个案管理模式在舌癌手术患者中的应用效果

Application effect of case management pattern on tongue neoplasms surgery patients

目的 探讨个案管理模式对舌癌游离皮瓣修复患者的影响.方法 随机抽取2015年1月—2016年10月在湖南省肿瘤医院头颈外科住院的舌癌患者148例,分为干预组74例和对照组74例.对照组实施头颈部肿瘤的常规管理模式,干预组采用个案管理模式,进行个案管理的评估、计划、实施、反馈、评价,提高舌癌患者生存质量和康复效果.应用华盛顿大学生存质量量表、奥马哈健康行为领域评价表、癌症精神适应量表评定两组患者术后1周和术后6个月情况.结果 术后1周,对照组奥马哈健康行为领域评价表、癌症精神适应量表评分分别为（40.74±2.58）、（33.15±1.90）分,干预组分别为（46.09±1.83）、（30.38±2.26）分,差异有统计学意义（P〈0.05）.术后6个月,对照组华盛顿大学生存质量量表、奥马哈健康行为领域评价表、癌症精神适应量表评定评分分别为（829.54±65.94）、（63.66±3.63）、（30.68±3.71）分,干预组分别为（1124.13±46.74）、（75.54±1.36）、（27.61±2.31）分,两组比较差异均有统计学意义（t值分别为-31.35、-26.38、6.04;P〈0.01）.结论 个案管理模式能有效提高舌癌手术患者的生存质量,对患者健康行为领域、精神适应有积极影响.

Objective To study the effect of case management pattern on tongue cancer free flap repair patients. Methods A total of 148 cases of tongue cancer patients who were treated in the head and neck surgery department of Hu＇nan Cancer Hospital from January 2015 to October 2016 were randomly selected as the research object. They were divided into intervention group （74 cases） and control group （74 cases）. The conventional management model of head and neck cancer was applied in the control group, at the same time, the intervention group adopted the case management pattern by assessing, planning, implementing, evaluating and responding to improve the effect of recovery and the tongue cancer patients＇ quality of life. University of Washington quality of life questionnaire （UW-QOL）, the health behavior of Omaha evaluation criteria, and mini-mental adjustment to cancer scale （Mini-MAC） were applied to evaluate patients＇ situation of the two groups 1 week and 6 months after surgery. Results At the time point of 1 week after surgery, the scores of the health behavior of Omaha evaluation criteria and Mini-MAC of the control group were （40.74±2.58）, （33.15±1.90） respectively, while the scores of the intervention group were （46.09±1.83）, （30.38±2.26） respectively, and there were statistical differences （P〈 0.05）. After 6 months, the scores of UW-QOL, the health behavior of Omaha evaluation criteria and Mini-MAC of the control group were （829.54±65.94）, （63.66±3.63）, （30.68±3.71）, and the intervention group scores were（1 124.13±46.74）, （75.54±1.36）, （27.61±2.31） respectively. The differences between two groups were statistically significant （t=-31.35, -26.38, 6.04;P〈 0.01）. Conclusions Case management model can effectively improve the quality of life in patients with tongue cancer after surgery. It was suggest to have positive effect on patients＇ health behavior and mental adaptation.