全程延续护理指导对胃癌患者化疗依从性的影响

The Influence of continuous nursing instruction on the compliance of patients with gastric cancer

目的探讨化疗全程延续护理指导对胃癌患者化疗依从性的影响。方法选择2013年5月至2014年12月在中山大学附属第一医院胃肠外科接受胃癌手术后首次化疗的144例患者，采用便利抽样法随机分为试验组和对照组各72例。对照组患者实施住院期间和出院前的健康教育，第1次化疗出院后电话随访实施延续护理指导；试验组患者在此基础上实施全程延续护理指导：包括增加住院期间的营养教育、发放营养处方和化疗不良反应应对措施；每次化疗出院后实施电话随访，指导患者掌握营养摄入和化疗不良反应的应对方法，强调化疗的重要性，督促准时回院化疗，比较2组患者的化疗依从性情况。结果试验组患者化疗次数的中位数为6.0次，对照组为4.5次，2组比较差异有统计学意义（Z=2.672，P=0.008），试验组患者化疗依从性高于对照组。不良反应是患者化疗脱失的主要原因，对照组患者因化疗不良反应脱失率高于试验组，差异有统计学意义（χ2=3.973，P=0.046）。结论胃癌术后化疗患者由于不良反应严重，化疗信心有待加强，而全程的延续护理指导有利于坚定患者的化疗信心，提高患者的化疗依从性。

Objective To explore the effect of nursing instruction on the compliance of patients with gastric cancer after chemotherapy. Methods Selected 144 patients who had underwent surgey for gastric cancer after the first chemotherapy from May 2013 to December 2014. Randomly divided into experimental group and control group, Health education for patients in the control group during the period of hospitalization and before discharge. Follow up the implementation of the first chemotherapy after the first follow-up nursing guidance. Patients in the experimental group on the basis of the implementation of the whole process of continuing nursing guidance, including the increase in the duration of hospitalization, nutrition education, nutrition, prescription and adverse drug reaction to respond to chemotherapy. After each chemotherapy, the telephone follow-up was carried out to guide the treatment of nutritional intake and adverse effects of chemotherapy, emphasizing the importance of chemotherapy. The chemotherapy compliance of the two groups were compared. Results The median number of chemotherapy in the experimental group was 6, while that was 4.5 in the control group, the difference was statistically significant, Z=2.672, P=0.008. The adverse reaction was the main reason for the loss of patients with chemotherapy, the drop rate in the control group because of adverse reaction of chemotherapy was higher than that of in the experimental group, χ2=3.973, P=0.046, the difference was statistically significant. Conclusions Due to serious adverse reactions in patients with gastric cancer after operation, chemotherapy confidence needs to be strengthened. The whole process of continuous nursing guidance is conducive to the patient′s chemotherapy confidence, improve the patient's chemotherapy compliance.