家属协同心理认知护理在乳腺癌切除术患者中的应用

doi:10.3760/cma.j.issn.1007-1245.2024.15.004

摘要/Abstract

摘要：

目的　探讨家属协同心理认知护理对乳腺癌切除术患者痛苦程度及积极应对方式的影响。方法　采用前瞻性研究，选取西安市中心医院在2022年2月至2023年2月期间收治的81例乳腺癌切除术患者作为研究对象，通过随机数字表法分为对照组（40例）和观察组（41例）。对照组采用常规护理，年龄（53.28±4.51）岁，肿瘤分期：Ⅰ期22例，Ⅱ期16例，Ⅲ期2例；观察组采用家属协同心理认知护理，年龄（53.34±4.47）岁，肿瘤分期：Ⅰ期23例，Ⅱ期14例，Ⅲ期4例。比较两组患者干预前及干预3个月后痛苦程度、积极应对方式［采用应对方式问卷（CSQ）］、癌因性疲乏［采用癌症疲乏量表（CFS）］及自护能力［自我护理能力测定量表（ESCA）］，统计学方法采用t检验、χ²检验。结果　干预3个月后，观察组的体力、宗教、情感、家庭、实际心理痛苦程度分别为（3.51±0.66）分、（3.14±0.71）分、（3.97±0.65）分、（3.52±0.88）分、（4.33±1.00）分，均低于对照组［（4.92±0.89）分、（4.22±0.90）分、（5.38±0.95）分、（5.07±1.23）分、（5.62±0.93）分］，观察组DT评分为（3.54±0.57）分，低于对照组（4.60±0.75）分，两组比较差异均有统计学意义（均P<0.05）；观察组CSQ评分中自责、幻想、退避评分分别为（0.41±0.06）分、（0.52±0.08）分、（0.43±0.04）分，均低于对照组［（0.62±0.09）分、（0.69±0.03）分、（0.62±0.06）分］，求助、解决问题、合理化等维度评分分别为（0.69±0.06）分、（0.63±0.06）分、（0.69±0.07）分，均高于对照组［（0.48±0.05）分、（0.49±0.05）分、（0.56±0.05）分］，两组比较差异均有统计学意义（均P<0.05）；观察组CFS评分中躯体疲劳、认知疲劳、情感疲劳维度评分分别为（15.37±1.84）分、（9.66±1.43）分、（8.02±1.23）分，均低于对照组［（22.61±2.41）分、（13.10±1.51）分、（12.97±1.64）分］，两组比较差异均有统计学意义（均P<0.05）；观察组ESCA评分中健康知识、自护技能、自我概念、自我责任维度分别为（49.58±4.40）分、（41.85±3.80）分、（30.29±3.38）分、（27.30±2.29）分，均高于对照组［（42.35±4.83）分、（37.06±3.11）分、（27.16±3.88）分、（24.11±2.04）分］，两组比较差异均有统计学意义（均P<0.05）。结论　对乳腺癌切除术患者给予家属协同心理认知护理，能够有效降低其痛苦程度及癌因性疲乏，提高积极应对方式及自护能力。

关键词:

乳腺癌, 家属协同心理认知护理, 乳腺癌切除术, 痛苦程度, 积极应对方式, 癌因性疲乏

Abstract: Objective　To explore the impact of family-involved psycho-cognitive care on the distress level and positive coping strategies of patients with breast cancer after mastectomy. Methods　Eighty-one patients with breast cancer taking mastectomy at Xi'an Central Hospital from February 2022 to February 2023 were selected for the randomized controlled trial, and were divided into a control group (40 cases) and an observation group (41 cases) by the random number table method. The control group were (53.28±4.51) years old; there were 22 cases of stage Ⅰ, 16 cases of stage Ⅱ, and 2 cases of stage Ⅲ. The observation group were (53.34±4.47) years old; there were 23 cases of stage Ⅰ, 14 cases of stage Ⅱ, and 4 cases of stage Ⅲ. The control group received conventional care, and the observation group family-involved psycho-cognitive care. The distress levels, positive coping strategies [using the Coping Strategies Questionnaire (CSQ)], cancer-related fatigue [using the Cancer Fatigue Scale (CFS)], and self-care ability [using the Self-Care Ability Scale (ESCA)] were compared between the two groups before and three months after the intervention by t and χ2 test. Results　Three months after the intervention, the scores of physical strength, religion, emotions, family, and practice of psychological distress in the observation group were lower than those in the control group [(3.51±0.66) vs. (4.92±0.89), (3.14±0.71) vs. (4.22±0.90), (3.97±0.65) vs. (5.38±0.95), (3.52±0.88) vs. (5.07±1.23), and (4.33±1.00) vs. (5.62±0.93)], with statistical differences between the two groups (all P<0.05). The score of DT in the observation group was lower than that in the control group [ (3.54±0.57) vs. (4.60±0.75)], with a statistical difference between the two groups (P<0.05). The scores of in self-blame, fantasy, and avoidance of CSQ in the observation group were lower than those in the control group [(0.41±0.06) vs. (0.62±0.09), (0.52±0.08) vs. (0.69±0.03), and (0.43±0.04) vs. (0.62±0.06)], with statistical differences between the two groups (all P<0.05); the scores of seeking help, problem-solving, and rationalization in the observation group were higher than those in the control group [(0.69±0.06) vs. (0.48±0.05), (0.63±0.06) vs. (0.49±0.05), and (0.69±0.07) vs. (0.56±0.05)], with statistical differences between the two groups (all P<0.05). The scores of physical fatigue, cognitive fatigue, and emotional fatigue of CFS in the observation group were lower than those in the control group [(15.37±1.84) vs. (22.61±2.41), (9.66±1.43) vs. (13.10±1.51), and (8.02±1.23) vs. (12.97±1.64)], with statistical differences between the two groups (P<0.05). The scores of health knowledge, self-care skills, self-concept, and self-responsibility of ESCA in the observation group were higher than those in the control group [(49.58±4.40) vs. (42.35±4.83), (41.85±3.80) vs. (37.06±3.11), (30.29±3.38) vs. (27.16±3.88), and (27.30±2.29) vs. (24.11±2.04)], with statistical differences between the two groups (all P<0.05). Conclusion　Family-involved psycho-cognitive care for patients taking breast cancer mastectomy can effectively reduce their pain levels, cancer-related fatigue, active coping strategies, and self-care ability.

