Abstract:

Objective　To explore the application effect of extended care during the immunotherapy period with atezolizumab for postoperative non-small cell lung cancer patients. Methods　This study was a randomized controlled trial. According to the random number table method, 102 non-small cell lung cancer patients who visited Henan Cancer Hospital from March 2019 to March 2022 were divided into a control group (51 cases) and an observation group (51 cases). There were 30 males and 21 females in the control group, aged (62.39±5.16) years, 3 cases in stage Ⅱ, 29 cases in stage Ⅲ, and 19 cases in stage Ⅳ. There were 31 males and 20 females in the observation group, aged (62.47±5.22) years, 2 cases in stage Ⅱ, 31 cases in stage Ⅲ, and 18 cases in stage Ⅳ. Both groups were treated with cisplatin combined with attillizumab for 4 consecutive courses of treatment with 3 weeks as 1 course. During the treatment period, routine care was given to the control group, while extended care was given to the observation group on the basis of the control group. The compliance behaviors, quality of life and psychological status before and after intervention, and nursing satisfaction were compared between the two groups. t test and χ² test were used. Results　The proportions of the patients in the control group who took medication as prescribed, persisted in exercise, had a reasonable diet, and had good emotions [70.59% (36/51), 68.63% (35/51), 64.71% (33/51), and 66.67% (34/51)] were lower than those in observation group [94.12% (48/51), 88.24% (45/51), 90.20% (46/51), and 92.16% (47/51)], with statistically significant differences (χ²=9.714, 5.795, 9.487, and 10.134, P=0.002, 0.016, 0.002, and 0.001). After intervention, the scores of physical function, sleep quality, emotional function, cognitive function, social function, and role function in both groups were higher than those before intervention, and those in the observation group [(75.69±4.13) points, (72.88±3.87) points, (71.33±4.57) points, (70.82±5.03) points, (72.77±4.66) points, and (77.17±3.89) points] were higher than those in the control group [(64.94±4.82) points, (63.72±3.96) points, (63.49±4.25) points, (62.49±5.17) points, (64.49±5.12) points, and (66.38±3.94) points], with statistically significant differences (all P<0.05). After intervention, the scores of anxiety, depression, and psychosis in both groups were lower than those before intervention, and those in the observation group [(1.36±0.32) points, (1.32±0.31) points, and (1.14±0.29) points] were lower than those in the control group [(1.73±0.38) points, (1.69±0.33) points, and (1.59±0.36) points], with statistically significant differences (all P<0.05). The overall nursing satisfaction in the observation group was higher than that in the control group [96.08% (49/51) vs. 82.35% (42/51)] (χ²=4.993, P=0.025). Conclusion　Extended care has a definite effect during the postoperative atezolizumab immunotherapy period for non-small cell lung cancer, which can effectively improve the patients' quality of life and psychological status, enhance their compliance behaviors and nursing satisfaction.

Key words:

Non-small cell lung cancer, Atezolizumab, Immunotherapy, Extended care

摘要：

目的　探讨延伸护理在非小细胞肺癌患者阿替利珠单抗免疫治疗期间的应用效果。方法　本研究为随机对照试验。根据随机数字表法将2019年3月至2022年3月于河南省肿瘤医院就诊的102例非小细胞肺癌患者分为对照组（51例）和观察组（51例）。对照组患者中男性30例，女性21例，年龄（62.39±5.16）岁；Ⅱ期3例，Ⅲ期29例，Ⅳ期19例；观察组患者中男性31例，女性20例，年龄（62.47±5.22）岁；Ⅱ期2例，Ⅲ期31例，Ⅳ期18例。两组患者手术切除后均采用顺铂联合阿替利珠单抗进行治疗，3周为1个疗程，连续治疗4个疗程。在治疗期间予以对照组患者常规护理，观察组患者在对照组的基础上进行延伸护理。比较两组患者遵医嘱行为情况，干预前后的生存质量、心理状态，护理满意度。采用t检验、χ²检验。结果　对照组按嘱用药、坚持锻炼、合理饮食、情绪良好患者占比［70.59%（36/51）、68.63%（35/51）、64.71%（33/51）、66.67%（34/51）］均低于观察组［（94.12%（48/51）、88.24%（45/51）、90.20%（46/51）、92.16%（47/51）］，差异均有统计学意义（χ²=9.714、5.795、9.487、10.134，P=0.002、0.016、0.002、0.001）。干预后，两组患者的躯体功能、睡眠质量、情绪功能、认知功能、社会功能、角色功能评分均较干预前升高，且观察组［（75.69±4.13）分、（72.88±3.87）分、（71.33±4.57）分、（70.82±5.03）分、（72.77±4.66）分、（77.17±3.89）分］均高于对照组［（64.94±4.82）分、（63.72±3.96）分、（63.49±4.25）分、（62.49±5.17）分、（64.49±5.12）分、（66.38±3.94）分］；两组患者的焦虑、抑郁、精神病性症状评分均较干预前降低，且观察组［（1.36±0.32）分、（1.32±0.31）分、（1.14±0.29）分］均低于对照组［（1.73±0.38）分、（1.69±0.33）分、（1.59±0.36）分］，差异均有统计学意义（均P<0.05）。观察组患者的护理总满意度高于对照组［96.08%（49/51）比82.35%（42/51）］（χ²=4.993，P=0.025）。结论　延伸护理在非小细胞肺癌患者阿替利珠单抗免疫治疗期间效果确切，可有效改善患者生活质量与心理状态，提高患者的遵医行为与护理满意度。

关键词:

非小细胞肺癌, 阿替利珠单抗, 免疫治疗, 延伸护理