饒婷
[摘要]目的 分析心理護(hù)理程序在乳腺包塊手術(shù)患者圍術(shù)期的應(yīng)用效果。方法 選取2015年2月~2018年3月我院收治的200例乳腺包塊手術(shù)患者作為研究對(duì)象,根據(jù)隨機(jī)分組原則分為對(duì)照組和觀察組,每組各100例。對(duì)照組實(shí)施常規(guī)護(hù)理程序,觀察組在對(duì)照組基礎(chǔ)上實(shí)施心理護(hù)理程序,比較兩組的住院時(shí)間、每日睡眠時(shí)間、每日進(jìn)食量、護(hù)理滿意度、焦慮和抑郁評(píng)分。結(jié)果 觀察組的住院時(shí)間[(12.01±0.11)d] 短于對(duì)照組,每日睡眠時(shí)間[(7.28±1.45)h]長(zhǎng)于對(duì)照組,每日進(jìn)食量[(78.15±27.90)kcal/kg]多于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組的護(hù)理總滿意度95.00%,高于對(duì)照組的78.00%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組的焦慮和抑郁評(píng)分低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)。結(jié)論 對(duì)乳腺包塊手術(shù)患者實(shí)施心理護(hù)理程序后,取得顯著效果,能緩解患者各項(xiàng)負(fù)面情緒,改善女性患者心理情況,促進(jìn)乳腺包塊手術(shù)順利進(jìn)行,能提高手術(shù)治療效果。
[關(guān)鍵詞]心理護(hù)理程序;乳腺包塊手術(shù);臨床效果;分析
[中圖分類號(hào)] R473.73 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721(2019)4(b)-0203-03
[Abstract] Objective To analyze the application effect of psychological nursing procedure in perioperative period of patients undergoing breast lump surgery patients. Methods A total of 200 cases of breast mass surgery patients admitted to our hospital from February 2015 to March 2018 were selected as study objects, and were divided into control group and observation group according to the principle of random grouping, 100 cases in each group. Routine nursing procedures were performed in the control group, and psychological nursing procedures were performed in the observation group. Hospital stay, daily sleep time, daily food intake, satisfaction, anxiety and depression score were compared between the two groups. Results The length of hospital stay ([12.01±0.11]d )was shorter than that of the control group, the daily sleep time ([7.28±1.45] h )was longer than that of the control group, and the daily food intake ([78.15±27.90] kcal/kg) was higher than that of the control group, with statistically significant differences (P<0.05). The satisfaction of the patients in the observation group was 95.00%, higher than that of the control group (78.00%), and the difference was statistically significant (P<0.05). The anxiety and depression scores of the observation group were lower than those of the control group, and the differences were statistically significant (P<0.05). Conclusion The psychological nursing program for patients undergoing breast mass surgery has achieved remarkable results, which can alleviate the negative emotions of patients, improve the psychological conditions of female patients, promote the smooth operation of breast mass surgery, and improve the surgical treatment effect.
