健康指导对晚期癌痛患者镇痛效果的影响

Influence of healthy guidance on the analgesic effects in the patients with terminal cancer pain

目的 观察健康指导对晚期癌痛患者镇痛效果的影响.方法 确诊晚期癌痛患者240例,随机分为常规镇痛组（A组）、健康教育组（B组）和健康指导组（C组）,各80例.A组依据癌痛规范化治疗规范用药;B组并进行针对性健康教育;C组并进行个体健康风险因素问卷调查,根据调查结果进行针对性健康指导.对比分析3组首诊当日、3、6、9、12个月时体重、上臂臂围、中国癌症患者生活质量评分（QLQ-52）及观察结束时吗啡月均用量、主要并发症、肿瘤诊疗、生存例数及平均生存日数和医疗满意度等效果评价指标.结果 3组患者体重、右上臂臂围和QLQ-52评分自6个月起均低于前1个时间点（P＜0.05）,其中,C组QLQ-52评分6、9、12个月时高于A、B组（P＜0.05）,同时吗啡月平均用量与主要并发症等观察指标C组低于其他两组（P＜0.05）,生存例数高于其他两组（P＜0.05）.结论 针对性健康指导可提高患者心理社会适应能力,改善生活质量同时显著提高癌痛治疗效果.

Objective To observe the influence of the healthy guidance on the analgesic effects in patients with terminal cancer pain. Methods Two hundred and forty patients with terminal cancer pain were randomly divided into routine analgesic treatment group （group A, n=80）, healthy educa- tion group （group B, n= 80） and healthy guidance group （group C, n= 80）. The patients in the group A received the standardized cancer pain treatment; the group B added with specific health education; Group C conducted an individual healthy guidance after questionnaire for health risk factors to the patients. The body weight, upper arm circumference and Chinese cancer patients quality of life score （QLQ-52） were compared at the time of first visit and 3, 6, 9 and 12 months after that. Mor- phine average monthly consumption, major complications, diagnosis and treatment of the tumor, survival cases and average survival days and medical satisfaction index were observed at the end of observation. Results Since the sixth months the body weight, right upper arm circumference and QLQ-52 score in the three groups were lower than those in the former time point （P〈0.05）. Among them, the QLQ-52 score in group C in 6,9,12 months was significantly higher than that in group A and B （P〈0. 05）. At the same time the morphine average monthly consumption and the main complications in group C were significantly lower and survival number was significantly higher than those in the other two groups （P〈0.05）. Conclusion Specific healthy guidance can improve the patient＇s psychological social adaptation ability and the quality of life, and increase the efficiency of the pain treatment significantly.