Key words:

Breast cancer, Family-involved psycho-cognitive care, Breast cancer mastectomy, Pain level, Active coping strategies, Cancer-related fatigue

周喜春李巧燕.

家属协同心理认知护理在乳腺癌切除术患者中的应用 [J]. 国际医药卫生导报, 2024, 30(15): 2479-2484.

Zhou Xichun, Li Qiaoyan.

Family-involved psycho-cognitive care for patients taking breast cancer mastectomy [J]. International Medicine and Health Guidance News, 2024, 30(15): 2479-2484.

参考文献

[1] 王丽娜,来李鑫,李慧林,等. 虚拟现实技术在乳腺癌术后康复训练中的应用进展[J]. 护理学杂志,2023,38(6):15-18. DOI:10.3870/j.issn.1001-4152.2023.06.015.
[2] Ali MA, Czene K, Eriksson L, et al. Breast tissue organisation and its association with breast cancer risk[J]. Breast Cancer Res, 2017,19(1):103. DOI: 10.1186/s13058-017-0894-6.
[3] 叶剑,耿晓莉,王欣然. 乳腺癌术后患者出院准备度的研究进展[J]. 中华护理杂志,2023,58(12):1512-1516. DOI:10.3761/j.issn.0254-1769.2023.12.015.
[4] 谢丽丽,王静静,王梅,等. 医护与家属协同护理模式对脑肿瘤患儿心理状态及并发症的影响[J]. 中国肿瘤临床与康复,2022,29(3):355-358. DOI:10.13455/j.cnki.cjcor.2022. 03.25.
[5] 胡玲,张贤峰,宋子正,等. 家属协同健康教育对老年肺癌患者癌因性疲乏、心理弹性及自我效能感的影响[J]. 中国老年学杂志,2023,43(12):3047-3050. DOI:10.3969/j.issn. 1005-9202.2023.12.059.
[6] 中国抗癌协会,国家肿瘤临床医学研究中心(天津医科大学肿瘤医院). 中国女性乳腺癌筛查指南[J]. 中国肿瘤临床,2019,46(9):430-432. DOI:10.3969/j.issn.1000-8179. 2019.09.572.
[7] 程绪平,陈萍,冯丹,等. NCCN指南2018心理痛苦管理第二版对我国癌症患者心理痛苦管理实践的启示[J/CD]. 中华肺部疾病杂志(电子版),2019,12(4):536-538. DOI:10.3877/cma.j.issn.1674-6902.2019.04.034.
[8] 沙冬玥,王仔珍,刘发云. 自我超越理论护理模式在乳腺癌切除术后患者中的应用[J]. 齐鲁护理杂志,2021,27(22):94-97. DOI:10.3969/j.issn.1006-7256.2021.22.036.
[9] 石海宁,陈玲,周丽静,等. 积极应对方式在乳腺癌术后患者自我效能感与恐动症间的中介效应[J]. 军事护理,2023,40(3):59-62. DOI:10.3969/j.issn.2097-1826.2023.03.014.
[10] 姚晓燕,王莹,黄琳. 基于认知负荷理论的健康教育在乳腺癌术后化疗患者中的应用效果观察[J]. 中国基层医药,2020,27(19):2408-2411. DOI:10.3760/cma.j.issn. 1008-6706.2020.19.024.
[11] 阳丽容,李燕辉,黄芊. 基于赋能理论的行为转变护理对乳腺癌术后化疗患者的影响[J]. 齐鲁护理杂志,2023,29(4):52-55. DOI:10.3969/j.issn.1006-7256.2023.04.016.
[12] 周旭,黄铮,朱为康. 乳腺癌相关淋巴水肿患者中医护理的证据总结[J]. 中华护理杂志,2023,58(17):2088-2094. DOI:10.3761/j.issn.0254-1769.2023.17.006.
[13] Munguti C, Mutebi MC, Ng'ang'a M, et al. Breast cancer recurrence rate in patients treated for early breast cancer[J]. J Clin Oncol,2020,38(15):12508.DOI:10.1200/jco.2020.38.15_suppl.e12508
