The effect of empowering nursing on compliance with dual induction therapy in patients with acute promyelocytic leukemia
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摘要:
目的 探究对双诱导治疗急性早幼粒细胞白血病（APL）患者采用赋权护理（EN）的临床价值及对患者赋权水平、治疗依从性及并发症的影响。 方法 选取2023年8月—2025年3月联勤保障部队第九四〇医院血液科收治的100例APL患者作为研究对象，采用随机数字表法分为对照组和试验组，各50例，对照组接受常规护理，试验组在常规护理基础上增加EN工作内容。比较2组赋权水平、治疗依从性、疾病缓解情况和并发症。 结果 试验组赋权水平优于对照组（Z=3.960，P < 0.001）；干预8个月后，2组用药、饮食、环境、心理及依从性总分显著高于干预前，且试验组各项得分及总分均显著高于对照组（P＜0.05）；外周血白细胞计数（WBC）水平显著高于对照组（P＜0.05），早幼粒细胞所占比率显著低于对照组（P＜0.05）；试验组出血、感染、分化综合征（DS）、中枢神经系统白血病（CNSL）等主要并发症发生率明显低于对照组（P＜0.05）。 结论 EN对于提高APL患者双诱导治疗依从性具有积极意义，在改善患者早幼粒细胞占比的同时降低了治疗过程中主要并发症的发生率。 -
关键词:
- 赋权护理 /
- 急性早幼粒细胞白血病 /
- 双诱导 /
- 治疗依从性
Abstract:Objective To explore the clinical value of empowerment nursing (EN) for patients with acute promyelocytic leukemia (APL) undergoing dual induction therapy, as well as its impact on patients' empowerment level, treatment compliance, and complications. Methods A total of 100 APL patients admitted to the Department of Hematology, 940th Hospital of the Joint Logistics Support Force of Chinese People's Liberation Army from August 2023 to March 2025 were enrolled and randomly divided into a control group (n=50, routine nursing) and an experimental group (n=50, routine nursing+EN) using a random number table method. Empowerment levels, treatment compliance, remission of disease, and complications were compared between the two groups. Results The empowerment level of the experimental group was superior to that of the control group (Z=3.960, P < 0.001). After 8 months of intervention, the scores for medication, diet, environment, psychological status, and overall compliance in both groups were significantly higher than those before the intervention, and these scores, as well as the total scores, were significantly higher in the experimental group (P < 0.05). The level of peripheral white blood cell count (WBC) was significantly higher than that in control group (P < 0.05), while the proportion of promyelocyte was significantly lower (P < 0.05). The incidence of major complications such as hemorrhage, infection, differentiation syndrome (DS) and central nervous system leukemia (CNSL) in the experimental group was significantly lower than those in the control group (P < 0.05). Conclusion EN has positive significance in improving compliance with dual induction therapy in APL patients, decreasinging the proportion of promyelocytes, reducing the incidence of major complications during treatment. -
Key words:
- Empowering nursing /
- Acute promyelocytic leukemia /
- Dual induction /
- Treatment compliance
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表 1 2组APL患者一般资料比较
Table 1. Comparison of general data between the two groups of APL patients
组别 例数 性别(例) 年龄(x±s，岁) 受教育程度(例) 婚姻状况(例) 男性 女性 专科以下 专科及以上 已婚 未婚及其他 对照组 50 28 22 48.55±5.74 34 16 39 11 试验组 50 29 21 48.71±5.90 39 11 40 10 统计量 0.041a 0.137b 1.268a 0.060a P值 0.840 0.891 0.260 0.806 组别 例数 生活方式(例) 工作状态(例) 骨髓早幼粒细胞占比(x±s，%) 外周血白细胞(x±s，×109/L) 群居 独居 无业 在职 退休 对照组 50 42 8 28 9 13 0.22±0.07 2.61±0.44 试验组 50 43 7 30 5 15 0.20±0.05 2.57±0.51 统计量 0.078a 0.367a 1.644b 0.420a P值 0.779 0.548 0.103 0.676 注：a为χ2值，b为t值。 
