多学科协作对乳腺癌化疗致周围神经病变患者的作用

doi:10.3760/cma.j.cn441417-20241029-12032

摘要/Abstract

摘要：

目的　探究多学科协作护理干预在缓解乳腺癌化疗后周围神经病变（chemotherapy-induced peripheral neuropathy，CIPN）症状中的实际效果及其可行性。方法　采用单中心前瞻性随机对照试验。选取陕西省肿瘤医院2022年2月至2024年1月期间收治的128例CIPN患者作为研究对象，按随机数表法分为对照组和研究组，各64例。对照组男1例，女63例，年龄31～56（32.84±2.75）岁；研究组男1例，女63例，年龄36～52（33.27±3.17）岁。对照组采取常规护理措施，研究组在常规护理基础上实施多学科护理干预方案。两组患者均干预3个月。比较两组的医学应对方式问卷（MCMQ）、Herth希望量表评分（HHI）、焦虑自评量表评分（SAS）、抑郁自评量表（SDS）、视觉模拟疼痛评分（VAS）、美国癌症治疗功能评价系统神经毒性生活质量量表（FACT/GOG-Ntx）进行评估。采用t检验和χ2检验进行统计学分析。结果　化疗结束3个月后，研究组屈服评分、回避维度评分均低于对照组［（12.57±2.64）分比（14.13±3.18）分、（14.62±2.23）分比（17.28±2.56）分］，面对维度评分高于对照组［（19.13±2.82）分比（17.65±2.63）分］，差异均有统计学意义（均P<0.05）；研究组HHI评分相较高于对照组［（40.81±4.51）分比（36.67±4.26）分］，SAS、SDS评分均低于对照组［（55.82±5.24）分比（60.19±5.73）分、（54.18±6.04）分比（59.57±6.38）分］，差异均有统计学意义（均P<0.05）。研究组化疗结束1个月、化疗结束3个月后的神经疼痛VAS评分低于对照组［（1.83±0.73）分比（2.46±0.86）分、（0.58±0.17）分比（1.04±0.39）分］（均P<0.05）。研究组患者化疗结束1个月、化疗结束3个月后的FACT/GOG-Ntx评分均低于对照组［（7.23±1.86）分比（10.84±2.49）分、（3.56±1.12）分比（5.27±1.58）分］（t=9.292、7.064，均P<0.05）。结论　多学科协作背景下的护理干预能有效改善乳腺癌化疗后周围神经病变患者的心理状态、疼痛程度及生活质量。

关键词: 乳腺癌, 多学科护理干预, 化疗, 周围神经病变, 生活质量

Abstract:

Objective　To explore the actual effectiveness and feasibility of multidisciplinary collaborative nursing interventions in alleviating symptoms of chemotherapy-induced peripheral neuropathy (CIPN) after breast cancer chemotherapy. Methods　A single-center prospective randomized controlled trial was conducted. The study involved 128 patients with CIPN treated at Shaanxi Provincial Cancer Hospital from February 2022 to January 2024.The patients were randomly divided into a control group and a study group, each consisting of 64 patients. The control group including 1 male and 63 females, aged 31-56 (32.84±2.75) years; the study group including 1 male and 63 females, aged 36-52 (33.27±3.17) years.The control group received routine nursing care, while the study group was administered a multidisciplinary nursing intervention protocol in addition to standard care.Both groups received the allocated interventions for 3 months. Medical Coping Modes Questionnaire (MCMQ), Herth Hope Index (HHI), Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS), Visual Analogue Scale (VAS) for pain, and the Neurotoxicity Quality of Life Scale (FACT/GOG Ntx) score of the American Cancer Treatment Functional Evaluation System were compared between two groups. t test and χ² test were used for statistically analysis. Results　After three months of intervention, the study group showed lower scores in the dimensions of submission and avoidance compared to the control group [(12.57±2.64) points vs. (14.13±3.18) points and (14.62±2.23) points vs. (17.28±2.56) points], while the score of the facing dimension was higher than the control group [(19.13±2.82) points vs. (17.65±2.63) points] (all P<0.05). The study group demonstrated significantly higher HHI scores compared to the control group[(40.81±4.51) points vs. (36.67±4.26) points], but showing lower scores on both SAS and SDS [(55.82±5.24) vs. (60.19±5.73)points and (54.18±6.04) points vs. (59.57±6.38) points], with all differences being statistically significant (all P< 0.05).The study group demonstrated significantly lower neuropathic pain VAS scores than the control group at both 1-month and 3-month post-chemotherapy [(1.83±0.73) points vs. (2.46±0.86)points、(0.58±0.17) points vs. (1.04±0.39)points]. Similarly, FACT/GOG-Ntx scores were significantly reduced in the study group compared to the control group at both 1-month and 3-month post-chemotherapy[(7.23±1.86) points vs. (10.84±2.49)points and (3.56±1.12) points vs. (5.27±1.58) points](t=9.292 and 7.064，both P<0.05). Conclusion　Nursing interventions within a multidisciplinary context effectively improve the psychological state, pain level, and quality of life of patients suffering from CIPN following breast cancer chemotherapy.

Key words: Breast cancer, , Multidisciplinary nursing intervention, , Chemotherapy, , Peripheral neuropathy, , Quality of life

王效邓智平张习凡李阳张彧. 多学科协作对乳腺癌化疗致周围神经病变患者的作用 [J]. 国际医药卫生导报, 2025, 31(12): 2093-2097.

Wang Xiao, Deng Zhiping, Zhang Xifan, Li Yang, Zhang Yu.

Effect of multidisciplinary collaboration for Chemotherapy induced peripheral neuropathy in Patients with breast cancer [J]. International Medicine and Health Guidance News, 2025, 31(12): 2093-2097.

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