以专科护士为主导的个案管理模式在膀胱癌术后化疗患者药物膀胱灌注中的应用

Application of case management mode led by specialist nurse in drug bladder perfusion for patients undergoing chemotherapy after bladder cancer surgery

目的:探讨专科护士为主导的个案管理模式在膀胱癌术后化疗患者药物膀胱灌注中的应用效果。方法:采用便利抽样法选择2018年3月—2019年6月在新乡市中心医院行膀胱灌注治疗的96例患者,根据随机数字表法分为观察组和对照组,各48例。对照组采用常规管理,观察组采用专科护士为主导的个案管理。采用Mishel疾病不确定感量表(MUIS)和癌症患者生命质量测定量表(FACT-G)分别评估两组患者的疾病不确定感和生活质量,比较两组的膀胱灌注依从率和并发症发生率,比较MUIS及FACT-G得分情况。结果:观察组48例患者均完成全部化疗疗程;对照组有7例患者未完成全部化疗疗程,其中包括1例在化疗第10个月退出研究未收集到完整资料,最终观察组收集48例,对照组收集47例。观察组的膀胱灌注依从率高于对照组(100.00%vs.85.52%),差异有统计学意义(χ^(2)=10.305,P=0.001);观察组的膀胱灌注并发症总发生率低于对照组(14.58%vs.55.32%),差异有统计学意义(χ^(2)=17.382,P<0.001)。第8个月和第12个月,观察组的MUIS得分低于对照组,差异有统计学意义(P<0.05);第4、8、12个月,观察组的FACT-G得分高于对照组,差异有统计学意义(P<0.05)。两组MUIS及FACT-G得分的交互效应、组间效应、时间效应差异均有统计学意义(P<0.05)。结论:随着膀胱灌注治疗时间的延长,膀胱癌患者的疾病不确定感逐渐增强及生活质量降低。专科护士为主导的个案管理模式可以提高膀胱灌注治疗患者依从性、生活质量,降低并发症发生率和疾病不确定感,提高膀胱灌注治疗管理效率。

Objective To explore the application effect of case management mode led by specialist nurses in bladder perfusion for patients undergoing chemotherapy after bladder cancer surgery.Methods A total of 96 patients receiving bladder perfusion treatment in Xinxiang Central Hospital from March 2018 to June 2019 were selected by the convenient sampling method and they were divided into the observation group and the control group according to random number table method,with 48 patients in each group.The control group adopted routine management,while the observation group adopted case management led by specialist nurses.Mishel Uncertainty in Illness Scale(MUIS)and Functional Assessment of Cancer Therapy-feneric Scale(FACT-G)were used to respectively evaluate the disease uncertainty and quality of life of patients of the two groups.The compliance rate and complication rate of bladder perfusion,MUIS and FACT-G scores were compared between the two groups.Results All 48 patients in the observation group completed the entire course of chemotherapy.In the control group,7 patients did not complete the entire course of chemotherapy,including 1 patient who withdrew from the study at the 10th month without complete data collected.Finally,48 cases were collected in the observation group and 47 cases collected in the control group.The compliance rate of bladder perfusion in the observation group was higher than that in the control group(100.00%vs.85.52%),and the difference was statistically significant(χ^(2)=10.305,P=0.001).The total incidence of bladder perfusion complications in the observation group was lower than that in the control group(14.58%vs.55.32%),and the difference was statistically significant(χ^(2)=17.382,P<0.001).At the 8th and 12th months,the MUIS scores of the observation group were lower than those of the control group,and the differences were statistically significant(P<0.05).At 4,8,and 12 months,the FACT-G scores of the observation group were higher than those of the control group,and the differences were statistically significant(P<0.05).The differences in the interaction effects,intergroup effects and time effects of MUIS and FACT-G scores between the two groups were statistically significant(P<0.05).Conclusions With the prolongation of bladder perfusion treatment time,the uncertainty of bladder cancer patients gradually increases and quality of life decreases.The case management mode led by specialized nurses can improve the compliance and quality of life of patients with bladder perfusion treatment,reduce the incidence of complications and disease uncertainty and improve management efficiency of bladder perfusion treatment.