The application of low-temperature hand and foot covers combined with "five precautions" education in the prevention of taxane-related peripheral neuropathy
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摘要:
目的 探讨非药物干预在预防紫杉类药物相关周围神经病变中的应用效果。 方法 选取蚌埠医科大学第一附属医院肿瘤内科住院且接受紫杉类药物化疗的252例患者作为研究对象,将2022年7—12月的125例患者作为对照组,2023年1—6月的127例患者作为观察组。对照组采用肿瘤内科化疗护理常规,观察组采用低温手足套联合“五防”教育。比较2组患者周围神经病变的症状体验、患者日常生活质量和居家安全不良事件情况。 结果 观察组手指/手麻木、脚趾/脚麻木、脚趾/脚刺痛、手指/手或脚趾/脚不舒服、肌肉或关节痛的发生率、症状严重程度及症状困扰程度均低于对照组(P<0.05);观察组影响握持小物品[38.58%(49/127)]、睡眠[46.46%(59/127)]、写字[55.91%(71/127)]、做平时的家务[62.99%(80/127)]的率均低于对照组[52.00%(65/125)、61.60%(77/125)、69.60%(87/125)、82.40%(103/125), P<0.05];观察组居家跌倒[5.51%(7/127)]和磕碰[7.87%(10/127)]发生率低于对照组[16.00%(20/125)和18.40%(23/125), P<0.05]。 结论 采用低温手足套联合“五防”教育可有效减少紫杉类药物相关周围神经病变发生,改善患者症状体验和日常生活质量,防止居家安全不良事件的发生。 Abstract:Objective To explore the application effect of non-pharmacological intervention in the prevention of taxane-related peripheral neuropathy. Methods A total of 252 patients who were hospitalized in the Department of Oncology of the First Affiliated Hospital of Bengbu Medical University and received taxane-based chemotherapy were selected as the study subjects. Among them, 125 patients from July to December 2022 were taken as the control group, and 127 patients from January to June 2023 were taken as the observation group. Patients in the control group received routine chemotherapy care from the medical oncology department, while patients in the observation group received low-temperature hand and foot covers combined with "five precautions" education. The peripheral neuropathy including symptom experience, quality of daily life, and adverse home safety events between the two groups were compared. Results The incidence, severity, and degree of symptom distress of finger/hand numbness, toe/foot numbness, toe/foot tingling, finger/hand or toe/foot discomfort, and muscle or joint pain in the observation group were lower than those in the control group (P < 0.05). The observation group had lower rates of holding small items [38.58% (49/127)], sleeping [46.46% (59/127)], writing [55.91% (71/127)], and doing household chores [62.99% (80/127)] compared to the control group [52.00% (65/125), 61.60% (77/125), 69.60% (87/125), 82.40% (103/125), P < 0.05]. The incidence of home falls (5.51%, 7/127) and collisions (7.87%, 10/127) in the observation group were lower than those in the control group [16.00% (20/125) and 18.40% (23/125), P < 0.05]. Conclusion The use of low-temperature hand and foot covers in combination with "five precautions" education can effectively reduce the occurrence of taxane-related peripheral neuropathy, improve patients' symptom experience and quality of daily life, and reduce the occurrence of adverse home safety events. -
表 1 2组恶性肿瘤患者一般资料比较
Table 1. Comparison of general information between two groups of malignant tumor patients
项目 对照组
(n=125)观察组
(n=127)统计量 P值 性别(例) 0.137a 0.711 男性 60 58 女性 65 69 年龄(x±s,岁) 59.95±14.08 60.80±14.15 0.478b 0.633 吸烟(例) 0.127a 0.721 是 79 83 否 46 44 饮酒(例) 0.387a 0.534 是 65 71 否 60 56 高血压/糖尿病史(例) 0.396a 0.529 是 41 37 否 84 90 药物分类(例) 1.494a 0.684 紫杉醇 64 71 多西他赛 34 29 白蛋白紫杉醇 25 23 紫杉醇脂质体 2 4 化疗次数(例) 0.779c 0.436 1~3次 86 93 4~8次 21 18 9~12次 14 14 >12次 4 2 肿瘤分期(例) 0.078c 0.938 Ⅰ期 14 16 Ⅱ期 13 9 Ⅲ期 39 42 Ⅳ期 59 60 注:a为χ2值,b为t值,c为Z值。 表 2 2组恶性肿瘤患者CIPN症状体验比较
Table 2. Comparison of CIPN symptom experience between two groups of malignant tumor patients
