双链互动管理对宫颈癌PICC置管化疗患者自我效能、自我管理行为及并发症的影响

Effects of double-chain interactive management on self-efficacy,self-management behaviors,and complications in patients with cervical cancer undergoing peripherally inserted central catheter for chemotherapy

目的探讨双链互动管理对宫颈癌经外周静脉穿刺中心静脉置管术(PICC)置管化疗患者自我效能、自我管理行为及并发症的影响。方法选取2019年1月至2021年1月西北大学附属医院收治的66例宫颈癌患者为研究对象,采用1:1简单随机数表法将入组患者分为观察组和对照组,每组33例。对照组患者予以肿瘤科宫颈癌常规护理,观察组患者在对照组基础上联合应用双链互动管理,均进行持续3个月的护理干预,均于第3个月门诊复诊时以问卷调查的形式进行相关指标的监测和评估。分别于护理前、护理3个月后采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评价患者的心理状态,自我效能量表(GSES)评价患者的自我效能水平,肿瘤科自制量表评价患者的自我管理行为水平,自我护理能力测定量表(ESCA)评价患者的自护能力;出院后6个月比较两组患者的并发症发生情况。结果护理3个月后,观察组患者的SAS评分和SDS评分分别为(24.66±6.21)分、(25.91±6.25)分,明显低于对照组的(34.23±6.42)分、(35.24±5.14)分,差异均有统计学意义(P<0.05);观察组患者GSES量表中的疾病与症状、饮食与运动、认知与行为评分分别为(34.23±3.12)分、(40.37±4.23)分、(41.33±4.28)分,明显高于对照组的(29.24±3.09)分、(37.48±3.98)分、(37.64±3.94)分,差异均有统计学意义(P<0.05);观察组患者的病情观察、情绪控制、生活方式管理自我管理行为评分分别为(4.32±0.38)分、(4.08±0.44)分、(4.52±0.25)分,明显高于对照组的(4.09±0.37)分、(3.72±0.39)分、(4.08±0.37)分,差异均有统计学意义(P<0.05);观察组患者的自我概念与能力、健康知识掌握水平、自护责任感评分分别为(41.25±6.35)分、(38.47±5.28)分、(32.16±5.12)分,明显高于对照组的(37.59±6.28)分、(34.39±5.14)分、(26.49±5.32)分,差异均有统计学意义(P<0.05);出院6个月后,观察组患者发生静脉炎、堵管、感染、血栓、导管移位的总并发症发病率为6.06%,明显低于对照组的24.24%,差异有统计学意义(P<0.05)。结论宫颈癌PICC置管化疗患者采用双链互动护理管理可提高自我效能水平,增强自我管理行为,降低导管相关并发症发病率。

Objective To explore the effects of double-chain interactive management on self-efficacy,self-management behaviors,and complications in patients with cervical cancer undergoing peripherally inserted central catheter(PICC)for chemotherapy.Methods A total of 66 patients with cervical cancer admitted to the Affiliated Hospital of Northwest University were enrolled as the research objects between January 2019 and January 2021.According to simple random number table method,they were divided into an observation group and a control group,with 33 patients in each group.The control group was given routine nursing of Department of Oncology,while observation group was given double-chain interactive management on the basis of the control group,both continuously for 3 months.The relevant indexes were monitored and evaluated by questionnaire at 3 months after nursing.Before and after 3 months of nursing,psychological status of patients was evaluated by Self-rating Anxiety Scale(SAS)and Self-rating Depression Scale(SDS).The self-efficacy level was evaluated by General Self-efficacy Scale(GSES).The levels of self-management behaviors were assessed by self-made scale in Department of Oncology.The self-care ability was evaluated by Exercise of Self-care Agency Scale(ESCA).The occurrence of complications between the two groups was compared at 6 months after discharge.Results After 3 months of nursing,SAS and SDS scores in the observation group were(24.66±6.21)points and(25.91±6.25)points,significantly lower than(34.23±6.42)points and(35.24±5.14)points in the control group(P<0.05).GSES scores(diseases and symptoms,diet and exercise,cognition and behaviors)in the observation group were(34.23±3.12)points,(40.37±4.23)points,and(41.33±4.28)points,significantly higher than(29.24±3.09)points,(37.48±3.98)points,(37.64±3.94)points in the control group(P<0.05).The scores of self-management behaviors(condition ob servation,emotional control,lifestyle management)in the observation group were(4.32±0.38)points,(4.08±0.44)points,and(4.52±0.25)points,significantly higher than(4.09±0.37)points,(3.72±0.39)points,(4.08±0.37)points in the control group(P<0.05).The scores of self-concept and ability,mastery level of health knowledge,and self-care responsibility in the observation group were(41.25±6.35)points,(38.47±5.28)points,and(32.16±5.12)points,significantly higher than(37.59±6.28)points,(34.39±5.14)points,(26.49±5.32)points in the control group(P<0.05).At 6 months after discharge,total incidence of complications(phlebitis,tube blockage,infection,thrombosis,catheter displacement)in the observation group was significantly lower than that in control group(6.06%vs 24.24%,P<0.05).Conclusion The application of double-chain interactive nursing management can improve self-efficacy,enhance self-management behaviors,and reduce the incidence of catheter-related complications in patients with cervical cancer undergoing PICC chemotherapy.