团体认知行为护理对白血病化疗患儿心理状态的改善作用研究

doi:10.3760/cma.j.cn441417-20250307-19029

摘要/Abstract

摘要：

目的　探讨白血病化疗患儿采取团体认知行为护理的干预效果。方法　选取驻马店市中心医院2022年8月至2024年8月期间收治的86例白血病患儿进行前瞻性研究，采用随机数字表法将其分为对照组（43例）和观察组（43例）。对照组男23例，女20例；年龄7～14（10.56±1.13）岁；病程1～3（2.19±0.33）年。观察组男22例，女21例；年龄7～14（10.59±1.14）岁；病程1～3（2.16±0.35）年。对照组采取常规护理，观察组采取团体认知行为护理，两组均持续护理6周。比较两组心理状态、应对方式、生活质量以及家属满意度。采用t检验、χ²检验进行统计学分析。结果　护理后，观察组儿童焦虑性情绪障碍筛查量表（SCARED）中分离性焦虑、广泛性焦虑、社交恐怖、学校恐怖、躯体化/惊恐评分分别为（5.54±1.01）分、（7.37±1.04）分、（4.39±1.05）分、（2.18±0.34）分、（11.87±1.26）分，均低于对照组的（8.76±1.07）分、（10.19±1.12）分、（6.08±1.10）分、（4.27±0.50）分、（15.35±1.64）分（t=14.350、12.099、7.288、22.666、11.034，均P<0.001）；观察组医学应对方式问卷（MCMQ）中面对评分为（17.96±1.94）分，高于对照组的（14.79±1.78）分，回避、屈服评分为（10.01±1.05）分、（8.71±1.04）分，均低于对照组的（12.39±1.08）分、（11.53±1.07）分（t=7.895、10.361、12.393，均P<0.001）；观察组儿童生存质量测定量表（PedsQL4.0）中感情功能、社会功能、角色功能、生理功能评分分别为（79.19±4.16）分、（82.29±4.70）分、（84.49±5.31）分、（85.15±4.53）分，均高于对照组的（72.28±4.04）分、（75.53±4.61）分、（76.06±5.23）分、（77.19±4.26）分（t=7.814、6.733、7.417、8.394，均P<0.001）。观察组患儿家属对护理服务的满意度为95.35%（41/43），高于对照组的81.40%（35/43）（χ²=4.074，P=0.044）。结论　团体认知行为护理可缓解白血病化疗患儿消极心理状态，有助于改善其应对方式，提升生活质量，提高患儿家属对护理服务的满意度。

关键词:

白血病, 化疗, 团体认知行为护理, 心理状态, 应对方式, 生活质量, 儿童

Abstract:

Objective　To investigate the intervention effect of group cognitive behavioral nursing in children undergoing chemotherapy for leukemia. Methods　A total of 86 children undergoing chemotherapy for leukemia in Zhumadian Central Hospital from August 2022 to August 2024 were selected for a prospective study. They were divided into a control group (43 cases) and an observation group (43 cases) by the random number table method. In the control group, there were 23 boys and 20 girls; the age ranged from 7 to 14 years old [with an average of (10.56±1.13) years old]; the disease duration was from 1 to 3 years [with an average of (2.19±0.33) years]. In the observation group, there were 22 boys and 21 girls; the age ranged from 7 to 14 years old [with an average of (10.59±1.14) years old]; the disease duration was from 1 to 3 years [with an average of (2.16±0.35) years]. The control group received routine nursing, while the observation group received group cognitive behavioral nursing. Both groups received continuous nursing for 6 weeks. The mental state, coping style, quality of life, and family satisfaction were compared between the two groups. Statistical analysis was conducted using the t test and χ² test. Results　After nursing, the scores of separation anxiety, generalized anxiety, social phobia, school phobia, and somatization/panic of the Screen for Child Anxiety Related Emotional Disorders (SCARED) in the observation group were (5.54±1.01) points, (7.37±1.04) points, (4.39±1.05) points, (2.18±0.34) points, and (11.87±1.26) points, which were all lower than those in the control group [(8.76±1.07) points, (10.19±1.12) points, (6.08±1.10) points, (4.27±0.50) points, and (15.35±1.64) points] (t=14.350, 12.099, 7.288, 22.666, and 11.034, all P<0.001). After nursing, the score of facing situations of the Medical Coping Modes Questionnaire (MCMQ) in the observation group was (17.96±1.94) points, which was higher than that in the control group [(14.79±1.78) points]; the scores of avoidance and submission in the observation group were (10.01±1.05) points and (8.71±1.04) points, which were lower than those in the control group [(12.39±1.08) points and (11.53±1.07) points] (t=7.895 10.361, and 12.393, all P<0.001). After nursing, the scores of emotional function, social function, role function, and physical function of the Pediatric Quality of Life Inventory Version 4.0 (PedsQL4.0) in the observation group were (79.19±4.16) points, (82.29±4.70) points, (84.49±5.31) points, and (85.15±4.53) points, which were all higher than those in the control group [(72.28±4.04) points, (75.53±4.61) points, (76.06±5.23) points, and (77.19±4.26) points] (t=7.814, 6.733, 7.417, and 8.394, all P<0.001). The satisfaction rate of family members towards the nursing services in the observation group was 95.35% (41/43), which was higher than that in the control group [81.40% (35/43)] (χ²=4.074, P=0.044). Conclusion　Group cognitive behavioral nursing can alleviate the negative psychological state in children undergoing chemotherapy for leukemia, improve their coping style, improve their quality of life, and enhance the satisfaction of family members with nursing services.

