医院—社区—家庭三元联动延...我护理能力及生活质量的影响_王玲.pdf

黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2医院社区家庭三元联动延伸护理服务对老年食管癌患者术后自我护理能力及生活质量的影响王玲郑州大学第一附属医院，河南郑州450000摘要目的：探讨医院社区家庭三元联动延伸护理服务对老年食管癌患者术后自我护理能力（ESCA）及生活质量的影响。方法：选取2019年5月2020年5月郑州大学第一附属医院收治的96例老年食管癌患者作为研究对象，根据入院建档顺序不同分为对照组和观察组，每组各48例。对照组实施常规护理，观察组在常规护理基础上实施医院社区家庭三元联动延伸护理服务。比较两组患者干预前后自我护理能力自我护理能力测定表（ESCA）评分、希望水平Herth希望量表（HHI）评分、临床症状食管癌专用症状量表（QLQ-OES18）评分、生活质量癌症患者生活功能指数量表（FLIC）评分情况。结果：干预前，两组患者ESCA评分比较，差异无统计学意义（t=0.732、0.709、1.011、0.968，P0.05）；干预后，观察组ESCA评分中各维度评分高于对照组，差异有统计学意义（t=9.572、7.850、11.514、9.722，P0.05）。干预前，两组患者HHI评分比较，差异无统计学意义（t=0.279、1.595、0.840，P0.05）；干预后，观察组HHI评分中各维度评分高于对照组，差异有统计学意义（t=7.732、6.405、13.821，P0.05）。干预前，两组患者QLQ-OES18评分比较，差异无统计学意义（t=0.693、0.798、0.415、0.634，P0.05）；干预后，观察组QLQ-OES18量表中各维度评分均低于对照组，差异有统计学意义（t=2.051、2.357、2.106、2.229，P0.05）。干预前，两组患者FLIC评分比较，差异无统计学意义（t=0.713、0.468、0.172，P0.05）；干预后，观察组FLIC评分中各维度评分高于对照组，差异有统计学意义（t=7.674、9.313、7.806，P0.05）。结论：在老年食管癌患者术后管理工作中，医院社区家庭三元联动延伸护理服务有利于提高患者希望水平，增强自护能力，减轻临床症状、改善生活质量。关键词三元联动；延伸护理服务；食管癌；老年；自我护理能力doi10.3969/j.issn.1004-5775.2023.02.027学科分类代码320.71中图分类号R473.73文献标识码BEffect of Hospital-Community-Family Triple Linkage Extended Nursing Service on Postoperative Self Care AbilityScore and Quality of Life in Elderly Patients with Esophageal Cancer/WANG Ling/The First Affiliated Hospital ofZhengzhou University,Zhengzhou,Henan,450000,ChinaAbstract Objective:To explore the effect of hospital-community-family ternary linkage extended nursing service on postoperative self-care ability(ESCA)score and quality of life in elderly patients with esophageal cancer.Methods:A total of 96 elderlypatients with esophageal cancer who were admitted to the hospital from May 2019 to May 2020 were selected as the research objects,and were divided into a control group and an observation group according to the order of admission and file establishment,with 48 cases in each group.The control group was given routine nursing,and the observation group was given hospital-community-family triple linkage extended nursing service on the basis of routine nursing.The self-care ability(Self-care Ability Assessment ESCA score),hope level(Herth Hope Inventory HHI score),and clinical symptoms(Esophageal Cancer Special SymptomScale QLQ-OES18 score)and quality of life(cancer patient living function index scale FLIC score)were compared between thetwo groups before and after the intervention.Results:Before intervention,there was no statistically significant difference in ESCAscores between the two groups(t=0.732,0.709,1.011,0.968,P0.05).After the intervention,the ESCA scores of each dimensionin the observation group were higher than those in the control group,and the difference was statistically significant(t=9.572,7.850,11.514,9.722,P0.05).Before intervention,there was no statistically significant difference in HHI scores between the two groups(t=0.279,1.595,0.840,P0.05).After the intervention,the HHI scores of the observation group were higher than those of the control group,and the difference was statistically significant(t=7.732,6.405,13.821,P0.05).Before intervention,there was no statistically significant difference in QLQ-OES18 scores between the two groups(t=0.693,0.798,0.415,0.634,P0.05).After intervention,the scores of each dimension in the QLQ-OES18 scale of the observation group were lower than those of the control group,and the difference was statistically significant(t=2.051,2.357,2.106,2.229,P0.05).Before intervention,there was no statistically significant difference in FLIC scores between the two groups(t=0.713,0.468,0.172,P0.05).After the intervention,the FLICscores in the observation group were higher than those in the control group,and the difference was statistically significant(t=7.674,9.313,7.806,P0.05).Conclusion:In the postoperative management of elderly patients with esophageal cancer,the hospital-com218黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2食管癌是临床常见的消化道肿瘤，多发于老年人群，随着人口老龄化进程加快，食管癌发病率逐年上升1。有资料显示，我国城市地区食管癌死亡率为9.62/10万，占全部恶性肿瘤的8.55%，位居第4位；农村地区死亡率为20.10/10万，占据恶性肿瘤的18.83%，位居第3位，对我国居民生命健康造成严重威胁2-3。目前，食管癌根治术是治疗食管癌的主要手段，但因对疾病的不确定感和术后放化疗引起的不良反应，多数患者希望水平不足、生活质量较差，对患者身心健康及病情控制造成不良影响4。另有理研究5指出，多数食管癌患者因疾病认知匮乏，造成自我护理能力薄弱，术后居家康复期间，难以做到对自身的良好照护，致使希望水平低下，自信心不足，影响预后和生活质量水平。因此，给予食管癌患者延伸护理服务迫在眉睫。医院社区家庭三元联动是近年新兴的护理模式，结合医院、社区、家庭三方职能，为满足院外患者需求提供了有力保证。鉴于此，本研究旨在探讨医院社区家庭三元联动延伸护理服务对老年食管癌患者术后自我护理能力（ESCA）及生活质量的影响，现将结果报告如下。1资料与方法1.1一般资料选取2019年5月2020年5月郑州大学第一附属医院收治的96例老年食管癌患者作为研究对象，根据入院建档顺序不同分为对照组和观察组，每组各48例。对照组中男25例，女23例；年龄6087岁，平均年龄（73.565.48）岁；病理分型为鳞癌35例，腺癌13例；临床分期为期24例，期17例，期7例；病灶部位为胸中段22例，胸上段18例，颈段5例，胸下段3例。观察组中男27例，女21例；年龄6088岁，平均年龄（72.125.03）岁；病理分型为鳞癌33例，腺癌15例；临床分期为期22例，期16例，期10例；病灶部位为胸中段23例，胸上段17例，颈段4例，胸下段4例。两组患者一般资料（性别、年龄、病理分型、临床分期及病灶部位）具有可比性（P0.05）。本研究经样本医院医学伦理委员会审核批准。1.2入选标准纳入标准：（1）均为于本院接受治疗的食管癌患者。（2）年龄60岁。（3）符合手术指征，均接受食管癌根治术治疗，手术顺利完成，恢复良好。（4）预计生存期6个月。（5）签署研究知情同意书。排除标准：（1）无法正常沟通交流。（2）精神疾病。（3）合并其他恶性肿瘤。1.3方法对照组实施常规护理。做好出院指导，如健康饮食、科学运动、遵医用药、保持良好情绪、并发症预防等；发放食管癌健康手册，嘱咐患者翻看学习；告知患者出院后注意接听医院随访电话，30 min/次，1次/月，共3次。观察组在常规护理基础上实施医院社区家庭三元联动延伸护