摘要
目的:了解喉癌患者全喉切除术后的生存质量及自护技能的需求和掌握情况,探讨并制定一套临床有效、可行的全喉切除术后患者心理、行为干预模式,以提高患者的生存质量,使患者早日康复,回归社会。
方法:通过设立干预组和对照组,对所有病人进行Zung焦虑自评量表(SAS)、抑郁自评量表(SDS)调查、气管造口相关知识自护技能掌握情况及生存质量问卷调查,对干预组在集中培训的过程中进行心理行为干预,然后对干预组与对照组进行统计学分析。
结果:1.本次共调查患者84人,分为干预组和对照组,对干预组和对照组患者的一般特征进行均衡性检验,干预组和对照组患者在性别、年龄、文化程度、职业类型、没有统计学差异。
2.对焦虑和抑郁自评量表得分采用重复测量方差分析,说明干预组干预前后与对照组得分的主效应差别有统计学意义,时间和组间的交互效应有统计学意义,干预的效应有统计学意义。
3.对干预组和对照组进行造口相关知识掌握情况分析可见:干预前,干预组和对照组在各项目的掌握正确率没有差别,认为是均衡可比的。干预组患者经干预后,对造口周围皮肤护理、气管套管清洗和消毒、日常生活注意事项和喉发音功能锻炼的掌握程度,除环境适宜的掌握(P＞0.078)、使用电子喉交流(P＞0.334)无统计学意义外,其余项目均有统计学差异(p＜0.05),干预组的掌握正确率明显高于对照组。
4.干预组、对照组的生存质量情况采用重复测量方差分析发现:对疼痛、活动能力、娱乐消遣、工作、说话交流,组间(干预组和对照组)交互作用有统计学意义,得出的干预效应有统计学意义,各项目的得分增高;对外貌、咀嚼、肩部功能,时间和组间交互效应和(干预组和对照组)干预的效应均无统计学意义。
5.对喉癌患者生存质量影响因素进行多元回归分析后发现,影响喉癌患者生存质量的影响因素主要为经济情况(b=5.32,p＜0.01)、自护技能(b=4.35,p＜0.01)、心理干预(b=3.58,p＜0.01)、年龄(b=3.45,p＜0.01)、文化程度(b=2.45,p＜0.01)、家人支持(b=2.31,p＜0.01)和付费方式(b=1.95,p＜0.01)。
结论:1.喉癌患者普遍存在严重的焦虑和抑郁症状;2.进行心理干预后可以明显改善喉癌患者的心理状态,提高喉癌患者的生存质量,而且这种干预措施是有效的;3.应用多种方式相结合的健康指导方式,能够提高病人对气管造口知识的掌握程度改善患者生活质量,有利于患者的早日康复和回归社会。
Objective:
To study the situation of the needs of life quality and the mastery of the skills of self-nursing in the patients of larynx carcinoma after the operation of laryngeal cut off,to discuss and establish a suit of effective and feasible psychological and behavior intervention models in patients of larynx carcinoma,to improve the life quality of patients and to make them recover and return the society early.
Methods:
All the patients were divided into two groups(intervention group and control group) and given questionnaire of life quality,questionnaire of the needs of tracheostomy related knowledge, questionnaire of the situation of mastery of tracheostomy related knowledge and the skills of self-nursing.Then the intervention group were given centralized training,repeated measurement analysis of covariance was used to analyz the data.
Results:
1.A total of 84 patients was divided into intervention and control groups in this investigation,a balanced test was used in the general characteristics of the intervention group and control group,the intervention group and control group patients in gender,age,educational level,occupation type have no significant difference.
2.Anxiety and depression self-rating scale scores by repeated measure analysis of variance that scores before and after the intervention of the main differences are statistically significant, time and the interaction between the group had a significant effect,the intervention had a significant effect.
3.Intervention and control groups in the purpose of knowing the right rate there is no difference before intervention,that is balanced comparable,the skin around the stoma care, tracheal casing cleansing and disinfection,daily attention to issues and functional training jets pronunciation of the master degree,with the exception of the environment suitable for the control(P＞0.078),the use of electronic communication jets(P＞0.334) was not significant,the remaining projects are significant differences(p＜0.05),grasp the correct intervention group was significantly higher than that in the intervention group after the intervention.
4.The quality of life was analyzed in the control group and intervention group,repeated measure analysis of variance were used to analyz the pain、activity、entertainment、work and exchange of words.the group(the intervention group and control group) had a significant interaction,The effect is significant,the purpose of scoring higher.The appearance,chewing, shoulder function,using repeated measure analysis of variance found that group(the intervention group and control group) interaction was not significant,the group(the intervention group and control group) the effect of intervention was not significant.
5.Multiple regression analysis about the Influencing factors of life quality of the patients of the larynx carcinoma showed,the main Influencing factors were economy situation(b=5.32, p＜0.01),skill of self-nursing(b=4.35,p＜0.01),mental intervention(b=3.58,p＜0.01),age (b=3.45,p＜0.01),culture degree(b=2.45,p＜0.01),family support(b=2.31,p＜0.01) and payment type(b=1.95,p＜0.01).
Conclusions:
1.Health guidance of multiple styles could improve the mastery extents of the knowledge of tracheostomy of the patients and improve their life qualities.
2.Anxiety and depression were popular among the patients of larynx carcinoma.
3.Mental intervention could improve the mental states of the patients of larynx carcinoma, improve their life qualities effectively.
4.Zung SAS and SDS could reflects the mental states of the patients of larynx carcinoma,it is very essential to give the patients of larynx carcinoma mental intervention,it is favorable for the patients recover and return the society early.
引文
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