Key words:

Leukemia, Chemotherapy, Group cognitive behavioral nursing, Mental state, Coping style, Quality of life, Children

王可朱丽君康颖杰.

团体认知行为护理对白血病化疗患儿心理状态的改善作用研究 [J]. 国际医药卫生导报, 2025, 31(19): 3315-3319.

Wang Ke, Zhu Lijun, Kang Yingjie.

Study on the improvement effect of group cognitive behavioral nursing on the mental state in children undergoing chemotherapy for leukemia [J]. International Medicine and Health Guidance News, 2025, 31(19): 3315-3319.

参考文献

[1] 杜妙花,黄心茹,郭咏佳.前馈控制用于白血病患儿PICC护理风险管理的效果[J].国际护理学杂志,2021,40(17):3184-3187. DOI:10.3760/cma.j.cn221370-20200229-00903.
[2] 杨琇莹,张丽英,张超琅.贝林妥欧单抗治疗急性B淋巴细胞白血病复发患儿的护理[J].护理与康复,2023,22(4):77-79. DOI:10.3969/j.issn.1671-9875.2023.04.019.
[3] 李婉玲,杨小乐,贺成玲.罗森塔尔效应的护理模式对急性淋巴细胞白血病初次化疗患儿心理状况及健康行为的影响[J].国际护理学杂志,2025,44(3):510-514. DOI:10.3760/cma.j.cn221370-20240219-00115.
[4] 张超琅,梁玉琴,魏林琳,等.急性淋巴细胞白血病患儿并发后部可逆性脑病综合征的护理[J].护理学杂志,2021,36(11):10-12. DOI:10.3870/j.issn.1001-4152.2021.11.010.
[5] 中国抗癌协会小儿肿瘤专业委员会.中国儿童急性早幼粒细胞白血病诊疗指南[J].中华实用儿科临床杂志, 2022, 37(2):81-88. DOI:10.3760/cma.j.cn101070-20211103-01309.
[6] 焦敏,杜亚松.儿童焦虑性情绪障碍筛查量表的临床应用[J].上海精神医学,2005,17(2):72-74. DOI:10.3969/j.issn.1002-0829.2005.02.003.
[7] 沈晓红,姜乾金.医学应对方式问卷中文版701例测试报告[J].中国行为医学科学,2000,9(1):18. DOI:10.3760/cma.j.issn.1674-6554.2000.01.008.
[8] 卢奕云,田琪,郝元涛,等.儿童生存质量测定量表PedsQL4.0中文版的信度和效度分析[J].中山大学学报(医学科学版),2008,29(3):328-331. DOI:10.3321/j.issn:1672-3554.2008.03.018.
[9] 吴军,朱俊玲,刘文斌,等.患者性别角色与护理服务满意度现状调查及相关关系探讨[J].中国性科学,2019,28(10):157-160. DOI:10.3969/j.issn.1672-1993.2019.10.043.
[10] Weischendorff S, De Pietri S, Rathe M, et al. Markers of neutrophil chemotaxis for identification of blood stream infections in children with acute lymphoblastic leukemia undergoing induction treatment[J]. Eur J Haematol,2023,110(6):762-771. DOI:10.1111/ejh.13962.
[11] 毛琴,毛孝容,李鑫,等.专科护士主导的营养管理方案在诱导缓解化疗期白血病患儿中的应用研究[J].中华护理杂志,2024,59(23):2900-2907. DOI:10.3761/j.issn.0254-1769.2024.23.013.
