基于跨理论模型的协同护理模式在胸腹腔镜食管癌根治术患者中的应用

Application of TTM-based Collaborative Care Model in Patients Undergoing Thoracoscopic Laparoscopic Radical Esophagectomy

目的:探讨基于跨理论模型(TTM)的协同护理模式在胸腹腔镜食管癌根治术患者中的应用效果。方法:将2020年9月1日~2022年9月30日择期进行胸腹腔镜根治术的116例食管癌患者采用随机数字表法均分为对照组和观察组各58例,对照组进行常规围术期护理,观察组采用基于TTM理论的协同护理模式。比较两组不良情绪[采用焦虑自评量表(SAS)和抑郁自评量表(SDS)],自我护理能力[采用自我护理能力测定量表(ESCA)],术后康复情况(包括术后胃肠引流时间、胸腔引流时间、首次排气时间、镇痛药物应用时间及平均住院时间),生活质量[采用癌症患者生活质量量表(EORTCQLQ-C30)]。结果:出院时,两组SAS、SDS评分均低于入院时(P<0.05),且观察组低于对照组(P<0.05);出院时,两组ESCA各维度评分及总分均高于入院时(P<0.05),且观察组自我概念、健康知识水平、护理技能评分及总分高于对照组(P<0.05);观察组术后胃肠和胸腔引流时间、排气时间、镇痛药应用时间及住院时间均短于对照组(P<0.05);出院时,两组EORTCQLQ-C30中躯体、认知、情绪及社会功能及总体健康状况评分均高于入院时(P<0.05),且观察组情绪功能、社会功能及总体健康状况评分高于对照组(P<0.05)。结论:基于TTM的协同护理模式应用于胸腹腔镜食管癌根治术患者,有利于消除患者不良情绪,提升自我护理能力,促进术后康复并改善生活质量。

Objective:To explore the application effect of trans-theoretical model(TTM)-based collaborative care model(CCM)in patients undergoing thoracoscopic laparoscopic radical esophagectomy.Methods:A total of 116 patients with esophageal cancer who underwent thoracoscopic laparoscopic radical surgery from September 1,2020 to September 30,2022 were divided into the control group and the observation group according to the random number table method,with 58 cases in each group.The control group was given routine perioperative nursing,and the observation group was given TTM combined with CCM.Negative emotions by the self-ratibg anxiety scale(SAS)and the self rating depression scale(SDS),self-care ability by determination by self-care ability scale(ESCA),the postoperative rehabilitation including gastrointestinal drainage time,thoracic drainage time,exhaust time,analgesic application time and hospital stay,and the quality of life by the cancer patients quality of life scale(EORTCQLQ-C30).were compared between the two groups.Results:The scores of SAS and SDS in the two groups were lower at discharge than those at hospitalization(P<0.05),and those in the observation group were lower than those in the control group(P<0.05).The scores of dimensions and total score of ESCA scale were higher at discharge than those at hospitalization(P<0.05),and the scores of self-concept,health knowledge level and nursing skills and total scores in the observation group were higher than those in the control group(P<0.05).The gastrointestinal drainage time,thoracic drainage time,exhaust time,analgesic application time and hospital stay in the observation group were shorter than those in the control group(P<0.05).The scores of physical function,cognitive function,emotional function and social function and scores of overall health status of EORTCQLQ-C30 scale were higher in both groups at discharge than those at hospitalization(P<0.05),and the scores of emotional function and social function and scores of overall health status in the observation group were higher than those in the control group(P<0.05).Conclusion:Application of TTM-based collaborative care model in patients undergoing thoracoscopic laparoscopic radical esophagectomy can help to eliminate adverse emotions,improve self-care ability,promote postoperative recovery and improve quality of life.