能，評(píng)分越高表明生活質(zhì)量越高。觀察過(guò)渡組和對(duì)照組患者術(shù)后出現(xiàn)的并發(fā)癥：感染、膽漏、消化道出血、輸入/輸出段梗阻、胰腸吻合口漏，計(jì)算并發(fā)癥的發(fā)生率,并對(duì)再入院率進(jìn)行統(tǒng)計(jì)分析。

2 結(jié)果

2.1 干預(yù)后兩組患者治療依從性的階段性比較 采用χ2檢驗(yàn)對(duì)干預(yù)后兩組患者治療依從性各指標(biāo)進(jìn)行比較。出院后1個(gè)月，過(guò)渡組服藥依從性高于對(duì)照組(P<0.05)；出院后3個(gè)月，過(guò)渡組各維度除吸煙外均高于對(duì)照組(P<0.05),生活維度比較，差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。見(jiàn)表1。

表1 兩組患者干預(yù)前后治療依從性的比較(n，%)

a為過(guò)渡組和對(duì)照組相比，P<0.05

2.2 干預(yù)后兩組患者生存質(zhì)量的比較 過(guò)渡組患者的社會(huì)功能評(píng)分、心理功能評(píng)分、軀體功能評(píng)分、角色功能評(píng)分及GQOL-74總評(píng)分均高于對(duì)照組(P<0.05)，見(jiàn)表2。

表2 兩組患者的生活質(zhì)量評(píng)分±s)

2.3 干預(yù)后兩組患者臨床指標(biāo)的比較 兩組患者出院后3個(gè)月臨床指標(biāo)比較，過(guò)渡組各項(xiàng)指標(biāo)均優(yōu)于對(duì)照組(P<0.05)，見(jiàn)表3。

表3 干預(yù)后兩組患者并發(fā)癥及再入院率的比較

3 討論

過(guò)渡期護(hù)理模式(transitional care model，TCM)是指當(dāng)患者在疾病治療與康復(fù)階段，由于診療環(huán)境和護(hù)理需求的改變，需要在各級(jí)醫(yī)療衛(wèi)生保健機(jī)構(gòu)之間進(jìn)行轉(zhuǎn)運(yùn)與過(guò)渡，過(guò)渡期護(hù)士(transitional care nurse，TCN)為確?；颊咴谶@一過(guò)渡期間護(hù)理工作的協(xié)調(diào)與連續(xù)而采取一系列相應(yīng)的護(hù)理行為，它填補(bǔ)了患者出院后醫(yī)療保健信息缺乏、護(hù)理服務(wù)中斷、健康需求難以滿足的空白，更加體現(xiàn)了護(hù)理工作的價(jià)值[3，4]。過(guò)渡期護(hù)理模式的主要宗旨是為患者及照顧者在出院后的過(guò)渡期間提供信息及支持，掌握自我照顧能力，使患者盡快恢復(fù)機(jī)體功能，降低再次入院率[5，6]。

胰腺癌患者術(shù)后需要較長(zhǎng)時(shí)間康復(fù)治療，由于受多種原因限制，較少能在醫(yī)院一次性完成疾病的全程治療與康復(fù)[7，8]?；颊呋貧w家庭后，離開(kāi)或缺少醫(yī)務(wù)人員的?？萍膊∽o(hù)理指導(dǎo)，往往失去安全感和依賴感，他們希望在出院后能獲得更多的健康知識(shí)和護(hù)理技能，順利完成由醫(yī)院到家庭的角色轉(zhuǎn)化[9]。所以對(duì)其開(kāi)展以TCM為基礎(chǔ)的護(hù)理干預(yù)模式，及時(shí)準(zhǔn)確地了解患者出院后過(guò)渡期出現(xiàn)的困難，向患者提供健康教育和相關(guān)支持，并對(duì)發(fā)現(xiàn)的問(wèn)題進(jìn)行指導(dǎo)和干預(yù)，可以有效提高過(guò)渡階段護(hù)理服務(wù)的連續(xù)性，彌補(bǔ)患者出院后醫(yī)療保健信息缺乏、護(hù)理服務(wù)中斷、健康需求難以滿足等不足之處[10]。

本研究通過(guò)分析患者過(guò)渡期存在的問(wèn)題，并在此基礎(chǔ)上對(duì)胰腺癌患者建立一個(gè)過(guò)渡期護(hù)理方案，包括對(duì)患者的評(píng)估、教育、監(jiān)督及實(shí)施等措施。得出過(guò)渡組患者在用藥、復(fù)查、運(yùn)動(dòng)、吸煙、飲酒方面依從性，生存質(zhì)量及再入院率等方面的改變效果都優(yōu)于對(duì)照組，獲得較明顯的干預(yù)效果，提高了患者在不穩(wěn)定時(shí)期的轉(zhuǎn)運(yùn)質(zhì)量。

本研究結(jié)果證實(shí)了過(guò)渡期護(hù)理模式在胰腺癌術(shù)后患者中應(yīng)用的有效性，較好地解決了患者安全過(guò)渡到正常工作及生活的問(wèn)題，豐富了過(guò)渡期護(hù)理模式的實(shí)踐內(nèi)容，為臨床發(fā)展有序有效的過(guò)渡期干預(yù)提供了參考。本研究的局限性是樣本量尚不夠大，隨訪時(shí)間不夠長(zhǎng)，未對(duì)方案的長(zhǎng)期效應(yīng)進(jìn)行觀察。且由于人力物力的限制，未能充分解決季節(jié)、樣本、回憶等方面存在的偏倚。

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The influence of transitional care on the compliance and quality of life in patients after pancreatic cancer surgery

LI Yancao

(DepartmentofCardiology，TheFirstAffiliatedHospitalofShantouUniversity,Shantou515000,China)

Objective:To explore the influence of transitional care on the related complications and quality of life in patients after pancreatic cancer surgery. Methods: 130 cases of pancreatic cancer enrolled were randomly divided into the transition group and the control group, 65 cases in each group. The control group was given routine care, and the transition group was implemented transitional care on the basis of conventional nursing care. The differences of the two groups before and after intervention in the treatment compliance, readmission rate and complications were compared, with the quality of life and the nursing satisfaction in patients investigated. Results: In terms of the treatment compliance, readmission rate and complications, these indicators in the transitional group were significantly better than that of the control group (P<0.05). The quality of life and satisfaction to nursing work in the transition group were significantly higher than that in the control group, the difference statistically significant (P<0.05). Conclusion: The transitional nursing in patients after pancreatic cancer surgery can obviously reduce the incidence of complications, improve patients' quality of life, and promote patients' satisfaction with care.

Pancreatic cancer; Transitional care; Satisfaction; Quality of life

2015-09-22)