早期胃癌内镜黏膜下剥离术个体化综合护理模式探讨

Application and evaluation of individualized comprehensive nursing model in patients with early gastric cancer treated by endoscopic submucosal dissection

目的探讨内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)治疗早期胃癌(early gastirc cancer,EGC)的个体化综合性护理模式。方法在我院接受ESD术治疗的EGC及癌前病变64例,随机分为个体化综合护理组(研究组)和常规护理对照组。研究组采用护理问题清单个体化评估基础上的针对性综合护理模式。观察指标包括焦虑评分、疾病不确定感、治疗的依从性、下床活动时间及住院时间,术后症状评分,出院时护理满意度调查。结果研究组护理干预后HADS评分与入院时相比显著降低[(14.32±4.38)vs(6.45±3.84),P<0.05)];与入院时相比手术前及出院时的疾病不确定感显著改善[(94.41±5.96)vs(82.55±7.83)vs(78.09±6.65),P<0.05];与对照组相比,治疗的依从性显著提高(92.9%vs 52.3%,P<0.05)、下床活动[(1.5±0.2)vs(2.7±0.6),P<0.05)]及住院时间[(6.8±0.7)vs(10.4±2.4),P<0.05)]天数明显缩短,术后12h症状明显减轻[(4.5±0.8)vs(5.4±1.3),P<0.05)],总体护理满意率显著提高[(4.60±0.36)vs(4.03±0.44),P<0.05)]。结论个体化综合护理模式可显著提高ESD治疗的护理质量及患者对护理的满意度。

Objective To study the individualized comprehensive nursing model suitable for patients with early gastric cancer （EGC） treated by endoscopic submucosal dissection （ESD）. Methods In this hospital 64 patients with EGC treated by ESD were randomized into individualized comprehensive nursing group（ study group） and conventional nursing group （control group）. The study group used targeted comprehensive nursing model based on nursing questions profile individualized assessment. Outcome measures in- cluded the HADS anxiety score, disease decreased uncertainty, the compliance of treatment, ambulation time and hospital stay, the post- operative symptom score, and nursing satisfaction survey. Results After nursing intervention, compared with that on admission, in study group, patients＇ HADS score was significantly lower than （ 14.32 ± 4.38 ） vs （6.45 ±3.84）, P 〈 0.05 ）, and the patient＇ s dis- ease uncertainty degree before operation and on discharge markedly improved （ 94.41± 5.96） vs （ 82.55 ± 7.83 ） vs （78.09± 6.65 ）, P 〈0.05 respectively）. Compared with that in control group , in the study group patients＇ the compliance of care was significantly higher, ambulation time （1.5 ±0.2 ） vs （2.7 ±0.6）, P 〈0.05）and hospital stay（6.8 ±0.7） vs （10.4 ±2.4）, P 〈0.05） days were shorter, postoperative symptom score at 12 h was significantly lower （4.5 ± 0. 8 ） vs （ 5.4 ± 1.3 ） , P 〈 0.05 ; nursing satisfaction score was markedly higher（4.60 ± 0.36） vs （4.03 ±0.44） ,P 〈 0.05. Conclusions Individualized comprehensive nursing mode can obviously improve nurses＇ care quality and enhance patients＇ nursing satisfaction.