王霞 季紅霞
[摘要] 目的 結(jié)合臨床探討中西醫(yī)結(jié)合護(hù)理干預(yù)方法對(duì)行肝癌介入術(shù)患者術(shù)后生活質(zhì)量和并發(fā)癥的積極影響。方法 便利選取2014年1月—2017年10月該院收治的接受肝癌介入術(shù)治療的患者70例,采用隨機(jī)數(shù)表法分為兩組,各組35例,對(duì)照組患者給予常規(guī)護(hù)理干預(yù),干預(yù)組患者給予中西醫(yī)結(jié)合護(hù)理干預(yù),對(duì)兩組患者的術(shù)后并發(fā)癥和生活質(zhì)量改善情況進(jìn)行隨訪(fǎng)評(píng)估和對(duì)比分析。結(jié)果 ①術(shù)后6個(gè)月內(nèi),干預(yù)組患者的總體并發(fā)癥率為11.3%,顯著低于對(duì)照組的34.3%,差異有統(tǒng)計(jì)學(xué)意義(χ2=5.185,P=0.023);②護(hù)理后,兩組患者的生活質(zhì)量評(píng)分均較護(hù)理前顯著增加,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),但護(hù)理后干預(yù)組的EORTC QLQ-C30量表總分?jǐn)?shù)高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 在術(shù)后,對(duì)行肝癌介入術(shù)的患者給予中西醫(yī)護(hù)理干預(yù),可有效降低術(shù)后并發(fā)癥率,提高患者生活質(zhì)量,促進(jìn)患者術(shù)后康復(fù)。
[關(guān)鍵詞] 中西結(jié)合護(hù)理干預(yù);肝癌介入術(shù)患者;并發(fā)癥;生活質(zhì)量
[中圖分類(lèi)號(hào)] R47 ? ? ? ? ?[文獻(xiàn)標(biāo)識(shí)碼] A ? ? ? ? ?[文章編號(hào)] 1674-0742(2020)10(a)-0146-03
Analysis of the Effect of Integrated Traditional Chinese and Western Nursing Intervention on Complications and Quality of Life of Patients with Liver Cancer after Interventional Operation
WANG Xia, JI Hong-xia
Department of Oncology, Sheyang County Hospital of Traditional Chinese Medicine, Yancheng, Jiangsu Province, 224300 China
[Abstract] Objective To explore the positive effects of integrated traditional Chinese and Western medicine nursing intervention methods on the quality of life and complications of patients undergoing interventional surgery for liver cancer. Methods Select 70 patients who received interventional treatment for liver cancer from January 2014 to October 2017 in the hospital. They were divided into two groups by random number table, 35 cases in each group. Patients in the control group were given routine nursing intervention and intervention group was treated with integrated traditional Chinese and western medicine nursing intervention, and the postoperative complications and quality of life improvement of the two groups of patients were followed up and evaluated and compared. Results 1.Within 6 months after surgery, the overall complication rate of the intervention group was 11.3%, which was significantly lower than the control group's 34.3%,the difference was statistically significant(χ2=5.185, P=0.023); 2.After nursing, the two groups of the patients quality of life scores were significantly higher than those before care,the difference was statistically significant(P<0.05), but the total score of the EORTC QLQ-C30 scale in the intervention group after care was higher than that of the control group,the difference was statistically significant(P<0.05). Conclusion After the operation, the nursing intervention of traditional Chinese and western medicine for patients undergoing interventional surgery for liver cancer can effectively reduce the postoperative complication rate, improve the quality of life of the patients, and promote the recovery of the patients after the operation.
