基于自我效能理论的护理干预对食管癌根治术后患者的影响

doi:10.3761/j.issn.0254-1769.2022.09.003

摘要/Abstract

摘要：

目的探讨基于自我效能理论的护理干预对食管癌根治术后患者营养状况以及癌因性疲乏的影响。方法采用便利抽样法,选取南昌市某三级甲等医院2017年1月—2020年12月收治的119例食管癌根治术后患者作为研究对象,按照随机数字表法将其分为试验组（n=59）与对照组（n=60）。试验组采取基于自我效能理论的护理干预,对照组接受术后常规护理干预,比较两组在出院时（T₀）、出院后1个月（T₁）、出院后3个月（T₂）、出院后6个月（T₃）以及出院后1年（T₄）的自我效能感、营养状况、癌因性疲乏情况。结果重复测量方差分析结果显示,干预后不同时间点试验组健康行为自我效能感量表得分均高于对照组,营养风险筛查表2002得分均低于对照组,差异有统计学意义（P<0.05）;在T₄时,试验组癌因性疲乏量表得分为（33.90±6.30）分,显著低于对照组的（44.93±7.66）分,差异具有统计学意义（P<0.001）。结论基于自我效能理论的护理干预可显著增加食管癌根治术后患者的自我效能感、改善其营养状况、缓解癌因性疲乏。

关键词: 食管癌, 自我效能感理论, 护理干预策略, 营养状况, 癌因性疲乏, 围手术期护理

Abstract:

Objective To investigate the effects of intervention strategies based on self-efficacy theory on nutritional status and cancer-induced fatigue（CRF） after total thoracoscopic esophageal cancer. Methods A total of 119 patients with esophageal cancer admitted to the Second Affiliated Hospital of Nanchang University from January 2017 to December 2020 were selected by convenience sampling method. They were divided into an experimental group（n=59） and a control group（n=60） according to random number method. Patients in the control group received conventional nursing,while patients in the experiment group take the self-efficacy theory as the instruction intervention strategy. The self-efficacy,nutritional status and T₄ CRF of 2 groups of patients were compared in the hospital（T₀）,1 month after discharge（T₁）,3 months after discharge（T₂）,6 months after discharge （T₃）,and 1 year after discharge（T₄）. Results The self-efficacy score of the experimental group was higher than that of the control group at different time points after intervention,and the risk score of nutritional status was lower than that of the control group,with statistical significances（P<0.05）. At T₄,the CRF score of the experiment group （33.90±6.30） was significantly lower than that of control group（44.93±7.66）（P<0.001）. Conclusion Nursing intervention strategies based on self-efficacy theory can significantly increase the self-efficacy of patients after thoracoscopic esophageal cancer surgery,improve their nutritional status,and alleviate CRF.

Key words: Esophageal Cancer, Self-Efficacy Theory, Nursing Intervention Strategy, Nutritional Status, Cancer Fatigue, Perioperative Nursing

邓雁, 余琼, 武福姣, 方亮. 基于自我效能理论的护理干预对食管癌根治术后患者的影响[J]. 中华护理杂志, 2022, 57(9): 1042-1047.

DENG Yan, YU Qiong, WU Fujiao, FANG Liang. Effects of nursing intervention strategies based on self-efficacy theory on nutritional status and cancer-induced fatigue after total thoracoscopic radical resection of esophageal cancer[J]. Chinese Journal of Nursing, 2022, 57(9): 1042-1047.

图/表 3

表1 两组一般资料比较[例（百分比,%）]

Table 1 Characteristics of general data of patients[case（percentage,%）]

表2 两组各时间点健康行为自我效能感量表得分比较（分,$\bar{x}\pm s$）

Table 2 Comparison of GSES scores between the two groups at each time point（score,$\bar{x}\pm s$）

表3 两组各时间点营养风险筛查表2002得分比较（分,$\bar{x}\pm s$）

Table 3 Comparison of NRS-2002 scores between the two groups at each time point（score,$\bar{x}\pm s$）

