分阶段改变理论的匹配护理模式在老年急性髓系白血病患者中的临床应用

Clinical application of matching nursing model based on staged change theory in the nursing of elderly patients with acute mye⁃loid leukemia

目的 分析分阶段改变理论(TTM)视角下的匹配护理模式在老年急性髓系白血病患者中的应用效果,为其临床应用提供方法。方法 选取2020年3月—2021年3月四川大学华西医院收治的老年急性髓系白血病(AML)患者139例,根据其分型分为Ⅰ组(具有特定细胞遗传学异常的AML,n=68)和Ⅱ组(不另做分类的AML,n=71);再将Ⅰ组患者随机分为对照Ⅰ组(n=34)和观察Ⅰ组(n=34),Ⅱ组患者随机分为对照Ⅱ组(n=35)和观察Ⅱ组(n=36)。采取常规护理干预对照Ⅰ组和对照Ⅱ组,采取TTM视角下匹配护理模式干预观察Ⅰ组和观察Ⅱ组,各组均进行3个月院内外干预。比较干预前和干预后4组患者治疗依从性[采用Morisky用药依从性问卷(MMAS-8)评估]、身体功能状态[采用卡式功能状态评分(KPS)评估]、生活质量[采用白血病生活质量评估量表(FACT-Leu)评估]。比较干预3个月内4组患者并发症发生率。结果 干预后,分别与对照Ⅰ组、对照Ⅱ组比较,观察Ⅰ组、观察Ⅱ组治疗依从性、KPS、 FACT-Leu评分更高(P<0.05),观察Ⅰ组治疗依从性、KPS、FACT-Leu评分高于观察Ⅱ组,但差异无统计学意义(P>0.05);干预期间,分别与对照Ⅰ组、对照Ⅱ组比较,观察Ⅰ组、观察Ⅱ组并发症发生率更低,观察Ⅰ组并发症发生率低于观察Ⅱ组,但差异均无统计学意义(P>0.05)。结论 TTM视角下的匹配护理模式干预老年AML患者可提高其治疗依从性,改善患者身体功能状态,提高其生活质量。

Objective To analyze the application effect of matching nursing model based on staged change(TTM)the⁃ory in the nursing of elderly patients with acute myeloid leukemia(AML),and provide a method for its clinical application.Methods A total of 139 elderly patients with AML admitted to West China Hospital of Sichuan University from March 2020 to March 2021 were selected.According to their classification,they were divided into groupⅠ(AML with specific cytogenetic abnormalities,n=68)and groupⅡ(AML without other classification,n=71).Then patients in the groupⅠwere further randomly divided into control groupⅠ(n=34)and observation groupⅠ(n=34);patients in the groupⅡwere further ran⁃domly divided into control groupⅡ(n=35)and observation groupⅡ(n=36).The control groupⅠand control groupⅡreceived conventional nursing intervention,and the observation groupⅠand observation groupⅡreceived matching nursing model intervention based on TTM theory.Each group received 3 months of intervention in and out of the hospital.The treat⁃ment compliance[Morisky Medication Adherence Scale(MMAS⁃8],physical function status[Karnofsky Performance Scale(KPS)]and quality of life[Function Assessment of Cancer Therapy⁃Leukemia Scale(FACT⁃Leu)]were compared among the four groups before and after intervention.The incidence of complications within 3 months of intervention were compared among the four groups.Results After intervention,compared with the control groupⅠand control groupⅡ,the observation groupⅠand observation groupⅡhad higher treatment compliance,KPS score and FACT⁃Leu score(P<0.05),and the treatment compliance,KPS score and FACT⁃Leu score of the observation groupⅠwere higher than those of the observation groupⅡ,but the difference was not statistically significant(P>0.05).During intervention,the incidence of complications in the observation groupⅠand observation groupⅡwere lower than those in the control groupⅠand control groupⅡ,and the incidence of complications in the observation groupⅠwas lower than that in the observation groupⅡ,but the differences were not statistically significant(all P>0.05).Conclusion The matching nursing model intervention based on TTM theory can improve the treatment compliance of elderly AML patients,improve their physical functional status and quality of life.