[Key words] Integrated Chinese and Western nursing intervention; Patients with liver cancer intervention; Complications; Quality of life
晚期肝癌患者常伴隨消化道出血、肝腎等嚴(yán)重并發(fā)癥,治療難度大、生存期短、生活質(zhì)量低下[1-2],介入治療是在影像學(xué)設(shè)備引導(dǎo)下將特制導(dǎo)管置入體內(nèi)對(duì)病灶進(jìn)行定位診斷和局部切除的微創(chuàng)技術(shù)[3],這種技術(shù)可準(zhǔn)確定位并徹底清除病灶,術(shù)后復(fù)發(fā)率低、創(chuàng)傷較開(kāi)腹術(shù)小、術(shù)后恢復(fù)也更快,因此在消化道疾病的臨床治療中被廣泛應(yīng)用。但據(jù)相關(guān)文獻(xiàn)報(bào)道,肝癌介入手術(shù)作為有創(chuàng)手術(shù),仍不可避免存在手術(shù)創(chuàng)傷,并因此引發(fā)一系列并發(fā)癥,導(dǎo)致患者的免疫力降低[4],采取有效的護(hù)理干預(yù)措施,對(duì)于預(yù)防并發(fā)癥、提高患者生活質(zhì)量、促進(jìn)術(shù)后康復(fù)、延長(zhǎng)生存期等均具有重要意義,該研究便利選取2014年1月—2017年10月該院70例肝癌介入術(shù)患者進(jìn)行分組護(hù)理比較,現(xiàn)報(bào)道如下。
1 ?資料與方法
1.1 ?一般資料
便利選取該院收治的肝癌介入手術(shù)患者70例,納入標(biāo)準(zhǔn):①患者臨床癥狀、實(shí)驗(yàn)室及影像學(xué)檢查結(jié)果符合中華人民共和國(guó)衛(wèi)生部制定的《原發(fā)性肝癌診療規(guī)范》(2011年版)標(biāo)準(zhǔn);②參照中國(guó)抗癌協(xié)會(huì)、肝癌專(zhuān)業(yè)委員會(huì)制定的《原發(fā)性的臨床診斷與分期標(biāo)準(zhǔn)》經(jīng)手術(shù)病理檢查確診為肝癌晚期;③患者KPS評(píng)分>50分,符合介入手術(shù)治療適應(yīng)證;④患者及家屬了解研究方法和目的,并自愿簽訂手術(shù)及研究同意協(xié)議;該研究經(jīng)醫(yī)院倫理委員會(huì)批準(zhǔn)。排除標(biāo)準(zhǔn):①肝腎功能不全患者;②合并凝血功能障礙的患者;③臨床資料不全或研究中途脫落、依從性差的患者;④對(duì)介入手術(shù)具有其他禁忌證患者。采用隨機(jī)數(shù)表法將70例患者分為兩組,每組35例,在術(shù)后采取不同的護(hù)理策略,對(duì)照組給予常規(guī)護(hù)理,該組男18例、女17例;患者年齡37~74歲,平均年齡(53.2±3.3)歲;FIGO分期IIIa期18例、IIIb期11例、IVa期6例。觀察組給予中西醫(yī)結(jié)合護(hù)理干預(yù),該組男20例、女15例,患者年齡38~72歲,平均年齡(53.5±3.1)歲;FIGO分期IIIa期17例、IIIb期13例、IVa期5例,經(jīng)統(tǒng)計(jì)學(xué)對(duì)比分析,兩組患者的年齡、性別及癌癥分期等資料比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05)。具有可比性。
1.2 ?方法
兩組患者均由同一組手術(shù)團(tuán)隊(duì)人員按照要求進(jìn)行手術(shù)治療,并在圍手術(shù)期給予如下護(hù)理。