[Key words] Psychological nursing procedures; Breast mass surgery; Clinical effects; Analysis
研究顯示,乳腺包塊為常見疾病,在早期患者無(wú)顯著癥狀,該疾病的發(fā)生和心理壓力、環(huán)境污染、飲食結(jié)構(gòu)密切相關(guān),一般對(duì)乳腺包塊患者均實(shí)施手術(shù)治療,但由于手術(shù)易給患者心理帶來(lái)較大沖擊,患者常伴有心理問(wèn)題,對(duì)乳腺包塊患者術(shù)后恢復(fù)造成影響,而實(shí)施有效的護(hù)理十分重要[1-2]。本研究對(duì)心理護(hù)理程序用于乳腺包塊手術(shù)患者的臨床效果進(jìn)行研究,現(xiàn)報(bào)道如下。
1資料與方法
1.1一般資料
選取2015年2月~2018年3月我院收治的200乳腺包塊手術(shù)患者作為研究對(duì)象,電腦隨機(jī)分為觀察組和對(duì)照組,每組各100例。本研究經(jīng)過(guò)我院醫(yī)學(xué)倫理委員會(huì)批準(zhǔn),患者均為良性病變。觀察組年齡20~50歲,平均(35.01±1.15)歲。對(duì)照組年齡21~50歲,平均(35.27±1.26)歲。兩組的一般資料比較,差異無(wú)統(tǒng)計(jì)學(xué)意義(P>0.05),具有可比性。
1.2方法
對(duì)照組給予常規(guī)護(hù)理程序。術(shù)前,應(yīng)告知患者乳腺包塊手術(shù)的術(shù)前注意要點(diǎn)和治療原理,詳細(xì)講解乳腺包塊手術(shù)過(guò)程,強(qiáng)調(diào)術(shù)前準(zhǔn)備和術(shù)前檢查的意義,鼓勵(lì)患者積極配合,術(shù)后對(duì)患者行加壓包扎止血,在術(shù)后留意患者彈力繃帶松緊度,由于疼痛容易導(dǎo)致患者發(fā)生焦慮、恐懼等情緒,護(hù)理人員可采用多種方式轉(zhuǎn)移患者注意力,在必要情況下對(duì)患者采用鎮(zhèn)痛藥,在術(shù)后72 h內(nèi)易發(fā)生血腫問(wèn)題,護(hù)理人員應(yīng)告知患者減少上肢運(yùn)動(dòng)[3]。
觀察組在對(duì)照組護(hù)理基礎(chǔ)上使用心理護(hù)理程序,包括心理護(hù)理計(jì)劃制定、心理護(hù)理計(jì)劃實(shí)施、心理護(hù)理診斷、心理護(hù)理評(píng)價(jià)等。①心理評(píng)估:護(hù)理人員應(yīng)和患者面對(duì)面交流,使用癥狀自評(píng)量表評(píng)估每位患者心理狀態(tài)。②心理護(hù)理診斷:對(duì)手術(shù)患者所伴有的心理問(wèn)題實(shí)施診斷,如抑郁、焦慮等,再根據(jù)患者自身情況實(shí)施心理護(hù)理,改善患者自身心態(tài)[4]。③心理護(hù)理計(jì)劃:應(yīng)結(jié)合患者自身心理問(wèn)題,制定心理護(hù)理計(jì)劃內(nèi)容[5]。④心理計(jì)劃實(shí)施:可制作手術(shù)宣傳圖冊(cè),使用圖文并茂方式告知患者手術(shù)具體步驟,告知患者實(shí)施手術(shù)能避免損傷乳腺管,預(yù)防泌乳受到影響,在手術(shù)中采用可吸收縫線,切口愈合后的瘢痕較淺,再邀請(qǐng)實(shí)施乳腺包塊手術(shù)后的患者講解自身心理體會(huì),增加手術(shù)患者的信心,能減輕患者不安和擔(dān)憂,護(hù)理人員應(yīng)陪同手術(shù)患者進(jìn)入手術(shù)間,為患者做好各項(xiàng)保暖措施,告知患者在手術(shù)過(guò)程中可能會(huì)引起不適感或輕微牽拉,在術(shù)中對(duì)每位患者反應(yīng)進(jìn)行觀察,在術(shù)后對(duì)手術(shù)患者生命體征實(shí)施觀察[6]。
1.3觀察指標(biāo)及評(píng)價(jià)標(biāo)準(zhǔn)
