个体化护理干预对慢性乙型肝炎患者抗病毒治疗依从性的影响
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摘要
目的探讨个体化护理干预在改善慢性乙型肝炎患者抗病毒治疗依从性中的应用效果。方法选取156例在本院参加聚乙二醇化重组集成干扰素变异体(PEG-IFN-SA)临床试验的慢性乙型肝炎受试者,随机分成对照组与研究组,各78例。对照组根据研究方案进行正常回访,研究组在给药后4、8、12、24周开展90项症状清单(SCL-90)问卷调查,了解患者在治疗期间所产生的家庭、社会、身心健康等方面的问题,制定个体化护理干预策略并落实到位。对比2组患者抗病毒治疗的完成状况及不良反应发生情况。结果对照组与研究组基于方案要求完成抗病毒治疗的患者分别为38(48.72%)例和58(74.36%)例,差异有统计学意义(χ~2=10.833,P<0.01)。对照组和研究组平均完成周数分别为(26.00±6.00)周和(32.00±7.00)周,差异有统计学意义(t=5.748,P<0.01)。研究组情绪变化及流感样症状发生率低于对照组,差异有统计学意义(P<0.05);2组眼痛、甲状腺功能异常、肌肉关节痛、胃肠道反应等其他不良反应的发生率比较,差异无统计学意义(P>0.05)。对照组10例患者出现不同程度的抑郁及焦虑症状。结论个性化护理干预能增加慢性乙型肝炎患者对干扰素抗HBV不良反应有关知识的认知程度,改善消极情绪,有益于增强患者对抗病毒治疗的信心,提高治疗依从性。
Objective To investigate the effect of individualized nursing interventions on compliance with antiviral therapy in patients with chronic hepatitis B virus(HBV) infection. Methods Totally 156 patients with chronic HBV infection who participated in the clinical trial of pegylated recombinant consensus interferon variant(PEG-IFN-SA) were included and randomly divided into the control group and the study group, with 78 cases in each group. Patients were followed up according to the schedule, and those in the study group were investigated by using Symptom-Checklist(SCL-90) at 4, 8, 12 and 24 weeks after administration of antiviral therapy. The targeted nursing interventions were carried out, aiming to address the family, social, physical and mental problems. The compliance with antiviral therapy and related adverse reactions were observed and compared between two groups. Results The compliance rate with antiviral therapy in the control group was lower than that in the study group(48.72% vs. 74.36%, χ~2=5.40,P<0.05). The averaged completed weeks was(26.00±6.00) in the control group and(32.00±7.00) in the study group, with a significant difference(t=3.51,P<0.05). The incidences of emotional change and influenza-like symptoms were lower in the study group than those in the control group(P<0.05). There was no significant difference in ocular pain, thyroid disorder, muscle and joint pain, gastrointestinal adverse reactions between two groups(P>0.05). There were 10 patients with depression and anxiety in the control group. Conclusion The individualized nursing intervention is effective to enhance the awareness of patients on antiviral therapy for HBV and related adverse reactions, in order to improve the treatment compliance and sustained response rate.
Objective To investigate the effect of individualized nursing interventions on compliance with antiviral therapy in patients with chronic hepatitis B virus(HBV) infection. Methods Totally 156 patients with chronic HBV infection who participated in the clinical trial of pegylated recombinant consensus interferon variant(PEG-IFN-SA) were included and randomly divided into the control group and the study group, with 78 cases in each group. Patients were followed up according to the schedule, and those in the study group were investigated by using Symptom-Checklist(SCL-90) at 4, 8, 12 and 24 weeks after administration of antiviral therapy. The targeted nursing interventions were carried out, aiming to address the family, social, physical and mental problems. The compliance with antiviral therapy and related adverse reactions were observed and compared between two groups. Results The compliance rate with antiviral therapy in the control group was lower than that in the study group(48.72% vs. 74.36%, χ~2=5.40,P<0.05). The averaged completed weeks was(26.00±6.00) in the control group and(32.00±7.00) in the study group, with a significant difference(t=3.51,P<0.05). The incidences of emotional change and influenza-like symptoms were lower in the study group than those in the control group(P<0.05). There was no significant difference in ocular pain, thyroid disorder, muscle and joint pain, gastrointestinal adverse reactions between two groups(P>0.05). There were 10 patients with depression and anxiety in the control group. Conclusion The individualized nursing intervention is effective to enhance the awareness of patients on antiviral therapy for HBV and related adverse reactions, in order to improve the treatment compliance and sustained response rate.
引文
[1] YU R, FAN R, HOU J. Chronic hepatitis B virus infection: epidemiology, prevention, and treatment in China[J]. Front Med, 2014, 8(2): 135-144.
[2] STOOP J N, RG V D M, BAAN C C, et al. Regulatory T cells contribute to the impaired immune response in patients with chronic hepatitis B virus infection[J]. Hepatology, 2010, 41(4): 771-778.
[3] 甄海洋, 朱宁. 慢性乙型肝炎干扰素治疗的效果及无应答患者的影响因素分析[J]. 海南医学, 2016, 27(6): 912-914.
[4] AYOUB W S, KEEFFE E B. Review article: current antiviral therapy of chronic hepatitis B[J]. Aliment Pharmacol Ther, 2011, 34(10): 1145-1158.
[5] YUEN M F, AHN S H, CHEN D S, et al. Chronic Hepatitis B Virus Infection: Disease Revisit and Management Recommendations[J]. J Clin Gastroenterol, 2016, 50(4): 286-294.
