基于循证的精准护理模式对肝癌介入患者围术期心理应激及术后并发症的影响

刘丽霞; 毛剑婷; 黄旭芳; 吴巧红

doi:10.16766/j.cnki.issn.1674-4152.002393

基于循证的精准护理模式对肝癌介入患者围术期心理应激及术后并发症的影响

doi: 10.16766/j.cnki.issn.1674-4152.002393

丽水市中心医院32病区介入诊疗中心，浙江丽水 323000

基金项目:

浙江省医药卫生科技计划项目 2020KY1086

详细信息

通讯作者:
刘丽霞, E-mail: 18957066667@189.cn

中图分类号: R473.73 R735.7
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- 文章访问数: 162
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- PDF下载量: 4
- 被引次数: 0
出版历程
- 收稿日期: 2021-06-12
- 网络出版日期: 2022-08-13

Effect of evidence-based precision nursing model on perioperative psychological stress and postoperative complications in patients with liver cancer undergoing interventional therapy

Interventional Treatment Center in the 32th Ward, Lishui Central Hospital, Lishui, Zhejiang 323000, China

摘要

摘要: 目的探究基于循证的精准护理模式对肝癌介入患者围术期心理应激及术后并发症的影响。方法丽水市中心医院介入诊疗中心自2020年开始实施基于循证的精准护理模式，实施前将2019年4—12月的50例患者纳入对照组，2020年1—8月实施后的46例患者纳入观察组，2组患者均给予肝动脉化疗栓塞术，对照组采用常规围术期护理，观察组采用基于循证的精准护理。比较2组心理应激反应评分、心理状态、依从性、术后并发症及护理满意度情况。结果术后3 d，观察组医学应对问卷(MCMQ)中屈服、回避状态得分[(7.18±1.77)分、(11.87±2.38)分]均显著低于对照组[(10.48±1.89)分、(13.29±2.33)分]，应对状态得分[(20.64±2.72)分]显著高于对照组[(18.85±2.93)分，均P＜0.05]。出院前，观察组汉密尔顿抑郁自评量表(HAMD)、汉密尔顿焦虑自评量表(HAMA)评分均显著低于对照组(均P＜0.05)。观察组低蛋白血症、胃肠道反应的发生率显著低于对照组(均P＜0.05)。观察组术后适当运动、饮食控制的遵医行为人数显著高于对照组(均P＜0.05)。观察组护理人员沟通能力、操作技能和医护配合度3个方面的护理满意度得分高于对照组(均P＜0.05)。结论基于循证的精准护理模式有助于改善肝癌介入治疗患者心理应激状态和不良情绪，减少术后并发症，护理满意度更高。
- 精准护理 /
- 肝癌 /
- 介入治疗 /
- 心理应激
Abstract: Objective To explore the effects of evidence-based precision nursing mode on peri-operative psychological stress and post-operative complications in patients undergoing liver cancer undergoing intervention therapy. Methods Before the implementation, 50 patients from April to December 2019 were included in the control group, and 46 patients after the implementation from January to August 2020 were included in the observation group. Both groups received hepatic arterial chemoembolization, and the control group received conventional perioperative surgery. The observation group adopted evidence-based precision nursing. The scores of psychological stress response, psychological status, compliance, post-operative complications and nursing satisfaction were compared between the two groups. Results At 3 days after surgery, the scores of yielding and avoiding status in the medical coping modes questionnaire of the observation group were (7.18±1.77) points and (11.87±2.38) points, which are significantly lower than the (10.48±1.89) points and (13.29±2.33) points of the control group, whereas the score of coping status was (20.64±2.72) points, which is significantly higher than the (18.85±2.93) points of the control group (all P < 0.05). Before discharge, scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) were significantly lower in the observation group than in the control group (all P < 0.05). The incidence of hypoproteinaemia and gastrointestinal reactions was significantly lower in the observation group than in the control group (all P < 0.05). After surgery, the number of cases with proper exercise and diet control in the observation group was significantly greater than that in the control group (all P < 0.05). The scores of satisfactions with communication ability, operating skills and medical-nursing cooperation of nursing staff in the observation group were higher than those in the control group (all P < 0.05). Conclusion The evidence-based precision nursing mode is beneficial to improve psychological stress status and negative emotions of patients undergoing liver cancer intervention therapy and reduce post-operative complications, with high nursing satisfaction.
- Precision nursing /
- Liver cancer /
- Intervention therapy /
- Psychological stress

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表 1 2组肝癌患者心理应激反应评分(x±s，分)

Table 1. Scores of psychological stress response in the two groups (x±s, points)

组别	例数	屈服	回避	应对
观察组	46	7.18±1.77	11.87±2.38	20.64±2.72
对照组	50	10.48±1.89	13.29±2.33	18.85±2.93
t值		8.810	2.953	3.094
P值		＜0.001	0.004	0.003

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表 2 2组肝癌患者心理状态评分(x±s，分)

Table 2. Scores of psychological state in the two groups (x±s, points)

组别	例数	HAMD评分		t值	P值	HAMA评分		t值	P值
组别	例数	术前	护理后7 d	t值	P值	术前	护理后7 d	t值	P值
观察组	46	14.78±3.61	3.02±0.63	37.623	＜0.001	12.96±2.41	3.54±0.63	36.156	＜0.001
对照组	50	15.18±3.68	4.11±0.65	42.033	＜0.001	13.24±2.43	4.08±0.78	40.356	＜0.001
t值		0.537	8.330			0.566	3.712
P值		0.593	＜0.001			0.573	＜0.001

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表 3 2组肝癌患者术后并发症情况[例(%)]

Table 3. Postoperative complications of liver cancer patients in the two groups [cases (%)]

组别	例数	低蛋白血症	感染	消化道出血	低钾低钠血症	胃肠道反应
观察组	46	23(50.00)	0	1(2.17)	0	26(56.52)
对照组	50	36(72.00)	2(4.00)	2(4.00)	1(2.00)	38(76.00)
χ²值		4.895	0.430	0.005	0.020	4.090
P值		0.027	0.512	0.941	0.967	0.043

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表 4 2组肝癌患者依从性比较[例(%)]

Table 4. Compliance of liver cancer patients in the two groups [cases (%)]

组别	例数	服药	饮食控制	定期复查	适当运动
观察组	46	45(97.83)	43(93.48)	46(100.00)	41(89.13)
对照组	50	44(88.00)	39(78.00)	48(96.00)	35(70.00)
χ²值		3.422	4.608	1.879	5.316
P值		0.064	0.032	0.170	0.021

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表 5 2组肝癌患者护理满意度评分(x±s，分)

Table 5. Scores of nursing satisfaction in the two groups (x±s, points)

组别	例数	病房环境	护理人员沟通能力	操作技能	医护配合度
观察组	46	98.76±2.99	98.11±2.75	98.07±3.09	98.65±2.97
对照组	50	97.65±2.64	95.72±3.13	95.79±3.23	95.70±2.56
t值		1.931	3.960	3.527	5.224
P值		0.056	＜0.001	0.001	＜0.001

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