[12] 张静,田桂平,李林林.基于生态系统理论为指导的家庭管理联合互动式健康教育在白血病患儿护理中的应用[J].中华现代护理杂志,2022,28(8):1075-1079. DOI:10.3760/cma.j.cn115682-20210416-01678.
[13] 牛敏瑞,董树婉,汪惠才,等.白血病患儿家长团体积极心理干预的效果评价[J].护理学杂志,2023,38(1):15-18. DOI:10.3870/j.issn.1001-4152.2023.01.015.
[14] 郭红涛,张静,李颖,等.共享决策辅助方案对白血病患儿父母决策冲突与疾病不确定感的影响[J].护理研究,2023,37(12):2227-2232. DOI:10.12102/j.issn.1009-6493.2023.12.025.
[15] 陆筠,戴谦.积极行为支持对学龄前急性白血病患儿情绪行为问题的干预效果[J].河北医药,2023,45(13):2051-2055. DOI:10.3969/j.issn.1002-7386.2023.13.032.
[16] 齐欣欣,朱海宏,马伟伟.团体认知行为在急性淋巴细胞白血病护理中的应用[J].河南科技大学学报(医学版),2019,37(3):233-235. DOI:10.15926/j.cnki.issn1672-688x.2019.03.021.
[17] 张宁,王晓宇,刘丹,等.入住无菌层流床联合风险控制模式护理对白血病患儿化疗感染的预防效果[J].中华医院感染学杂志,2023,33(12):1906-1909. DOI:10.11816/cn.ni.2023-221900.
[18] 朱蔼欣,卢贤秀,林春燕,等.以家庭为中心的护理在白血病患儿诱导化疗中的应用[J].国际医药卫生导报,2021,27(10):1474-1477. DOI:10.3760/cma.j.issn.1007-1245.2021.10.013.
[19] 杨婷,王燕青,童婵娟.基于信息化短距离沟通延伸护理对白血病患儿及家属的影响[J].中国医药导报,2022,19(35):176-180. DOI:10.20047/j.issn1673-7210.2022.35.40.
[20] 郎维雅,蔡雪亚,杨羽.以视频咨询为基础的延续护理在白血病患儿维持治疗期的应用[J].中华现代护理杂志,2021,27(14):1902-1905. DOI:10.3760/cma.j.cn115682-20200806-04758.
[21] 谭苏芳,毛琴,毛孝容,等.白血病化疗患儿胃肠道症状群护理的证据总结[J].中国护理管理,2024,24(9):1341-1346. DOI:10.3969/j.issn.1672-1756.2024.09.012.
[22] 黄佳颖,叶红雨,朱沙,等. 8例急性淋巴细胞白血病患儿应用培门冬酰胺酶继发颅内静脉窦血栓的护理[J].护理学报,2024,31(24):68-70. DOI:10.16460/j.issn1008-9969.2024.24.068.
[23] 梁爽,姚娟,郭小利,等.1例急性淋巴细胞白血病患儿合并右手背坏死性筋膜炎的护理[J].肿瘤药学,2024,14(2):256-260. DOI:10.3969/j.issn.2095-1264.2024.02.19.
[24] 薛晓飞,窦凌松,柳林红.层流病房白血病患儿PICC堵管原因分析和护理对策[J].中国小儿血液与肿瘤杂志,2022,27(3):197-200. DOI:10.3969/j.issn.1673-5323.2022.03.011.
[25] 林静静,张红.团体游戏辅导式护理对学龄期白血病患儿负性情绪及治疗依从性影响[J].护理实践与研究,2023,20(3):408-412. DOI:10.3969/j.issn.1672-9676.2023.03.020.
[26] 顾纯,王敏华,马金玲,等.品管圈联合坚强概念在白血病患儿健康教育中的应用效果研究[J]. 中华现代护理杂志,2025,31(2):253-257. DOI:10.3760/cma.j.cn115682-20240112-00238.