护士主导下认知和运动训练对中晚期肝癌患者癌因性疲乏的改善作用

Effects of nurse-led exercise and cognitive behavioral intervention on reducing cancer-related fatigue in patients with medium advanced hepatocellular carcinoma

目的探讨护士主导下认知和运动训练对中晚期肝癌患者癌因性疲乏和睡眠质量、抑郁的改善作用。方法79例行经导管动脉化疗栓塞(TACE)的中晚期肝癌患者按照随机数字表法分为干预组38例和对照组41例,对照组给予常规护理,干预组在常规护理基础上联合认知和运动训练,比较2组患者一般资料。分别于化疗前、护理干预第2周、护理干预第6周采用Piper疲乏调查量表评价2组患者癌因性疲乏情况,抑郁自我评定量表评价患者抑郁情况,匹兹堡睡眠质量指数调查问卷评价患者睡眠质量。结果干预第2、6周干预组癌因性疲乏评分为(4.14±0.40)分和(3.91±0.37)分,明显低于对照组的(4.94±0.38)分和(5.03±0.44)分,差异有统计学意义(t=9.116、12.195,均P<0.05)。干预第2、6周干预组抑郁自评量表评分为(44.74±6.01)分和(41.30±7.43)分,明显低于对照组的(50.53±7.49)分和(48.39±6.16)分,差异有统计学意义(t=3.771、4.630,均P<0.05)。干预第2、6周干预组睡眠质量评分为(7.25±0.36)分和(6.29±0.96)分,低于对照组的(8.86±0.57)分和(7.86±0.91)分,差异有统计学意义(t=2.013、2.189,均P<0.05)。结论护士主导下认知和运动训练可以明显改善中晚期肝癌患者癌因性疲乏和抑郁症状,并能明显提高患者睡眠质量。

Objective To investigate the feasibility of a nurse-led exercise and cognitive behavioral intervention for medium-advanced hepatocellular carcinoma patients with cancer-related fatigue,sleep quality and depression outcomes.Methods A total of seventy-nine medium-advanced hepatocellular carcinoma patients were enrolled in this study,the patients were randomly assigned to intervention group and control group.The control group given conventional nursing intervention,intervention group received exercise and cognitive behavioral therapy.The baseline characteristics between two groups were compared,the fatigue outcome was measured by the Piper Fatigue Scale at before intervention,after a 2-week intervention,after a 6-week intervention.Besides,depression and sleep quality were measured using the self-rating depression scale and the Pittsburgh sleep quality index questionnaire,respectively.Results After 2-week and 6-week of intervention,the fatigue scores in the intervention group(4.14±0.40 and 3.91±0.37)were markedly higher than in the control group(4.94±0.38 and 5.03±0.44)(t=9.116,12.195,all P<0.05).Moreover,the intervention group(44.74±6.01)points and(41.30±7.43)points demonstrated lower scores of depressions compared to the control group(50.53±7.49)and(48.39±6.16)after 2-week and 6-week of intervention(t=3.771,4.630,all P<0.05).The intervention group(7.25±0.36)points and(6.29±0.96)points also showed lower scores of sleep quality when compared to the control group(8.86±0.57)points and(7.86±0.91)points after 2-week and 6-week of intervention(t=2.013,2.189,all P<0.05).Conclusion Nurse-delivered exercise and cognitive behavioral intervention have benefits in helping medium-advanced hepatocellular carcinoma patients to decrease cancer-related fatigue,depressive symptoms,and improving their quality of sleep.