临床护理路径对围手术期乳腺癌患者疼痛及心理状态的影响

Impact of clinical nursing pathway on pain and psychological state of perioperative patients with breast cancer

目的探讨基于人性化理念的临床护理路径对围手术期乳腺癌患者疼痛及心理状态的影响。方法根据纳入、排除标准,选取2014年1月至2016年11月期间湖北省荆门市第二人民医院心胸乳腺外科收治的160例围手术期乳腺癌患者进行前瞻性研究。采用随机数字表法将患者分为2组(观察组和对照组),每组80例。对照组采用常规围手术期护理,观察组采用基于人性化理念的临床护理路径。采用疼痛分级指数(PRI)、视觉模拟量表(VAS)与疼痛强度(PPI)评定患者疼痛程度;采用Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)与Connor-Davidson心理弹性量表(CD-RISC)评定患者心理状态;并比较2组患者间护理满意度的差异。2组间PRI、VAS、PPI及SAS、SDS、CD-RISC评分比较采用t检验,护理满意度比较采用χ~2检验;组内护理前后的计量资料比较采用配对t检验。结果护理后,观察组PRI、VAS、PPI、SAS与SDS评分分别为(1.52±0.51)、(1.25±0.54)、(0.71±0.43)、(35.21±6.24)、(36.01±6.17)分,明显低于护理前的(8.69±1.32)、(4.96±1.08)、(2.79±0.62)、(62.31±12.14)、(61.58±11.39)分(t=45.319、27.482、24.657、17.758、17.655,P均<0.001),也低于对照组的(4.23±1.02)、(1.79±0.82)、(1.27±0.57)、(50.16±7.89)、(50.31±8.21)分(t=21.255、4.919、7.015、13.293、12.454,P均<0.001),但是,观察组CD-RISC为(71.36±10.38)分,明显高于护理前的(46.32±8.02)分(t=17.074,P<0.001),也高于对照组的(58.21±9.15)分(t=8.500,P<0.001)。观察组护理满意度为95.0%(76/80),明显高于对照组的68.8%(55/80)(χ~2=18.573,P<0.001)。结论基于人性化理念的临床护理路径有助于缓解围手术期乳腺癌患者的疼痛并改善其心理状态,从而提高护理质量,值得临床推广应用。

Objective To study the impact of humanitarian care-based clinical nursing pathway on pain and psychological state of perioperative patients with breast cancer. Methods According to the inclusion and exclusion criteria, 160 perioperative patients with breast cancer in the Department of Cardiothoracic and Breast Surgery,Second People＇s Hospital of Jingmen City from January 2014 to November 2016 were enrolled for this prospective study. The patients were divided into two groups （ observation group and control group） using random number table method, 80 cases in each group. The patients were given conventional perioperative nursing in control group,humanitarian care-based clinical nursing pathway in observation group. The pain was assessed by pain rating index （ PRI）, visual analogue scale （ VAS） and present pain intensity （PPI）. Psychological state was assessed by Zung self-rating anxiety scale （ SAS）,Zung self-rating depression scale （SDS） and Connor-Davidson resilience scale （CD-RISC）. The patient satisfaction with nursing was compared between two groups. Quantitative data （PRI,VAS,PPI,SAS,SDS and CD-RISC scores） between two groups were compared using t test, and counting data （ nursing satisfaction） between two groups were compared using X^2 test. Quantitative data before and after nursing were compared using paired t test. Results After nursing, PRI,VAS,PPI,SAS and SDS scores in observation group were 1. 52±0. 51,1. 25±0. 54,0. 71±0. 43,35. 21土 6. 24 and 36. 01±6. 17,significantly lower than those before nursing （8. 69±1. 32,4. 96±1. 08,2. 79±0. 62,62.31±12.14,61.58±11.39）（t = 45.319,27.482,24.657,17.758,17.655,all P〈0.001）,and significantly lower than those in control group （4. 23±1. 02,1. 79±0. 82,1. 27±0. 57,50. 16±7. 89,50. 31土 8. 21） （t = 21. 255,4. 919,7. 015,13. 293,12. 454,all P〈0. 001） . However,CD-RISC score after nursing in observation group was 71. 36±10. 38,significantly higher than 46. 32±8. 02 before nursing （t = 17. 074,P〈 0. 001）,and 58. 21 ±9. 15 in control group （t = 8. 500,P 〈0. 001）. Patient satisfaction with nursing in observation group was significantly higher than that in control group [95.0% （76/80） vs 68. 8% （55/80）, X^2 = 18. 573,P〈0. 001）. Conclusions Humanitarian care-based clinical nursing pathway can help to relieve the pain and improve psychological state of perioperative patients with breast cancer,thus improving the quality of nursing care. It is worthy of clinical application