[14] Thompson AM. Breast conservation therapy versus mastectomy for breast cancer[J]. Lancet Oncol, 2020,21(4):493-494. DOI: 10.1016/S1470-2045(20)30174-1.
[15] 林志敏,黄郁,刘闪闪,等. NBASS-APS模式护理在乳腺癌切除术患者中的应用[J]. 齐鲁护理杂志,2022,28(8):26-28. DOI:10.3969/j.issn.1006-7256.2022.08.008.
[16] 付婷,付琴香. 乳腺癌术后腋网综合征的危险因素分析[J]. 护理学杂志,2019,34(14):19-21. DOI:10.3870/j.issn.1001-4152.2019.14.019.
[17] 赵静,凌秀凤,张蓉艳,等. 认知行为团体心理护理结合家属参与护理改善辅助生殖技术治疗不孕症患者心理状态的效果[J]. 中国医药导报,2023,20(28):172-175. DOI:10.20047/j.issn1673-7210.2023.28.38.
[18] 刘丽红,张惠玲,伍传梅,等. 家属同步认知干预联合心理辅导对宫颈癌患者心理状态和术后恢复的影响[J]. 癌症进展,2022,20(7):747-750. DOI:10.11877/j.issn.1672-1535. 2022.20.07.26.
[19] 黄珂,杨敏. 家属参与式心理护理配合6S管理模式对脑梗死患者社会适应及心境状态的影响[J]. 国际护理学杂志,2022,41(4):616-620. DOI:10.3760/cma.j.cn221370- 20200705-00161.
[20] 朱一凡,陈芷谦,郭巧红,等. 196例乳腺癌化疗患者尊严现状及影响因素分析[J]. 护理学报,2020,27(12):33-38. DOI:10.16460/j.issn1008-9969.2020.12.033.
[21] 郭俊,肖志杰. 家属认知功能训练联合心理干预对阿尔茨海默病患者认知功能的影响[J]. 中国临床心理学杂志,2019,27(2):424-426. DOI:10.16128/j.cnki.1005-3611. 2019.02.044.
[22] 刘璐,周晓萍,赵瑞东,等. 家属参与的精细化干预对妊娠合并宫颈癌患者心理状态、生活质量的影响[J]. 癌症进展,2023,21(1):86-89. DOI:10.11877/j.issn.1672-1535. 2023.21.01.20.
[23] 邢红岩,王芸香. 积极心理暗示对乳腺癌术后患者心理状态的影响[J]. 中国实用护理杂志,2018,34(1):33-37. DOI:10.3760/cma.j.issn.1672-7088.2018.01.009.
[24] 付欢,田晓娟,龚烨萱.家属参与"合作式"护理模式对手术治疗血管瘤患儿术后恢复的影响[J].中国美容医学,2022,31(7):168-171.DOI:10.15909/j.cnki.cn61-1347/r.005154.
[25] 王立馨,张郁,刘晓庆. 家属参与式认知行为干预在结直肠癌患者术后化疗期间的护理效果[J]. 中国肿瘤临床与康复,2020,27(9):1112-1115. DOI:10.13455/j.cnki.cjcor.2020.09.23..
[26] 王梅芳,姚晚侠. 综合治疗期乳腺癌患者癌因性疲乏的纵向研究[J]. 中华现代护理杂志,2017,23(4):466-470. DOI:10.3760/cma.j.issn.1674-2907.2017.04.006.
[27] 朱晓果,芦夏,吴朝宛. 家属协同护理模式对肺癌患者希望水平、癌因性疲乏及生活质量的影响[J]. 保健医学研究与实践,2022,19(2):101-103. DOI:10.11986/j.issn.1673- 873X. 2022.02.026.
[28] 胡学琴,黄艾艾,李群,等. 医护与家属协同护理模式在小儿肺炎干预中的应用[J]. 齐鲁护理杂志,2023,29(3):46-49. DOI:10.3969/j.issn.1006-7256.2023.03.013.
[29] 张影,钟洪英,唐玉芝. 3-PR参与式健康教育对乳腺癌术后化疗患者治疗依从性、自护技能的影响[J]. 中国基层医药,2022,29(8):1243-1246. DOI:10.3760/cma.j.cn341190- 20200407-00587.
[30] 林希. 跨理论模型联合家属参与在高热惊厥患儿中的应用[J]. 国际医药卫生导报,2020,26(2):277-278. DOI:10.3760/cma.j.issn.1007-1245.2020.02.041.
[31] 顿新辉.舒适化心理干预对乳腺癌化疗患者心理应激反应及自我效能的影响[J].哈尔滨医药,2023,43(3):118-120. DOI: 10.3969/j.issn.1001-8131.2023.03.045.