作者：张芳静，周乾华，汪海燕，陈娟

单位：安徽省第二人民医院 胸心外科，安徽 合肥 230011

Authors: Zhang Fangjing, Zhou Qianhua, Wang Haiyan, Chen Juan

Unit: Department of Thoracic and Cardiovascular Surgery, Anhui NO.2 Provincial, People's Hospital, Hefei 230011, Anhui, China

摘要：

目的 通过自我效能联合自我护理干预模式,构建针对行重组人血管内皮抑制素联合同步放化疗治疗的晚期食管癌患者的护理方案,并评价其临床应用价值。方法 2018年6月至2020年6月安徽省第二人民医院共收治行重组人血管内皮抑制素联合同步放化疗的晚期食管癌患者86例,采用随机数字表法随机分至以自我效能与自我护理为核心的综合护理组(观察组,n=43)和常规护理组(对照组,n=43)。比较两组患者治疗前后自我效能感、自我护理效能及生活质量的差异。结果 治疗前1 d,两组患者各项评价指标的比较,差异均无统计学意义(均P>0.05)。与对照组相比,观察组在治疗结束后7 d高水平自我效能感的比例和治疗结束后1个月高水平自我护理能力的比例均明显增加[分别为41.9%比7.0%(P<0.001)和65.1%比23.3%(P<0.001)]。观察组治疗后总体健康状态[(62.4±11.5)分比(57.7±9.4)分]、躯体功能[(73.2±14.3)分比(61.2±13.5)分]、情绪功能[(65.3±16.7)分比(57.2±15.4)分]及社会功能评分[(61.3±14.4)分比(54.3±9.1)分]均明显优于对照组(均P<0.05),而疲倦[33.3(22.2, 50.0)分比56.7(22.2, 77.8)分]、食欲下降[16.7(0, 33.3)分比33.3 (16.7, 66.7)分]及便秘症状评分[0 (0, 33.3)分比33.3 (0, 66.7)分]均显著低于对照组(均P <0.05)。结论 以自我效能与自我护理为核心的综合护理方案可显著提高行重组人血管内皮抑制素联合同步放化疗治疗的晚期食管癌患者的自我护理能力,明显改善生活质量。

关键词：食管癌；晚期；自我护理；自我效能；生活质量

Abstract：

Objective To evaluate the effect of nursing program combining self-efficacy and self-care on patients with advanced esophageal cancer receiving recombinant human endostatin and concurrent chemoradiotherapy. Method Eighty six patients with advanced esophageal cancer who underwent recombinant human endostatin and concurrent chemoradiotherapy from June 2018 to June 2020 in the Second People's Hospital of Anhui Province were randomly assigned to comprehensive nursing program that incorporates self[1]efficacy and self-care （observation group, n=43） and conventional nursing program （control group, n=43）. To compare the differences in self -efficacy, self -care efficacy and quality of life between the two groups before and after treatment. Result The baselines of all the observational outcomes were comparable between the two groups （all P>0.05）. As compared to the control group, the observation group had significantly higher proportion of patients with high level of self-efficacy on day 7 post treatment （41.9% vs 7.0%, P<0.001）, and of those with self-care ability 1 month after therapy （65.1% vs 23.3%, P<0.001）. The results of life quality evaluation showed that the overall health status[（62.4±11.5） vs （57.7±9.4）], physical function [（73.2±14.3）vs（61.2±13.5）], emotional function [（65.3±16.7）vs（57.2±15.4）] and social function [（61.3±14.4） vs（54.3±9.1）] were significantly enhanced in the observation group compared with control group （all P<0.05）, and the scores for fatigue [33.3（22.2, 50.0） vs 56.7（22.2, 77.8）], appetite [16.7(0, 33.3) vs 33.3(16.7, 66.7)] and constipation symptoms [0(0, 33.3) vs 33.3(0, 66.7)] were significantly lower in the observation group compared with control group （all P <0.05）. Conclusion Nursing program combining self -efficacy and self -care improves the capability of self -care and quality -of -life of patients with advanced esophageal cancer receiving recombinant human endostatin and concurrent chemoradiotherapy.

Key Words: Esophageal cancer; Advanced; Self-care; Self-efficacy; Quality of life