[6] 马金玲. 应用干扰素治疗慢性乙型肝炎的教育指导[J]. 中国医药导报, 2010, 7(12): 142-143.
[7] 蒋汝刚, 付翔, 周静, 等. 成年人接种乙肝疫苗后无(弱)应答状况及其影响因素分析[J]. 中华疾病控制杂志, 2011, 15(3): 210-212.
[8] 杨亚娟, 荆瑶, 费才莲. 脑卒中患者自我管理的研究进展[J]. 解放军护理杂志, 2013, 30(17): 44-46.
[9] 申春喜. 全程优质护理服务对慢性乙型肝炎患者治疗的影响[J]. 蚌埠医学院学报, 2012, 37(3): 354-356.
[10] LAU G K K, LEUNG Y, FONG D Y T, et al. High hepatitis B virus (HBV) DNA viral load as the most important risk factor for HBV reactivation in patients positive for HBV surface antigen undergoing autologous hematopoietic cell transplantation[J]. Blood, 2002, 99(7): 2324-2330.
[11] 陈细定, 廖华, 张翠芳, 等. 以自我效能为中心的护理干预对慢性乙型肝炎病人治疗依从性及自我护理能力的影响[J]. 护理研究, 2014, 28(21): 2616-2617.
[12] 陈佳佳. 信息支持护理模式对慢性乙肝患者治疗依从性及生活质量的影响[J]. 国际护理学杂志, 2013, 32(8): 1797-1798.
[13] 刘桂兰, 胥莹, 潘慧, 等. 68例慢性乙型肝炎患者对疾病认知及心理和行为问卷调查[J]. 昆明医科大学学报, 2015, 36(6): 144-147.
[14] 宋江美, 林栋羚, 薛静静, 等. 综合护理干预对慢性乙型肝炎患者疾病的认知度和负性情绪影响的研究[J]. 川北医学院学报, 2016, 31(5): 762-765.
[15] 狄静, 吴春明. 个性化护理干预对慢性乙型肝炎病人负性心理的影响[J]. 全科护理, 2012, 10(1): 26-28.
[16] 杨莉, 林细吟, 吴建瑜, 等. 慢性乙型肝炎患者生存质量与社会支持的相关性研究进展[J]. 中华护理杂志, 2010, 45(8): 767-768.
[2] STOOP J N, RG V D M, BAAN C C, et al. Regulatory T cells contribute to the impaired immune response in patients with chronic hepatitis B virus infection[J]. Hepatology, 2010, 41(4): 771-778.
[3] 甄海洋, 朱宁. 慢性乙型肝炎干扰素治疗的效果及无应答患者的影响因素分析[J]. 海南医学, 2016, 27(6): 912-914.
[4] AYOUB W S, KEEFFE E B. Review article: current antiviral therapy of chronic hepatitis B[J]. Aliment Pharmacol Ther, 2011, 34(10): 1145-1158.
[5] YUEN M F, AHN S H, CHEN D S, et al. Chronic Hepatitis B Virus Infection: Disease Revisit and Management Recommendations[J]. J Clin Gastroenterol, 2016, 50(4): 286-294.
[6] 马金玲. 应用干扰素治疗慢性乙型肝炎的教育指导[J]. 中国医药导报, 2010, 7(12): 142-143.
[7] 蒋汝刚, 付翔, 周静, 等. 成年人接种乙肝疫苗后无(弱)应答状况及其影响因素分析[J]. 中华疾病控制杂志, 2011, 15(3): 210-212.
[8] 杨亚娟, 荆瑶, 费才莲. 脑卒中患者自我管理的研究进展[J]. 解放军护理杂志, 2013, 30(17): 44-46.
[9] 申春喜. 全程优质护理服务对慢性乙型肝炎患者治疗的影响[J]. 蚌埠医学院学报, 2012, 37(3): 354-356.
[10] LAU G K K, LEUNG Y, FONG D Y T, et al. High hepatitis B virus (HBV) DNA viral load as the most important risk factor for HBV reactivation in patients positive for HBV surface antigen undergoing autologous hematopoietic cell transplantation[J]. Blood, 2002, 99(7): 2324-2330.
[11] 陈细定, 廖华, 张翠芳, 等. 以自我效能为中心的护理干预对慢性乙型肝炎病人治疗依从性及自我护理能力的影响[J]. 护理研究, 2014, 28(21): 2616-2617.
[12] 陈佳佳. 信息支持护理模式对慢性乙肝患者治疗依从性及生活质量的影响[J]. 国际护理学杂志, 2013, 32(8): 1797-1798.
[13] 刘桂兰, 胥莹, 潘慧, 等. 68例慢性乙型肝炎患者对疾病认知及心理和行为问卷调查[J]. 昆明医科大学学报, 2015, 36(6): 144-147.
[14] 宋江美, 林栋羚, 薛静静, 等. 综合护理干预对慢性乙型肝炎患者疾病的认知度和负性情绪影响的研究[J]. 川北医学院学报, 2016, 31(5): 762-765.
[15] 狄静, 吴春明. 个性化护理干预对慢性乙型肝炎病人负性心理的影响[J]. 全科护理, 2012, 10(1): 26-28.
[16] 杨莉, 林细吟, 吴建瑜, 等. 慢性乙型肝炎患者生存质量与社会支持的相关性研究进展[J]. 中华护理杂志, 2010, 45(8): 767-768.