基于同质医疗服务理念的护理模式对结直肠癌造口患者情绪及生存质量的影响

周洁; 鲍向英

doi:10.16766/j.cnki.issn.1674-4152.002437

基于同质医疗服务理念的护理模式对结直肠癌造口患者情绪及生存质量的影响

doi: 10.16766/j.cnki.issn.1674-4152.002437

周洁,
鲍向英^,

浙江大学医学院附属第二医院大肠外科二病区，浙江杭州 310000

基金项目:

浙江省中医药科技计划项目 2019zb070

详细信息

通讯作者:
鲍向英，E-mail：zrxwk2@zju.edu.cn

中图分类号: R473.73 R735.3
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- 文章访问数: 80
- HTML全文浏览量: 27
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2021-04-21
- 网络出版日期: 2022-08-20

Effect of nursing model based on the concept of homogeneous medical service on the mood and quality of life of patients with colorectal cancer stoma

ZHOU Jie,
BAO Xiang-ying^,

Department of Colorectal Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang 310000, China

摘要

摘要: 目的探讨以同质医疗服务理念为基础的护理模式对结直肠癌造口患者情绪及生存质量的影响，以期为临床结直肠癌造口护理提供参考依据。方法选择2017年4月30日—2019年12月1日在浙江大学医学院附属第二医院行永久性结直肠癌造口的患者120例，其中2017年4月30日—2018年7月31日入组患者为对照组，2018年8月1日—2019年12月1日入组患者为观察组，每组60例。对照组给予结直肠癌造口常规护理，观察组给予以同质医疗服务为基础的创新型护理措施。比较2组患者干预前后不良情绪评分、健康希望水平、生存质量、并发症发生情况及护理满意度。结果干预后，观察组健康问卷(PHQ-9)得分、广泛性焦虑量表(GAD-7)评分[(10.53±2.27)分，(9.73±1.91)分]均明显低于对照组[(11.85±2.73)分，(11.03±2.03)分，均P < 0.05]，健康希望量表评分(HHI)与生存质量评分[(29.59±7.38)分，(60.02±6.73)分]明显高于对照组[(25.69±5.87)分，(76.48±7.39)分，均P < 0.05]；干预期间，观察组并发症发生率明显低于对照组(P < 0.05)，护理满意度明显高于对照组(P < 0.05)。结论对永久性结直肠癌造口患者实施以同质医疗为基础的干预护理，能够有效缓解患者不良情绪、提高健康希望水平并减少造口并发症的发生，有助于促进医患和谐，且对提高患者生存质量具有积极作用。
- 同质医疗服务 /
- 创新 /
- 结直肠癌造口 /
- 不良情绪 /
- 生存质量
Abstract: Objective To explore the impact of the nursing model based on the concept of homogeneous medical service on the mood and quality of life of patients with colorectal cancer stoma in order to provide a reference for clinical colorectal cancer stoma care. Methods From April 30, 2017 to December 1, 2019, 120 patients with permanent colostomy for colorectal cancer in the Second Affiliated Hospital of Zhejiang University School of Medicine were selected. Amongst them, the patients admitted from April 30, 2017 to July 31, 2018 were set as the control group, and the patients admitted from August 1, 2018 to December 1, 2019 were set as the observation group, with 60 cases in each group. Patients in the control group were given routine nursing measures for colorectal cancer stoma, and patients in the observation group were given innovative nursing measures based on homogeneous medical services. The adverse emotion score, health hope level, quality of life, complications and nursing satisfaction were compared between the two groups before and after the intervention. Results After the intervention, the scores of patient health questionnaire-9 and generalised anxiety disorder-7 in the observation group [(10.53±2.27) points, (9.73±1.91) points] were significantly lower than those in the control group [(11.85±2.73) points, (11.03±2.03) points, all P < 0.05], and the scores of health hope inventory and quality of life in the observation group [(29.59±7.38) points, (60.02±6.73) points] were significantly higher than those in the control group [(25.69±5.87) points, (76.48±7.39) points, all P < 0.05]. During the intervention, the incidence of complications in the observation group was significantly lower than that in the control group (P < 0.05), and the nursing satisfaction was significantly higher than that in the control group (P < 0.05). Conclusion The implementation of homogeneous medical-based intervention care for patients with permanent colorectal cancer stoma can effectively alleviate patients' bad mood, improve the level of health hope and reduce the occurrence of stoma complications. It will help to promote the harmony between doctors and patients and has a positive effect in improving the quality of life of patients.
- Homogeneous medical service /
- Innovation /
- Colorectal cancer stoma /
- Bad mood /
- Quality of Life

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表 1 2组结直肠癌患者一般资料比较

Table 1. Comparison of general data of colorectal cancer patients between the two groups

