心力衰竭患者及照顾者接受姑息治疗的效果评价
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摘要
目的探讨姑息治疗对Ⅲ～Ⅳ级心力衰竭(以下简称心衰)患者及照顾者生存质量的影响。方法将80例Ⅲ～Ⅳ心力衰竭患者随机分为对照组40例,干预组40例,对照组患者及照顾者采用常规心衰护理,干预组患者在常规心衰护理基础上使用姑息治疗,使用埃德蒙顿症状评估量表(ESAS)、堪萨斯城生存质量表(KCCQ)、护理负担量表(Zarit)分别评价两组患者及照顾者干预前,干预后3、6、12个月患者及照顾者生存质量情况。结果经重复测量方差分析,干预前,干预后3、6、12个月组间比较差异有统计学意义(P<0.01)。采用姑息治疗的患者症状及生存质量明显优于对照组(P<0.05),干预组照顾者负担显著低于对照组,差异有统计学意义(P<0.05)。结论对Ⅲ～Ⅳ级心衰患者及照顾者进行姑息治疗,能显著提高患者症状管理,改善患者及照顾者的生存质量。
Objective To investigate the effect of palliative care on the quality of life of patients with Grade Ⅲ-Ⅳ heart failure and their caregivers. Methods Eighty patients with Ⅲ-Ⅳ heart failure were randomly divided into control group(40 cases) and intervention group(40 cases). Patients in control group and their caregivers were treated with conventional heart failure nursing. Patients in the intervention group were treated with palliative care based on conventional heart failure nursing. The Edmonton Symptom Assessment Scale(ESAS), the Kansas City Life Quality Scale(KCCQ), and the Nursing Burden Scale(Zarit) were used to evaluate the quality of life of the patients and their caregivers and their caregivers. The evaluations were completed before intervention, and at the 3~(rd) month, 6~(th) month and 12~(th) month after the intervention. Results After repeated measures analysis of variance, there was a statistically significant difference between the 2 groups at the 3 months, 6 months, and 12 months after the intervention(P<0.01). The quality of life of palliative care patients and their caregivers was significantly better than that of the control group(P<0.05). Conclusion Palliative care for patients with grade Ⅲ-Ⅳ heart failure and their caregivers can significantly improve symptom management and improve the quality of life of patients and their caregivers.
Objective To investigate the effect of palliative care on the quality of life of patients with Grade Ⅲ-Ⅳ heart failure and their caregivers. Methods Eighty patients with Ⅲ-Ⅳ heart failure were randomly divided into control group(40 cases) and intervention group(40 cases). Patients in control group and their caregivers were treated with conventional heart failure nursing. Patients in the intervention group were treated with palliative care based on conventional heart failure nursing. The Edmonton Symptom Assessment Scale(ESAS), the Kansas City Life Quality Scale(KCCQ), and the Nursing Burden Scale(Zarit) were used to evaluate the quality of life of the patients and their caregivers and their caregivers. The evaluations were completed before intervention, and at the 3~(rd) month, 6~(th) month and 12~(th) month after the intervention. Results After repeated measures analysis of variance, there was a statistically significant difference between the 2 groups at the 3 months, 6 months, and 12 months after the intervention(P<0.01). The quality of life of palliative care patients and their caregivers was significantly better than that of the control group(P<0.05). Conclusion Palliative care for patients with grade Ⅲ-Ⅳ heart failure and their caregivers can significantly improve symptom management and improve the quality of life of patients and their caregivers.
引文
[1] Kane PM,Murtagh FEM,Ryan KR,et al.Strategies to address the shortcomings of commonly used advanced chronic heart failure descriptors to improve recruitment in palliative care research:A parallel mixed-methods feasibility study[J].Palliat Med,2018,32(2):517-524.
[2] Unroe KT,Grenier MA,Hernandez AF,et al.Resource use in the last 6 months of life among Medicare beneficiaries with heart failure,2000-2007[J].Arch Int Med,2011,171(3):196-203.
[3] Cook,C,Cole G,Asaria P,et al.The annual global economic burden of heart failure[J].Int J Cardiol,2014,171(3):368-376.
[4] Connor S.The Global Atlas of Palliative Care at the End of Life:An Advocacy Tool[J].Eur J Palliat Care,2014,21(4):180-183.
[5] Ng AY,Wong FK,Lee PH.Effects of a transitional palliative care model on patients with end-stage heart failure:study protocol for a randomized controlled trial[J].Trials,2016,17:173.
[6] World Health Organization (WHO).National Cancer Control Programmes:Policies & Managerial Guidelines[M].Geneva:WHO,2002.
[7] Schenker Y,White D,Rosenzweig M,et al.Care Management by Oncology Nurses To Address Palliative Care Needs:A Pilot Trial To Assess Feasibility,Acceptability,and Perceived Effectiveness of the CONNECT Intervention[J].J Palliat Med,2015,18(3):232-240.
[8] Lee KS,Lennie TA,Dunbar SB,et al.The Association between Regular Symptom Monitoring and Self-Care Management in Patients with Heart Failure[J].J Cardiovasc Nurs,2015,30(2):145-151.
[9] Bruera E,Kuehn N,Miller MJ,et al.The edmonton symptom assessment system(ESAS):a simple method for the assessment of palliative care petients[J].J Palliat Care,1991,7(2):6-9.
