目的 探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌(early gastirc cancer,EGC)的个体化综合性护理模式。方法 在我院接受ESD术治疗的EGC及癌前病变64例,随机分为个体化综合护理组(研究组)和常规护理对照组。研究组采用护理问题清单个体化评估基础上的针对性综合护理模式。观察指标包括焦虑评分、疾病不确定感、治疗的依从性、下床活动时间及住院时间,术后症状评分,出院时护理满意度调查。结果 研究组护理干预后HADS评分与入院时相比显著降低[(14.32±4.38) vs (6.45±3.84), P＜0.05)];与入院时相比手术前及出院时的疾病不确定感显著改善[(94.41±5.96) vs (82.55±7.83) vs ( 78.09±6.65) ,P＜0.05];与对照组相比,治疗的依从性显著提高(92.9% vs 52.3%, P＜0.05)、下床活动[(1.5±0.2 ) vs (2.7±0.6), P＜0.05)]及住院时间[(6.8±0.7) vs (10.4±2.4), P＜0.05)]天数明显缩短,术后12 h 症状明显减轻[(4.5±0.8) vs(5.4±1.3),P＜0.05)],总体护理满意率显著提高[(4.60±0.36) vs(4.03±0.44),P＜0.05)]。结论 个体化综合护理模式可显著提高ESD治疗的护理质量及患者对护理的满意度。
Abstract
Objective To study the individualized comprehensive nursing model suitable for patients with early gastric cancer(EGC) treated by endoscopic submucosal dissection(ESD). Methods In this hospital 64 patients with EGC treated by ESD were randomized into individualized comprehensive nursing group(study group) and conventional nursing group (control group). The study group used targeted comprehensive nursing model based on nursing questions profile individualized assessment. Outcome measures included the HADS anxiety score,disease decreased uncertainty,the compliance of treatment, ambulation time and hospital stay,the postoperative symptom score, and nursing satisfaction survey. Results After nursing intervention, compared with that on admission, in study group, patients’ HADS score was significantly lower than(14.32±4.38) vs (6.45±3.84), P＜0.05), and the patient’s disease uncertainty degree before operation and on discharge markedly improved (94.41±5.96) vs (82.55±7.83) vs (78.09±6.65),P＜0.05 respectively). Compared with that in control group , in the study group patients’ the compliance of care was significantly higher , ambulation time (1.5±0.2 ) vs (2.7±0.6), P＜0.05)and hospital stay(6.8±0.7) vs (10.4±2.4), P＜0.05) days were shorter, postoperative symptom score at 12 h was significantly lower(4.5±0. 8) vs (5.4±1.3),P＜0.05; nursing satisfaction score was markedly higher(4.60±0.36) vs (4.03±0.44),P＜0.05. Conclusions Individualized comprehensive nursing mode can obviously improve nurses’ care quality and enhance patients’ nursing satisfaction.
关键词
个体化综合护理模式 /
护理问题清单 /
护理路径 /
内镜黏膜下剥离术 /
早期胃癌
Key words
individualized comprehensive nursing model /
nursing problem list /
nursing pathway /
endoscopic submucosal dissection /
early gastric cancer
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 冯 倩,戈之铮.内镜黏膜下剥离术在早期胃癌治疗中的应用进展.[J].世界华人消化杂志,2011,19(19):2031-2035.
[2] Kim M, Jeon S W, Cho K B, et al. Predictive risk factors of perforation in gastric endoscopic submucosal dissection for early gastric cancer: a large, multicenter study[J].Surg Endosc, 2013,27(4):1372-1378.
[3] Miyahara K, Iwakiri R, Shimoda R,et al.Perforation and postoperative bleeding of endoscopic submucosal dissection in gastric tumors: analysis of 1190 lesions in low- and high-volume centers in Saga, Japan[J]. Digestion, 2012,86(3):273-280.
[4] Park C H, Kim H, Kang Y A, et al. Risk factors and prognosis of pulmonary complications after endoscopic submucosal dissection for gastric neoplasia[J].Dig Dis Sci, 2013,58(2):540-546.
[5] 江春华,吴玉勤,张红燕,等.内镜黏膜下剥离术治疗早期胃癌的护理[J].中国实用护理杂志,2009,25(20):64-65.
[6] 张 婕,陈 炫,卢忠生,等.内镜黏膜下剥离术治疗老年早期胃癌的围手术期护理.[J]. 军医进修学院学报, 2012,33(11): 1141-1142.
[7] Wang G L,Hsu S H,Feng A C,et al.The HADS and the DT for screening psychosocial distress of cancer patients in Taiwan [J].Psychooncology,2011,20(6):639-1669.
[8] Hamilton G A.Measuring adherence in a hypertension clinical trial[J].Eur J Cardiovasc Num,2003,2:219-228.
[9] Mishel M H.The measurement of uncertainty in illness.[J].Nnrs Res,1981,30(5):258-263.
[10] 常立阳,冯志仙,邵荣雅,等.住院患者护理满意度测评量表的构建. [J].中华护理杂志,2012,47(5):454-456.
PDF(751 KB)
