整体护理模式对乳腺癌患者围术期应激反应及生活质量的影响

Effects of holistic nursing mode on stress response during perioperative period and quality of life of patients with breast cancer

目的：探讨整体护理模式对乳腺癌患者围术期应激反应及术后生活质量的影响。方法选取2008年6月—2012年6月收治的86例早期乳腺癌患者为研究对象，随机分为干预组和对照组，干预组采用整体护理模式，对照组常用常规护理模式，对比分析两组患者手术前后焦虑及抑郁情绪、皮质醇水平等应激反应相关指标以及术后生活质量。结果术后2周整体护理组患者 HAMA、HAMD 评分分别为（12．4±5．3）分、（11．2±4．4）分，均较术前明显降低（t ＝7．867，8．364，P ＜0．001），且改善程度优于对照组（t ＝2．695，4．347，P ＜0．01）。术后2周整体护理组患者 Cor 指标为（275．4±74．2）ng／ml，较入院时明显降低（t ＝5．267，P ＜0．001），且明显低于对照组，差异有统计学意义（t ＝2．922，P ＜0．01）。出院后3个月对所有患者进行随访，整体护理组患者 SF-36生活质量量表中生理功能（PF）、躯体疼痛（BP）、生理职能（RP）、总体健康感（GH）等各个角度评分均明显高于对照组，差异均有统计学意义（P ＜0．01）；整体护理组患者 FACT-B 4．0量表中生理状况、社会家庭状况、情感状况等各维度评分及总量表评分均明显高于对照组，差异有统计学意义（P ＜0．01）。结论整体护理模式能有效减轻乳腺癌患者围术期抑郁、焦虑等应激反应，增强患者战胜疾病的信心，提高患者术后的生活质量。

Objective To investigate the effect of holistic nursing mode on stress response during perioperative period and postoperative quality of life of patients with breast cancer.Methods A total of 86 patients with early stage breast cancer,who admitted in our hospital from June 2008 to June 2012,were selected as objects and divided into intervention group （holistic nursing mode）and control group （routine nursing mode）.The comparison were conducted between two groups in anxiety and depression emotion,level of compound F and so on response reaction indexes before and after operation and postoperative quality of life. Results 2 weeks after operation,HAMA and HAMD were （12.4 ±5.3）points and （11.2 ±4.4）points in the intervention group,decreased significantly compared with the scores before operation （t =7.867,8.364;P 〈0.001）,and the improvement degree was better than that of the control group （t =2.695,4.347;P 〈0.01）;in the intervention group,Cor index was （275.4 ±74.2 ）ng /ml,decreased significantly compared with admission （t =5.267,P 〈0.001 ）,and was significantly lower than the control group （t =2.922,P 〈0.01）.After 2 weeks operation,the Cor index was （275.4 ±74.2）ng/ml in the intervention group,which was apparently decreased compared with the score of admission and significantly lower than that of the control group （t =2.922,P 〈0.01 ）.3 months after interventions,all patients received follow-up,and the physiological function （PF）,bodily pain （BP）,role physiology （RP）,general health （GH）,and so on other roles′scores in the intervention group were significantly higher than those of the control group （P 〈0.01）;in FACT-B 4.0 of the intervention group,the dimensions of physiological status,social-family status,emotional status,etc.and total score were apparently higher than those of the control group （P 〈0.01 ）.Conclusions The holistic nursing mode can effectively reduce breast cancer patients′depression,anxiety and other stress response in perioperative period,enhance the confidence of patients to overcome the disease and greatly improve the patients quality of life.