The effect of task-oriented family participation nursing model on patients and caregivers after esophageal cancer surgery
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摘要:
目的 探讨基于任务导向法的家庭参与护理模式对食管癌手术患者自我护理能力、照顾者照顾能力以及患者预后的影响。 方法 采用方便抽样法，选择浙江省肿瘤医院2022年1—6月及2023年1—6月经组织或细胞学确诊为食管鳞癌并行择期手术治疗的食管癌住院患者各78例，分别设为对照组及观察组。对照组给予常规健康教育，观察组在常规健康教育的基础上给予基于任务为导向的家庭健康教育及技能培训。通过技能培训课程设计、实施及效果评价，比较2组患者自我护理能力、照顾者照顾能力、手术前后血液指标(入院1 d与术后7 d)、术后住院时间、带管出院人数及并发症发生人数。 结果 2组患者干预前自我护理能力得分差异无统计学意义[99(92, 105)分vs. 100(90, 106)分, P>0.05]，干预后得分组间差异有统计学意义[129(124, 133)分vs. 118(111, 124)分，P < 0.001]；2组干预后照顾者能力得分差异有统计学意义(P < 0.001)；观察组术后7 d中性粒细胞计数、术后7 d白细胞计数、术后住院时间、肺部感染发生人数均低于对照组，差异有统计学意义(P＜0.05)。 结论 基于任务为导向的家庭参与护理模式能提高食管癌手术患者自我护理能力及照顾者照顾能力，改善食管癌患者术后炎性指标，降低并发症发生率，减少住院时间，具有一定的临床意义和推广价值。 Abstract:Objective To investigate the effects of a task-oriented family engagement care model on self-care ability, caregiver caregiving ability, and patient prognosis in esophageal cancer surgery. Methods A convenient sampling method was used to select 78 esophageal cancer inpatients diagnosed with esophageal squamous carcinoma and treated with elective surgery by histology or cytology from January to June 2022 and from January to June 2023. They were divided into a control group and an observation group, receiving task-oriented family health education and skills training based on routine health education. The self-care ability, competency of caregivers, preoperative and postoperative blood indexes (1 day after admission and 7-day postoperative period), average hospitalization days, number of patients discharged with a tube, and complications were compared between the two groups through the design, implementation, and evaluation of skills training course. Results There was no statistically significant difference in the scores of self-care ability between the two groups before intervention [99 (92, 105) vs. 100 (90, 106), P>0.05], but a significant difference was found after intervention [129 (124, 133) vs. 118 (111, 124), P < 0.001]. The caregiver ability score also showed a significant difference after intervention (P < 0.001). The neutrophil count, leukocyte count, average postoperative hospital days, and the number of complications of the observation group were lower than those of the control group 7 days postoperatively (P < 0.05). Conclusion The task-oriented family participation-based care model can improve the self-care ability and caregiver care ability of esophageal cancer surgical patients, enhance the postoperative inflammatory indexes, reduce the rate of complications, and shorten hospitalization days. This model has significance clinical importance and promotion value. -
表 1 2组食管癌患者基本资料比较(例)
Table 1. Comparison of baseline characteristics of esophageal cancer patients in two groups (cases)
项目 观察组(n=78) 对照组(n=78) 统计量 P值 年龄(岁) 0.329a 0.566 ≤60 19 16 ＞60 59 62 性别 0.083a 0.774 男性 72 71 女性 6 7 BMI 0.534a 0.465 ＜24 56 60 ≥24 22 18 文化程度 -0.596b 0.551 文盲 15 9 小学 30 37 初中 26 22 高中及以上 7 10 既往史 无 39 46 1.267a 0.260 有 39 32 注：a为χ2值，b为Z值。 
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表 2 2组食管癌患者自我护理能力及照顾者照顾能力比较[M(P25, P75), 分]
Table 2. Comparison of self-care ability in esophageal cancer patients and caregiving ability of caregivers between two groups [M(P25, P75), points]
组别 例数 患者自我护理能力 干预前后差值 照顾者照顾能力 干预前后差值 干预前 干预后 干预前 干预后 观察组 78 99(92, 105) 129(124, 133) 28(23, 34) 11(9, 13) 3(2, 4) 8(6, 9) 对照组 78 100(90, 106) 118(111, 124) 19(16, 23) 11(9, 13) 5(4, 6) 7(5, 8) Z值 -0.069 -7.256 -8.072 -0.150 -6.712 -4.573 P值 0.945 < 0.001 < 0.001 0.881 ＜0.001 ＜0.001
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表 3 2组食管癌患者实验室营养指标比较(x±s)
Table 3. Comparison of laboratory nutritional indices in esophageal cancer patients between two groups (x±s)
组别 例数 血清白蛋白(g/L) 前白蛋白(mg/L) 血红蛋白(g/dL) 入院1 d 术后7 d 入院1 d 术后7 d 入院1 d 术后7 d 观察组 78 43.31±4.60 37.01±3.62 238.67±53.98 187.74±73.07 121.68±19.50 103.58±14.39 对照组 78 42.14±4.46 36.32±3.61 229.31±60.80 200.52±62.67 125.65±19.67 108.10±15.94 统计量 1.603a 0.319b 1.017a 2.688b 1.268a 5.394b P值 0.111 0.573 0.311 0.104 0.207 0.056 注：a为t值，b为F值。
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表 4 2组食管癌患者实验室炎性指标比较[M(P25, P75), ×109/L]
Table 4. Comparison of laboratory inflammatory indices between two groups of esophageal cancer patients[M(P25, P75), ×109/L]
组别 例数 淋巴细胞计数 入院1 d 术后7 d 干预前后差值 观察组 78 1.30(1.00, 1.90) 0.95(0.70, 1.40) -0.40(-0.63, 0.01) 对照组 78 1.30(0.90, 1.50) 1.10(0.80, 1.40) -0.20(-0.80, 0.30) Z值 1.111 -0.563 -1.278 P值 0.267 0.573 0.201 组别 例数 中性粒细胞计数 入院1 d 术后7 d 干预前后差值 观察组 78 4.05(2.80, 5.40) 4.35(3.20, 5.70) -0.30(-1.43, 1.33) 对照组 78 3.90(3.00, 5.23) 5.00(3.50, 7.13) 0.45(-1.08, 3.23) Z值 -0.523 -2.131 -2.170 P值 0.601 0.033 0.030 组别 例数 白细胞计数 入院1 d 术后7 d 干预前后差值 观察组 78 6.00(4.68, 8.03) 6.25(4.8, 7.63) -0.65(-1.83, 1.45) 对照组 78 5.70(4.75, 7.30) 6.80(4.90, 9.48) 0.35(-1.60, 3.50) Z值 -0.004 -2.078 -2.127 P值 0.997 0.038 0.033
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表 5 2组食管癌患者并发症发生情况、带管出院人数及住院时间比较
Table 5. Comparison of complications, number of discharges with tubes, and length of stay in two groups of esophageal cancer patients
组别 例数 肺部感染(例) 吻合口瘘(例) 带管出院(例) 住院时间(x±s, d) 观察组 78 2 5 63 13.06±4.06 对照组 78 9 9 15 15.27±5.90 统计量 4.792a 1.256a 59.077a 2.715b P值 0.029 0.262 ＜0.001 0.007 注：a为χ2值，b为t值。
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