1.2.1 ?常規(guī)護(hù)理干預(yù) ?對(duì)照組采取常規(guī)護(hù)理措施,包括術(shù)前健康教育、心理干預(yù)、介入手術(shù)準(zhǔn)備(如手術(shù)前進(jìn)行凝血功能、血常規(guī)及合并癥檢查、指導(dǎo)患者禁飲食、手術(shù)備皮消毒、手術(shù)器械準(zhǔn)備等);做好術(shù)中配合(麻醉、手術(shù)巡視、生命體征監(jiān)測(cè)等);術(shù)后給予飲食指導(dǎo)、壓迫穿刺部位、正確咳嗽、打噴嚏方法等預(yù)防腹壓升高及相關(guān)并發(fā)癥發(fā)生。
1.2.2 ?中西醫(yī)結(jié)合護(hù)理干預(yù) ?觀察組給予中西醫(yī)結(jié)合護(hù)理干預(yù),重點(diǎn)在于預(yù)防并發(fā)癥,護(hù)理內(nèi)容包括:①尿潴留護(hù)理:在術(shù)前告知患者尿潴留危害及術(shù)前排尿練習(xí),術(shù)后模擬流水聲導(dǎo)尿,同時(shí)配合中醫(yī)按摩腹部促進(jìn)排尿:具體操作為用揉法或按摩法順時(shí)針按壓下腹部,用力均勻,由輕漸重,待膀胱成球狀時(shí),右手托住膀胱底,向前下方擠壓膀胱,有尿排出后再用左手放在右手背上加壓排尿;②胃腸道護(hù)理,應(yīng)用中醫(yī)針刺方法,在術(shù)后取穴中脘、足三里、內(nèi)關(guān)實(shí)施針刺,術(shù)后2次/d、30 min/次,直至患者排氣成功;③辨證飲食和中藥湯劑護(hù)理:患者在術(shù)后多數(shù)消化不良、食欲較差,在排氣成功后,除在術(shù)后禁止食用生冷、辛辣、難消化、易產(chǎn)氣等食物外,可酌情給予患者健脾和胃藥食,如小米、銀耳、紅棗、木耳、鯽魚(yú)等,做成粥食,少食多餐;此外,給予中藥湯劑紫蓮消積飲調(diào)脾進(jìn)食,方藥組成:稱(chēng)取紫草、黃芪、茯苓、葛根、赤芍、女貞子、雞骨草、瓜蔞皮各15 g,白術(shù)、五靈脂、淫羊藿各10 g;三七粉3 g;半枝蓮、蛇舌草各30 g;以400 mL水煎煮2次,150 mL/劑,2劑/d,早、晚餐后1 h服用,術(shù)后服用2~4個(gè)月;④肝區(qū)疼痛護(hù)理:護(hù)理人員通過(guò)外敷雙柏散膏抗炎消腫,通過(guò)針灸刺激陵泉、太沖穴消腫止痛、通筋活絡(luò),針刺2次/d,30 min/次。
1.3 ?觀察指標(biāo)
1.3.1 ?并發(fā)癥率 ?觀察并詳細(xì)記錄在肝癌介入手術(shù)術(shù)后6個(gè)月內(nèi)患者出現(xiàn)的并發(fā)癥表現(xiàn)及例數(shù),常見(jiàn)并發(fā)癥包括胃腸道不適(惡心嘔吐、腹痛)、肝功能障礙(AST升高)、尿潴留及炎癥反應(yīng)(發(fā)熱)等,均根據(jù)患者主訴、體查、血液檢查和實(shí)驗(yàn)室檢查結(jié)果、影像學(xué)檢查結(jié)果確定。
1.3.2 ?生活質(zhì)量評(píng)分 ?在護(hù)理前后采用EORTC制定的生命質(zhì)量測(cè)定量表QLQ-C30(V3.0)評(píng)價(jià)肝癌患者生活質(zhì)量,共包括30個(gè)條目,1~28條目列出生活質(zhì)量(包括社會(huì)功能、軀體疼痛、精神狀態(tài)、自理能力)缺陷表現(xiàn),分四級(jí)評(píng)分,1分:沒(méi)有;2分:偶爾;3分:較多;4分:經(jīng)常;29~30條目由患者對(duì)健康總體狀況進(jìn)行評(píng)分,分7個(gè)等級(jí)計(jì)分,1分:非常差;7分:非常好;QLQ-C30量表總分30~130分,評(píng)分越高,表示患者生活質(zhì)量越好。
1.4 ?統(tǒng)計(jì)方法
采用SPSS 25.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行分析,計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,進(jìn)行t檢驗(yàn);計(jì)數(shù)資料采用[n(%)]表示,進(jìn)行χ2檢驗(yàn),P<0.05 為差異有統(tǒng)計(jì)學(xué)意義。
