延续性健康管理对肝癌手术患者术后心理状态和健康行为的影响

Effect of continuous health management on mental state and health behavior of postoperative patients with liver cancer

目的探讨延续性健康管理对肝癌手术患者术后心理状态和健康行为的影响。方法将120例行肝癌手术的患者采用随机数字表法分为对照组(n=60)和干预组(n=60)。对照组采用常规管理方法,干预组在对照组的基础上采用延续性健康管理方案。记录患者依从性情况,分别于干预前后对患者采用汉密尔顿焦虑量表(HAMA)、汉密顿抑郁量表(HAMD)、自我管理行为能力测定量表中文版(ESCA)进行评价,并统计不同年龄及文化程度患者的ESCA评分结果。结果干预后,干预组患者依从率为98.33%(59/60),高于对照组的83.33%(50/60),差异有统计学意义(P﹤0.05)。干预后,两组患者HAMA和HAMD评分与治疗前比较均降低(P﹤0.05),且干预组HAMA和HAMD评分均明显低于对照组(P﹤0.01)。干预后,干预组患者自护技能、自我责任感、自我概念、健康知识评分及总分均上升,且均高于对照组,差异均有统计学意义(P﹤0.05)。干预前,不同年龄及文化程度患者ESCA评分比较,差异均无统计学意义(P﹥0.05);干预后,﹤60岁患者ESCA评分明显高于≥60岁患者(P﹤0.01),本科及以上患者ESCA评分高于高中、中专、大专患者及初中及以下患者(P﹤0.05),高中、中专、大专患者ESCA评分高于初中及以下患者(P﹤0.05)。结论延续性健康管理能有效提高肝癌术后患者院外治疗依从性,改善患者术后负性心理,提高患者自我管理能力,同时在管理过程中应加强对年龄较大、文化程度较低患者的关注及指导。

Objective To explore the effect of continuous health management on mental state and health behavior of postoperative patients with liver cancer.Method A total of 120 patients underwent surgery for liver cancer were randomly divided into control group(n=60,treated with routine management)and intervention group(n=60,treated with continuous health management+methods used in the control group).The compliance was recorded;Hamilton anxiety rating scale(HAMA),Hamilton depression rating scale(HAMD)and exercise of self-care agency scale(ESCA)were performed before and after intervention;the results of ESC A for patients with different ages and education allevels were calculated.Result The compliance rate of the intervention group was significantly higher than that of the control group after intervention(98.33%83.33%,P<0.05);the scores of HAMA and HAMD in the two groups both decreased after intervention(P<0.05),with significant lower scores in the intervention group than those in the control group(P<0.05).After intervention,the scores of self-care skills,self-care responsibility,self-concept,health knowledge and the total scores of ESCA in the intervention group increased and were higher than those in the control group(P<0.05).There was no significant difference for scores of ESCA in different ages and educational levels(P>0.05)before intervention versus higher ESCA scores of patients<60 ages than those≥60 years(P<0.01),higher scores of patients with undergraduate or more than those with senior high school,technical secondary school and junior college education(P<0.05),whose scores were higher than those junior middle school educationor less after intervention(P<0.05).Conclusion Continuous health management can effectively improve compliance of out-of-hospital treatment,negative psychology and self-management ability of postoperative patients with liver cancer,during which more attention and guidance should be paid to the patients with older ages and lower educational levels.