[10] 武江华,尤黎明,张俊娥,等.肺癌化疗病人症状负担与生活质量的相关性研究[J].护理研究,2014,28(1A):14-16.
[11] 邓艳红,董吁钢,陈丹丹,等.堪萨斯城生存质量表对慢性心力衰竭患者生存质量评估的可行性评价[J].中华心血管病杂志,2004,32(8):676-679.
[12] 程莉莉,路璐,王烈.中文版Zarit护理负担量表的评价[J].职业与健康,2008,24(22):2383-2385.
[13] Bakitas M,Lyons KD,Hegel MT,et al.Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer:the Project ENABLE Ⅱ randomized controlled trial[J].JAMA,2009,302(7):741-749.
[14] Gary RA,Dunbar SB,Higgins MK,et al.Cmbined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure[J].J Psychosom Res,2010,69(2):119-131.
[15] Kaczkurkin AN,Foa EB.Cognitive-behavioral therapy for anxiety disorders:an update on the empirical evidence[J].Dialogues Clin Neurosci,2015,17(3):337-346.
[16] 苏士云.老年慢性心力衰竭患者的自我管理现状及影响因素研究[J].护理实验与研究,2017,14(19):49-50.
[17] Br?nnstr?m M,Boman K.A new model for integrated heart failure and palliative advanced homecare-rationale and design of a prospective randomized study[J].Eur J Cardiovasc Nurs,2013,12(3):269-275.
[18] Namukwaya E,Grant L,Downing J,et al.Improving care for people with heart failure in Uganda:serial in-depth interviews with patients′ and their health care professionals[J].BMC Res Notes,2017,10(1):184.
[19] Steinberg L,White M,Arvanitis J,et al.Approach to advanced heart failure at the end of life[J].Can Fam Physician,2017,63(9):674-680.
[2] Unroe KT,Grenier MA,Hernandez AF,et al.Resource use in the last 6 months of life among Medicare beneficiaries with heart failure,2000-2007[J].Arch Int Med,2011,171(3):196-203.
[3] Cook,C,Cole G,Asaria P,et al.The annual global economic burden of heart failure[J].Int J Cardiol,2014,171(3):368-376.
[4] Connor S.The Global Atlas of Palliative Care at the End of Life:An Advocacy Tool[J].Eur J Palliat Care,2014,21(4):180-183.
[5] Ng AY,Wong FK,Lee PH.Effects of a transitional palliative care model on patients with end-stage heart failure:study protocol for a randomized controlled trial[J].Trials,2016,17:173.
[6] World Health Organization (WHO).National Cancer Control Programmes:Policies & Managerial Guidelines[M].Geneva:WHO,2002.
[7] Schenker Y,White D,Rosenzweig M,et al.Care Management by Oncology Nurses To Address Palliative Care Needs:A Pilot Trial To Assess Feasibility,Acceptability,and Perceived Effectiveness of the CONNECT Intervention[J].J Palliat Med,2015,18(3):232-240.
[8] Lee KS,Lennie TA,Dunbar SB,et al.The Association between Regular Symptom Monitoring and Self-Care Management in Patients with Heart Failure[J].J Cardiovasc Nurs,2015,30(2):145-151.
[9] Bruera E,Kuehn N,Miller MJ,et al.The edmonton symptom assessment system(ESAS):a simple method for the assessment of palliative care petients[J].J Palliat Care,1991,7(2):6-9.
[10] 武江华,尤黎明,张俊娥,等.肺癌化疗病人症状负担与生活质量的相关性研究[J].护理研究,2014,28(1A):14-16.
[11] 邓艳红,董吁钢,陈丹丹,等.堪萨斯城生存质量表对慢性心力衰竭患者生存质量评估的可行性评价[J].中华心血管病杂志,2004,32(8):676-679.
[12] 程莉莉,路璐,王烈.中文版Zarit护理负担量表的评价[J].职业与健康,2008,24(22):2383-2385.
[13] Bakitas M,Lyons KD,Hegel MT,et al.Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer:the Project ENABLE Ⅱ randomized controlled trial[J].JAMA,2009,302(7):741-749.
[14] Gary RA,Dunbar SB,Higgins MK,et al.Cmbined exercise and cognitive behavioral therapy improves outcomes in patients with heart failure[J].J Psychosom Res,2010,69(2):119-131.
[15] Kaczkurkin AN,Foa EB.Cognitive-behavioral therapy for anxiety disorders:an update on the empirical evidence[J].Dialogues Clin Neurosci,2015,17(3):337-346.
[16] 苏士云.老年慢性心力衰竭患者的自我管理现状及影响因素研究[J].护理实验与研究,2017,14(19):49-50.
[17] Br?nnstr?m M,Boman K.A new model for integrated heart failure and palliative advanced homecare-rationale and design of a prospective randomized study[J].Eur J Cardiovasc Nurs,2013,12(3):269-275.
[18] Namukwaya E,Grant L,Downing J,et al.Improving care for people with heart failure in Uganda:serial in-depth interviews with patients′ and their health care professionals[J].BMC Res Notes,2017,10(1):184.
[19] Steinberg L,White M,Arvanitis J,et al.Approach to advanced heart failure at the end of life[J].Can Fam Physician,2017,63(9):674-680.