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表 2 2组APL患者赋权水平比较[例(%)]
Table 2. Comparison of empowerment levels between the two groups of APL patients [cases (%)]
组别 例数 高度赋权 中度赋权 低度赋权 对照组 50 18(36.00) 22(44.00) 10(20.00) 试验组 50 38(76.00) 9(18.00) 3(6.00) 注：2组赋权水平比较，Z=3.962，P＜0.001。
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表 3 2组APL患者治疗依从性比较(x±s，分)
Table 3. Comparison of treatment compliance between the two groups of APL patients (x±s, points)
组别 例数 用药 饮食 环境 心理 总分 干预前 干预8个月 干预前 干预8个月 干预前 干预8个月 干预前 干预8个月 干预前 干预8个月 对照组 50 15.75±3.68 20.62±5.10b 17.85±2.68 23.49±6.52b 17.42±3.77 20.58±4.62b 14.60±3.22 23.74±6.21b 70.84±6.61 90.83±6.73b 试验组 50 15.57±4.02 31.75±5.44b 17.93±4.51 30.37±5.13b 18.20±4.78 28.97±5.25b 14.49±4.17 32.54±5.66b 71.49±6.81 131.55±7.41b 统计量 0.234a 58.291c 0.108a 29.932c 0.906a 47.651c 0.148a 41.267c 0.484a 89.697c P值 0.816 ＜0.001 0.914 ＜0.001 0.367 ＜0.001 0.883 ＜0.001 0.629 ＜0.001 注：a为t值，c为F值；与同组干预前比较，bP＜0.05。
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表 4 2组APL患者外周血WBC、早幼粒细胞所占比率比较(x±s)
Table 4. Comparison of the proportions of WBC and promyelocytes in peripheral blood between the two groups of APL patients (x±s)
组别 例数 WBC(×109) 早幼粒细胞所占比率(%) 干预前 干预8个月 干预前 干预8个月 对照组 50 2.61±0.44 3.34±0.27b 0.22±0.07 0.10±0.02b 试验组 50 2.57±0.51 4.67±0.42b 0.20±0.05 0.03±0.01b 统计量 0.420a 354.773c 1.644a 490.000c P值 0.676 ＜0.001 0.103 ＜0.001 注：a为t值，c为F值；与同组干预前比较，bP＜0.05。
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表 5 2组APL患者并发症情况比较[例(%)]
Table 5. Comparison of complications between the two groups of APL patients [cases (%)]
组别 例数 出血 感染 DS CNSL 总发生 对照组 50 8(16.00) 4(8.00) 2(4.00) 0 14(28.00) 试验组 50 2(4.00) 1(2.00) 1(2.00) 0 4(8.00) 注：2组并发症总发生率比较，χ2=5.488，P=0.019。
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[1] 章建国, 秦慧. 急性早幼粒细胞白血病患者发生分化综合征的影响因素及转归[J]. 江苏医药, 2024, 50(6): 609-613.Zhang J G, Qin H. Influencing factors and outcomes of differentiation syndrome in acute promyelocytic leukemia patients[J]. Jiangsu Med J, 2024, 50(6): 609-613. [2] 朗德龙, 冯玉虎. 全口服无化疗方案与化疗方案治疗急性早幼粒细胞白血病疗效对比[J]. 临床血液学杂志, 2021, 34(11): 776-780, 784.Lang D L, Feng Y H. The comparison of chemotherapy and oral chemo-free therapy for acute promyelocytic leukemia[J]. J Clin Hematol, 2021, 34(11): 776-780, 784. [3] 赵晨阳, 张欣欣, 龚莎, 等. 砷剂治疗急性早幼粒细胞白血病诱发带状疱疹再激活的研究[J]. 中国实验血液学杂志, 2022, 30(1): 72-76.Zhao C Y, Zhang X X, Gong S, et al. Study on herpes zoster reactivation induced by arsenic in patients with acute promyelocytic leukemia[J]. J Exp Hematol, 2022, 30(1): 72-76. [4] 韩瑜, 罗要国, 李转珍. 基于赋权理论的健康教育对社区老年高血压患者的效果研究[J]. 中华全科医学, 2022, 20(10): 1728-1732. doi: 10.16766/j.cnki.issn.1674-4152.002690Han Y, Luo Y G, Li Z Z. Research on the effect of health education based on empowerment theory on elderly hypertensive patients[J]. Chinese Journal of General Practice, 2022, 20(10): 1728-1732. doi: 10.16766/j.cnki.issn.1674-4152.002690 [5] 俞惠萍, 方小萍, 崔蕾. 以家庭为中心的赋权模式在护理中的研究进展[J]. 实用医院临床杂志, 2024, 21(5): 202-205.Yu H P, Fang X P, Cui L. Research progress of family-centered empowerment model in nursing[J]. Pract J Clin Med, 2024, 21(5): 202-205. [6] 中华医学会血液学分会, 中国医师协会血液科医师分会. 