症状 发生例数[例(%)] χ2值 P值 发生频次[M(P25, P75), 次] Z值 P值 对照组(n=125) 观察组(n=127) 对照组(n=125) 观察组(n=127) 手指/手麻木 90(72.00) 45(35.43) 33.867 < 0.001 1.00(0.00, 1.00) 0.00(0.00, 2.00) 1.883 0.06 脚趾/脚麻木 80(64.00) 34(26.77) 22.906 < 0.001 2.00(0.00, 4.00) 0.00(0.00, 1.00) 6.613 < 0.001 手指/手刺痛 15(12.00) 12(9.45) 0.429 0.513 0.00(0.00, 1.00) 0.00(0.00, 0.00) 1.096 0.273 脚趾/脚刺痛 18(14.40) 8(6.30) 4.468 0.035 3.00(0.00, 5.00) 0.00(0.00, 3.00) 6.159 < 0.001 手指/手或脚趾/脚不舒服 92(73.60) 45(35.43) 36.989 < 0.001 4.00(0.00, 5.50) 0.00(0.00, 3.00) 6.443 < 0.001 对冷温度敏感 36(28.80) 28(22.05) 1.516 0.218 0.00(0.00, 0.00) 0.00(0.00, 0.00) 1.558 0.119 肌肉或关节痛 61(48.80) 40(31.50) 7.854 0.005 1.00(0.00, 1.50) 0.00(0.00, 2.00) 1.865 0.062 胳膊或腿无力 48(38.40) 40(31.50) 1.321 0.250 1.00(0.00, 4.50) 0.00(0.00, 2.00) 3.695 < 0.001 很难保持身体平衡 25(20.00) 18(14.17) 1.511 0.219 0.00(0.00, 0.00) 0.00(0.00, 0.00) 1.330 0.184 症状 严重程度[M(P25, P75), 分] Z值 P值 困扰程度[M(P25, P75), 分] Z值 P值 对照组(n=125) 观察组(n=127) 对照组(n=125) 观察组(n=127) 手指/手麻木 4.00(0.00, 6.00) 0.00(0.00, 4.00) 5.151 < 0.001 2.00(0.00, 4.00) 0.00(0.00, 3.00) 3.931 < 0.001 脚趾/脚麻木 2.00(0.00, 6.00) 0.00(0.00, 2.00) 5.189 < 0.001 1.00(0.00, 2.00) 0.00(0.00, 1.00) 4.127 < 0.001 手指/手刺痛 0.00(0.00, 0.00) 0.00(0.00, 0.00) 0.576 0.564 0.00(0.00, 0.00) 0.00(0.00, 0.00) 0.567 0.571 脚趾/脚刺痛 0.00(0.00, 0.00) 0.00(0.00, 0.00) 2.256 0.024 0.00(0.00, 0.00) 0.00(0.00, 0.00) 2.197 0.028 手指/手或脚趾/脚不舒服 4.00(0.00, 8.00) 0.00(0.00, 4.00) 5.672 < 0.001 1.00(0.00, 2.00) 0.00(0.00, 2.00) 4.416 < 0.001 对冷温度敏感 0.00(0.00, 3.00) 0.00(0.00, 0.00) 1.286 0.198 0.00(0.00, 2.00) 0.00(0.00, 0.00) 1.215 0.224 肌肉或关节痛 0.00(0.00, 4.00) 0.00(0.00, 2.00) 3.045 0.002 0.00(0.00, 2.00) 0.00(0.00, 1.00) 2.991 0.003 胳膊或腿无力 0.00(0.00, 3.00) 0.00(0.00, 2.00) 1.152 0.249 0.00(0.00, 2.00) 0.00(0.00, 2.00) 1.218 0.223 很难保持身体平衡 0.00(0.00, 0.00) 0.00(0.00, 0.00) 1.134 0.257 0.00(0.00, 0.00) 0.00(0.00, 0.00) 1.265 0.206 表 3 2组恶性肿瘤患者日常生活质量影响得分比较
Table 3. Comparison of quality of daily life impact scores between two groups of malignant tumor patients
项目 影响例数[例(%)] χ2值 P值 生活质量影响得分[M(P25, P75), 分] Z值 P值 对照组(n=125) 观察组(n=127) 对照组(n=125) 观察组(n=127) 穿衣服(扣纽扣、拉拉链) 27(21.60) 20(15.75) 1.422 0.233 0.00(0.00, 0.00) 0.00(0.00, 0.00) 0.992 0.321 走路 95(76.00) 90(70.87) 0.851 0.356 7.00(2.00, 8.00) 3.00(0.00, 7.00) 3.234 0.001 捡起小物品 59(47.20) 45(35.43) 3.599 0.058 0.00(0.00, 4.00) 0.00(0.00, 3.00) 1.859 0.063 握持小物品 65(52.00) 49(38.58) 4.578 0.032 1.00(0.00, 5.00) 0.00(0.00, 6.00) 1.467 0.142 开车 80(64.00) 74(58.27) 0.871 0.351 6.00(0.00, 7.00) 1.00(0.00, 4.00) 3.198 0.001 工作 95(76.00) 89(70.08) 3.491 0.062 6.00(1.00, 8.00) 4.00(0.00, 8.00) 1.541 0.123 参加业余活动 101(80.80) 96(75.59) 1.002 0.317 6.00(4.00, 8.00) 5.00(1.00, 8.00) 1.807 0.071 锻炼 84(67.20) 72(56.69) 2.949 0.086 4.00(0.00, 7.00) 1.00(0.00, 6.50) 1.585 0.113 睡眠 77(61.60) 59(46.46) 5.815 0.016 5.00(0.00, 8.00) 0.00(0.00, 7.00) 2.866 0.004 性生活 103(82.40) 98(77.17) 1.069 0.301 7.00(4.00, 8.00) 5.00(1.50, 8.00) 1.495 0.135 与他人相处 85(68.00) 79(62.20) 0.931 0.335 3.00(0.00, 6.00) 2.00(0.00, 6.00) 0.953 0.341 写字 87(69.60) 71(55.91) 5.052 0.025 5.00(0.00, 7.00) 1.00(0.00, 5.00) 3.202 0.001 做平时的家务 103(82.40) 80(62.99) 11.934 0.001 5.00(2.00, 8.00) 2.00(0.00, 7.00) 2.826 0.005 享受生活 115(92.00) 109(85.83) 2.431 0.119 6.00(3.00, 8.00) 4.00(2.00, 7.00) 2.978 0.003 表 4 2组恶性肿瘤患者居家安全不良事件发生情况比较[例(%)]
Table 4. Comparison of adverse home safety events between two groups of malignant tumor patients[cases (%)]
组别 例数 跌倒 磕碰 烫伤 冻伤 锐器伤 对照组 125 20(16.00) 23(18.40) 0 0 0 观察组 127 7(5.51) 10(7.87) 0 0 0 χ2值 7.244 6.133 P值 0.007 0.013 -
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