组别	例数	性别(例)		年龄(x±s，岁)	BMI(x±s)	肿瘤分期(例)				疾病类型(例)		文化程度(例)
组别	例数	男性	女性	年龄(x±s，岁)	BMI(x±s)	Ⅰ	Ⅱ	Ⅲ	Ⅳ	直肠癌	结肠癌	初中及以下	高中	本科及以上
对照组	60	37	23	60.25±11.87	21.87±2.87	17	18	21	4	39	21	31	19	10
观察组	60	35	25	62.17±12.13	21.35±2.39	13	19	22	6	34	26	33	18	9
统计量		0.139^a		-0.876^b	1.078^b	-0.845^c				0.874^a		-0.375^c
P值		0.709		0.383	0.283	0.398				0.350		0.708
注：^a为χ²值，^b为t值，^c为Z值。

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表 2 2组结直肠癌患者干预前后焦虑、抑郁得分比较(x±s，分)

Table 2. Comparison of anxiety and depression scores between two groups of colorectal cancer patients before and after intervention (x±s, points)

组别	例数	PHQ-9		GAD-7
组别	例数	干预前	干预后	干预前	干预后
对照组	60	13.76±3.39	11.85±2.73^a	12.28±2.52	11.03±2.03^a
观察组	60	13.93±3.43	10.53±2.27^a	11.91±2.39	9.73±1.91^a
t值		-0.273	3.098	0.825	3.613
P值		0.785	0.002	0.411	< 0.001
注：与同组干预前比较，^aP < 0.05

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表 3 2组结直肠癌患者干预前后HHI得分比较(x±s，分)

Table 3. Comparison of HHI scores of colorectal cancer patients in two groups before and after intervention (x±s, points)

组别	例数	对现实和未来的态度		与他人保持亲密的关系		采取积极的行动		总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	60	7.23±1.87	8.29±2.09^a	7.93±1.91	8.69±2.11^a	7.91±2.21	8.71±2.01^a	23.07±6.52	25.69±5.87^a
观察组	60	7.59±2.03	9.57±2.27^a	8.13±2.23	9.97±2.19^a	7.67±2.05	10.05±2.23^a	23.39±7.17	29.59±7.38^a
t值		-1.010	-3.213	-0.528	-3.260	0.617	-3.457	-0.256	-3.203
P值		0.314	0.002	0.599	0.001	0.539	< 0.001	0.799	0.002
注：与同组干预前比较，^aP < 0.05。

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表 4 2组结直肠癌患者干预前后生存质量总分及各领域得分比较(x±s，分)

Table 4. Comparison of total quality of life scores and scores in various fields of colorectal cancer patients in two groups before and after intervention (x±s, points)

组别	例数	情感状况		社会/家庭状况		生理状况		功能状况		生存质量总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	60	10.88±1.79	12.11±2.11^a	15.93±2.41	17.77±3.13^a	15.01±2.31	17.33±2.63^a	13.81±2.35	15.33±2.26^a	55.64±6.97	60.02±6.73^a
观察组	60	10.71±2.01	15.89±2.43^a	16.03±2.27	20.83±3.49^a	15.17±2.25	21.33±2.51^a	14.09±2.57	18.43±2.38^a	56.00±7.13	76.48±7.39^a
t值		0.489	-9.098	-0.234	-7.234	-0.384	-8.523	-0.623	-7.316	-0.280	-12.756
P值		0.625	< 0.001	0.815	< 0.001	0.701	< 0.001	0.535	< 0.001	0.780	< 0.001
注：与同组干预前比较，^aP < 0.05。

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表 5 2组结直肠癌患者并发症情况比较[例(%)]

Table 5. Comparison of complications in patients with colorectal cancer in two groups[cases (%)]

组别	例数	造口损伤	造口感染	造口脱垂	造口狭窄	合计
对照组	60	3(5.00)	7(11.67)	3(5.00)	8(13.33)	21(35.00)
观察组	60	1(1.67)	1(1.67)	2(3.33)	2(3.33)	6(10.00)
注：2组并发症发生情况比较，χ²=10.753，P=0.001。

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表 6 2组结直肠癌患者护理满意度比较[例(%)]

Table 6. Comparison of nursing satisfaction of colorectal cancer patients in two groups [cases (%)]

组别	例数	非常满意	满意	一般	不满意	总满意
对照组	60	15(25.00)	20(33.33)	20(33.33)	5(8.33)	35(58.33)
观察组	60	24(40.00)	25(41.67)	11(18.33)	0	49(81.67)
统计量		-2.773^a				7.778^b
P值		0.006				0.005
注：^a为Z值，^b为χ²值。

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