比較兩組的住院時(shí)間、每日睡眠時(shí)間、每日進(jìn)食量、護(hù)理滿意度、焦慮和抑郁評(píng)分。滿意度分為滿意、一般、不滿意3個(gè)指標(biāo)。滿意:護(hù)理后,對(duì)護(hù)理和護(hù)理模式的滿意程度評(píng)分81~100分;一般:滿意程度評(píng)分60~80分。不滿意:低于59分。總滿意=滿意+一般[7]。焦慮和抑郁評(píng)分使用漢密頓抑郁量表(HAMD)及漢密頓焦慮量表(HAMA);兩個(gè)量表主要包括14個(gè)反映焦慮癥狀和抑郁癥狀的項(xiàng)目,HAMA、HAMD評(píng)分采用0~4分評(píng)分法,無(wú)癥狀為0分、輕度為1分、中等為2分、重度為3分、極重為4分,分?jǐn)?shù)越高代表患者焦慮癥和抑郁癥越嚴(yán)重[8]。
1.4統(tǒng)計(jì)學(xué)方法
采取SPSS 26.0統(tǒng)計(jì)學(xué)軟件對(duì)數(shù)據(jù)進(jìn)行處理,計(jì)量資料用均數(shù)±標(biāo)準(zhǔn)差(x±s)表示,采用t檢驗(yàn),計(jì)數(shù)資料用百分率(%)表示,采用χ2檢驗(yàn),以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2結(jié)果
2.1兩組住院時(shí)間、每日睡眠時(shí)間、每日進(jìn)食量的比較
觀察組的住院時(shí)間[(12.01±0.11)d]短于對(duì)照組,每日睡眠時(shí)間[(7.28±1.45)h]長(zhǎng)于對(duì)照組,每日進(jìn)食量[(78.15±27.90)kcal/kg]多于對(duì)照組,差異均有統(tǒng)計(jì)學(xué)意義(P<0.05)(表1)。
2.2兩組護(hù)理總滿意度的比較
觀察組護(hù)理總滿意度為95.00%,高于對(duì)照組的78.00%,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)(表2)。
3.3兩組HAMA和HAMD評(píng)分的比較
觀察組HAMA和HAMD評(píng)分低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05)(表3)。
3討論
研究顯示,近年來(lái)乳腺包塊發(fā)病率呈上升趨勢(shì),由于女性患者對(duì)乳房十分重視,常伴有嚴(yán)重負(fù)面心理,導(dǎo)致乳腺包塊手術(shù)效果受到影響,而實(shí)施有效的護(hù)理措施十分重要[9]。因此,本對(duì)心理護(hù)理程序用于乳腺包塊手術(shù)患者的臨床效果進(jìn)行研究,探討心理護(hù)理程序的效果。
常規(guī)護(hù)理程序?yàn)閭鹘y(tǒng)護(hù)理方式,其主要包括術(shù)前術(shù)后的各項(xiàng)護(hù)理,由于多種因素影響,導(dǎo)致常規(guī)護(hù)理程序效果不佳,使其在乳腺包塊手術(shù)患者的應(yīng)用中受到限制[10]。心理護(hù)理程序?yàn)榕R床新型護(hù)理模式,通過(guò)對(duì)患者實(shí)施心理評(píng)估、再制定干預(yù)措施,由于手術(shù)患者自身心理問(wèn)題十分嚴(yán)重,患者常伴有妄想、抑郁和焦慮情況,導(dǎo)致對(duì)乳腺包塊手術(shù)抗拒,使手術(shù)無(wú)法順利實(shí)施,而開展心理護(hù)理程序后,包括心理護(hù)理計(jì)劃制定、心理護(hù)理計(jì)劃實(shí)施、心理護(hù)理診斷、心理護(hù)理評(píng)價(jià)等多項(xiàng)操作,能顯著改善患者負(fù)面情緒,提高女性患者對(duì)乳腺包塊手術(shù)的信心,保障手術(shù)順利進(jìn)行。心理護(hù)理程序與常規(guī)護(hù)理程序比較,具有多種優(yōu)勢(shì),能避免常規(guī)護(hù)理程序中的不足,其具有較強(qiáng)的針對(duì)性,能改善患者心理狀態(tài)[11-14]。如今心理護(hù)理程序已經(jīng)成為乳腺包塊手術(shù)患者首選護(hù)理方式,受到多數(shù)患者青睞,在臨床廣泛應(yīng)用[15]。
本研究結(jié)果顯示,觀察組的住院時(shí)間[(12.01±0.11)d]短于對(duì)照組,每日睡眠時(shí)間[(7.28±1.45)h]長(zhǎng)于對(duì)照組,每日進(jìn)食量[(78.15±27.90)kcal/kg]多于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P<0.05);觀察組護(hù)理總滿意度95.00%高于對(duì)照組的78.00%(P<0.05);觀察組的HAMA和HAMD評(píng)分明低于對(duì)照組(P<0.05)。
綜上所述,對(duì)乳腺包塊手術(shù)患者實(shí)施心理護(hù)理程序,取得顯著效果,能緩解患者負(fù)面情緒,改善女性患者心理情況,促進(jìn)手術(shù)順利進(jìn)行,能提高手術(shù)治療效果,值得臨床推廣及應(yīng)用。
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(收稿日期:2018-08-03 本文編輯:崔建中)