中国急性早幼粒细胞白血病诊疗指南(2018年版)[J]. 中华血液学杂志, 2018, 39(3): 179-183.Hematology Branch of Chinese Medical Association, Hematologists Branch of Chinese Medical Doctor Association. Chinese guidelines for diagnosis and treatment of acute promyelocytic leukemia (2018)[J]. Chin J Hematol, 2018, 39(3): 179-183. [7] 喻蓉, 陈卓园园, 曹红, 等. 癌症赋权问卷中文版的信度与效度[J]. 中国实用护理杂志, 2021, 37(35): 2779-2783.Yu R, Chen Z Y Y, Cao H, et al. Reliability and validity of the Chinese version of the cancer empowerment questionnaire[J]. Chin J Pract Nurs, 2021, 37(35): 2779-2783. [8] 张燕芳, 朱晨影, 康媛源, 等. 砷剂联合方案抗血液肿瘤的临床应用与研究进展[J]. 中国现代应用药学, 2023, 40(9): 1260-1269.Zhang Y F, Zhu C Y, Kang Y Y, et al. Clinical application and advances of arsenic trioxide combined regimen against hematological tumors[J]. Chin J Mod Appl Pharm, 2023, 40(9): 1260-1269. [9] 寇雪琴, 高力频. 探讨优质护理对白血病患者化疗不良情绪和治疗依从性的改善评价[J]. 现代消化及介入诊疗, 2020(S01): 405-406.Kou X Q, Gao L P. Exploring the impact of high-quality nursing on the alleviation of adverse emotions and treatment compliance in leukemia patients undergoing chemotherapy[J]. Mod Digestion Interv, 2020(S01): 405-406. [10] ZENG X L, HENEGHAN M B, BADAWY S M. Adherence to oral chemotherapy in acute lymphoblastic leukemia during maintenance therapy in children, adolescents, and young adults: a systematic review[J]. Current Oncology, 2023, 30(1): 720-748. doi: 10.3390/curroncol30010056 [11] 高欣, 王旭利. 初诊白血病患者对疾病进展的恐惧现状及治疗依从性调查分析[J]. 医学信息, 2020, 33(12): 123-125.Gao X, Wang X L. Investigation and analysis of the current status of the fear of disease progression and treatment compliance in newly diagnosed leukemia patients[J]. Med Inform, 2020, 33(12): 123-125. [12] 刘峰利, 汤书脘, 汪丹, 等. 互联网+背景下赋权增能健康教育模式在糖尿病视网膜病变患者延伸护理中的应用[J]. 海南医学, 2023, 34(9): 1330-1334.Liu F L, Tang S W, Wang D, et al. Application of empowerment health education in extended nursing of patients with diabetic retinopathy under the background of Internet Plus[J]. Hainan Med J, 2023, 34(9): 1330-1334. [13] 孙文雯, 孙如, 董丽丽, 等. 基于赋权理论的延伸护理模式对乳腺癌患者淋巴水肿的防控效果研究[J]. 长春中医药大学学报, 2020, 36(5): 1034-1037.Sun W W, Sun R, Dong L L, et al. Study on the prevention and control effect of lymphedema in patients with breast cancer by extended nursing mode based on empowerment theory[J]. J Changchun Univ Chin Med, 2020, 36(5): 1034-1037. [14] 何柏霖, 郭玉霞, 温普生, 等. 儿童急性淋巴细胞白血病血小板输注影响因素及疗效预测模型的构建与验证[J]. 中国循证儿科杂志, 2023, 18(6): 435-441.He B L, Guo Y X, Wen P S, et al. Influencing factors and efficacy prediction model of platelet transfusion for children with acute lymphoblastic leukemia[J]. Chin J Evid Based Pediatr, 2023, 18(6): 435-441. [15] 陈泳珊, 陈佩妍, 张娜, 等. 口服营养补充对急性淋巴细胞白血病儿童诱导化疗期血液系统并发症等的影响: 随机对照研究的中期结果[J]. 中国小儿血液与肿瘤杂志, 2024, 29(2): 103-108.Chen Y S, Chen P Y, Zhang N, et al. The impact of oral nutritional supplementation on Hematological complications in Children with acute lymphoblastic Leukemia during induction chemotherapy: interim results of a randomized controlled study[J]. J Chin Pediatr Blood Cancer, 2024, 29(2): 103-108.
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