摘要
目的探讨叙事医学模式在行肾癌根治术患者围手术期医疗护理中的应用效果。方法将2014年2月至2016年10月行肾癌根治术的124例患者按区组随机化分组方法随机分为对照组与干预组各62例，干预组采用叙事医学模式对患者进行围手术期护理，对照组采用泌尿外科常规围手术期护理。使用Zung焦虑自评量表（SAS）、抑郁自评量表（SDS）和社会支持评定量表（SSRS）对患者的心理状况及社会支持情况进行评估。比较2组术后康复指标如并发症、首次进食时间、住院时间、住院费用等。结果2组患者术前均存在焦虑、抑郁心理状况，且2组术前各量表评分比较差异无统计学意义（P〉0．05）；干预组患者术后SAS、SDS及SSRS评分分别为（44．71±4．67）、（40．84±4．05）、（43．21±3．60）分，术前分别为（54．98±5．93）、（46．52±5．07）、（31．87±3．22）分，干预组手术前后比较差异有统计学意义（t=18．73、8．85、18．18，均P〈0．01），对照组患者术后SAS、SDS及SSRS评分分别为（53．24±5．97）、（44．63±4．37）、（32．61±2．72）分，术前分别为（54．92±5．83）、（46．53±4．89）、（32．16±2．48）分，对照组手术前后比较差异无统计学意义（t=1．590、1．400、1．910，P〉0．05）。干预组患者术后并发症发生率、首次进食时间、住院时间、住院费用分别为22．58％（14／62）、（2．50±0．92）d、（11．16±3．72）d、（2．46±0．40）万元，对照组分别为48．39％（30／62）、（3．98±1．44）d、（15．48±5．44）d、（4．02±0．31）万元，2组比较差异有统计学意义（r=9．02，t=2．07、8．06、3．93，P〈0．05或0．01）。结论运用叙事医学模式，能更好地将人文关怀融入患者的临床医疗护理工作中，有效改善患者的心理状况，促进患者术后快速康复。
Objective To investigate the effect of narrative medicine mode in perioperative medical and nursing care for patients underwent radical nephrectomy. Methods A total of 124 patients received radical nephrectomy from February 2014 to October 2016 were selected and divided into experimental group and control group by block randomization grouping method with 62 cases each. Narrative medical treatment and care was applied in experimental group while control group received conventional treatment and care. The psychological status and social support of the patients were evaluated by Zung Self-rating Anxiety Scale（SAS）, Self-rating Depression Scale （SDS） and social support rating scale（SSRS）, as well as rehabilitation indexes including complications, first feeding time, hospitalization time, costs, etc. Results Anxiety and depression status were existed in both experimental and control groups before operations, and there were no significant difference in all preoperative scales between two groups （P〉0.05）. The score of SAS, SDS, SSRS was （44.71±4.67）, （40.84± 4.05）, （43.21 ± 3.60） points after operation and （54.98 ±5.93）, （46.52 ±5.07）, （31.87± 3.22） points before operation in experimental group. The score of SAS, SDS, SSRS was （53.24±5.97）, （44.63±4.37）, （32.61 ± 2.72） points after operation and （54.92 ± 5.83）, （46.53 ± 4.89）, （32.16± 2.48） points before operation in control group. Significant differences were found between before and after operation in experimental group （t=18.73, 8.85, 18.18, all P〈0.01）. However, no significant difference could be found between before and after operation in control group （t=1.590, 1.400, 1.910, P〉0.05）. After operation, the complications, first feeding time, hospitalization time and costs was 22.58%（14/62）, （2.50±0.92） d, （11.16±3.72） d, （24.6±4.0） thousand yuan in experimental group, which was 48.39%（30/62）, （3.98± 1.44） d, （15.48±5.44） d, （40.2± 3.1） thousand yuan in control group. Significant differences were found between experimental group and control group 0（2=9.02, t=2.07, 8.06, 3.93, P〈0.05 or 0.01）. Conclusions Narrative medicine mode can provide medical care filled with respect, empathy, and humanistic concern, andimprove patients＇ psychological status, thus promoting rehabilitation.
出处
《中国实用护理杂志》
2017年第20期1525-1529,共5页
Chinese Journal of Practical Nursing
基金
国家临床重点专科建设项目（卫办医政函[2012]649号）
安徽省自然科学基金面上项目（1508085MH160）
安徽省教育厅高校人文社会科学研究项目（SK2017A0171）
关键词
肾肿瘤
叙事医学
肾癌根治术
人文关怀
Kidney neoplasms
Narrative medicine
Nephrectomy
Humanistie