2 ?結(jié)果
2.1 ?兩組患者的并發(fā)癥情況比較
在肝癌介入術(shù)后,干預(yù)組患者的總體并發(fā)癥率為11.3%,顯著低于對(duì)照組的34.3%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表1。
2.2 ?兩組患者的生活質(zhì)量分析
與護(hù)理前(手術(shù)后12 h)相比,護(hù)理后1個(gè)月,干預(yù)組患者的EORTC QLQ-C30量表總分?jǐn)?shù)改善水平顯著優(yōu)于對(duì)照組患者,差異有統(tǒng)計(jì)學(xué)意義(P<0.05),見(jiàn)表2。
3 ?討論
肝癌介入手術(shù)是治療晚期肝癌的有效方法,這種手術(shù)創(chuàng)傷相對(duì)較小、可在一定程度上延長(zhǎng)患者生存期[5]。然而,介入手術(shù)中涉及置入導(dǎo)管、探查和切除腫塊等操作,若操作不當(dāng)或欠精密,則很有可能造成誤傷,從而引發(fā)消化道出血、胃腸道不適、肝功能損傷等并發(fā)癥,影響術(shù)后康復(fù)和預(yù)后[6-7]。
因此,針對(duì)并發(fā)癥特點(diǎn)進(jìn)行圍術(shù)期護(hù)理顯得尤為關(guān)鍵,傳統(tǒng)的常規(guī)臨床護(hù)理缺少針對(duì)性和預(yù)見(jiàn)性[8],而中醫(yī)理論則十分重視對(duì)術(shù)后的機(jī)體機(jī)能、免疫力進(jìn)行調(diào)理[9],在疑難雜癥及術(shù)后康復(fù)治療中具有廣闊應(yīng)用前景。該研究對(duì)70例肝癌介入術(shù)患者進(jìn)行分組護(hù)理,對(duì)照組給予常規(guī)護(hù)理,干預(yù)組給予中西醫(yī)結(jié)合護(hù)理干預(yù),結(jié)果顯示,干預(yù)組術(shù)后并發(fā)癥率、護(hù)理后EORTC QLQ-C30量表總分?jǐn)?shù)改善水平均顯著優(yōu)于對(duì)照組[觀察組:對(duì)照組,并發(fā)癥率:11.3% vs 34.3%(χ2=5.185,P=0.023);護(hù)理后EORTC QLQ-C30量表總分?jǐn)?shù):(72.8±5.2)分 vs (61.3±4.8)分,(t=9.614,P<0.05],這樣的結(jié)果也與李德敬[10]關(guān)于研究組并發(fā)癥發(fā)生率低于參照組3.64% vs 21.82%(χ2=14.875,P=0.000<0.05);研究組護(hù)理后生活質(zhì)量評(píng)分高于參照組(82.15±2.51)分 vs (70.98±1.69)分(t=23.376,P=0.000<0.05)的研究結(jié)果一致。經(jīng)分析,患者術(shù)后生活質(zhì)量的提升和并發(fā)癥的減少與實(shí)施中西醫(yī)護(hù)理有關(guān):①尿潴留護(hù)理可促進(jìn)術(shù)后患者自行排尿、預(yù)防腹壓增加造成出血等并發(fā)癥;②胃腸道護(hù)理能促進(jìn)患者術(shù)后排氣、進(jìn)食,中醫(yī)針刺激活相關(guān)穴位,有輔助作用、促進(jìn)術(shù)后恢復(fù);③重要湯劑護(hù)理則具有健脾和胃功效,對(duì)患者術(shù)后營(yíng)養(yǎng)攝取、預(yù)防消化道不適具有積極作用;④應(yīng)用通筋活絡(luò)法刺激肝區(qū)穴位,有助于減少術(shù)后肝區(qū)疼痛或促使其消失。
綜上所述,在術(shù)后對(duì)行肝癌介入術(shù)的患者給予中西醫(yī)護(hù)理干預(yù),可有效降低術(shù)后并發(fā)癥率,提高患者生活質(zhì)量,促進(jìn)患者術(shù)后康復(fù)。
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(收稿日期:2020-07-04)