参考文献 23

[1]	王宁, 刘硕, 杨雷, 等. 2018全球癌症统计报告解读[J]. 肿瘤综合治疗电子杂志, 2019, 5(1):87-97.
	Wang N, Liu S, Yang L, et al. Interpretation on the report of global cancer statistics 2018[J]. J Multidiscip Cancer Manag Electron Version, 2019, 5(1):87-97.
[2]	刘曙正, 于亮, 陈琼, 等. 2003-2012年食管癌高发区林州市不同病理类型食管癌发病及生存状况分析[J]. 中华预防医学杂志, 2017, 51(5):393-397.
	Liu SZ, Yu L, Chen Q, et al. Analysis of the incidence and survival status of different pathological types of esophageal cancer in Linzhou city,a high incidence area of esophageal cancer from 2003 to 2012[J]. Chin J Preven Med, 2017, 51(5):393-397.
[3]	Schoppmann SF, Prager G, Langer F, et al. Fifty-five minimally invasive esophagectomies:a single centre experience[J]. Anticancer Res, 2009, 29(7):2719-2725. PMID
[4]	钱会娟, 袁长蓉. 癌症自我管理研究现状及启示[J]. 中华护理杂志, 2010, 45(12):1147-1150.
	Qian HJ, Yuan CR. Research progress of self-management in cancer patients[J]. Chin J Nurs, 2010, 45(12):1147-1150.
[5]	Austin JD, Robertson MC, Shay LA, et al. Implications for patient-provider communication and health self-efficacy among cancer survivors with multiple chronic conditions:results from the Health Information National Trends Survey[J]. J Cancer Surviv, 2019, 13(5):663-672. DOI URL
[6]	陈佩娟, 张露, 张春梅, 等. 鼻咽癌放疗患者自我管理效能感对张口功能锻炼依从性的影响研究[J]. 中华护理杂志, 2016, 51(9):1049-1053.
	Chen PJ, Zhang L, Zhang CM, et al. Effects of self-care self-efficacy on mouth open training compliance among patients with nasopharyngeal carcinoma after radiotherapy[J]. Chin J Nurs, 2016, 51(9):1049-1053.
[7]	Durosier Mertilus DS, Lengacher CA, Rodriguez CS. A review and conceptual analysis of cancer pain self-management[J]. Pain Manag Nurs, 2021, 42(21):126-129.
[8]	Song CH, Cao JJ, Zhang F, et al. Nutritional risk assessment by scored patient-generated subjective global assessment associated with demographic characteristics in 23,904 common malignant tumors patients[J]. Nutr Cancer, 2019, 71(1):50-60. DOI URL
[9]	谢晓冬, 张潇宇. 癌因性疲乏最新进展:NCCN(2018版)癌因性疲乏指南解读[J]. 中国肿瘤临床, 2018, 45(16):817-820.
	Xie XD, Zhang XY. Latest progress in cancer-related fatigue:interpretation of National Comprehensive Cancer Network guidelines for cancer-related fatigue version 2018[J]. Chin J Clin Oncol, 2018, 45(16):817-820.
[10]	Inglis JE, Janelsins MC, Culakova E, et al. A longitudinal assessment to evaluate the impact of higher body mass index on cancer-related fatigue in breast cancer patients receiving chemotherapy[J]. J Clin Oncol, 2018, 36(15 suppl):10061.
[11]	王程浩, 韩泳涛. 2020年中国临床肿瘤学会《食管癌诊疗指南》解读[J]. 肿瘤预防与治疗, 2020, 33(4):285-290.
	Wang CH, Han YT. Interpretation of the 2020 guidelines for the diagnosis and treatment of esophageal cancer by Chinese society of clinical oncology[J]. J Cancer Control Treat, 2020, 33(4):285-290.
[12]	Bandura A. Self-efficacy:toward a unifying theory of behavioral change[J]. Psychol Rev, 1977, 84(2):191-215. DOI PMID
[13]	王才康, 胡中锋, 刘勇. 一般自我效能感量表的信度和效度研究[J]. 应用心理学, 2001, 7(1):37-40.
	Wang CK, Hu ZF, Liu Y. Evidences for reliability and validity of the Chinese version of General Self-Efficacy Scale[J]. Chin J Appl Psychol, 2001, 7(1):37-40.
[14]	Kondrup J, Rasmussen HH, Hamberg O, et al. Nutritional risk screening(NRS 2002):a new method based on an analysis of controlled clinical trials[J]. Clin Nutr, 2003, 22(3):321-336. PMID
[15]	姬艳博, 许翠萍, 孙菲菲, 等. 癌因性疲乏自评量表的编制及信效度检验[J]. 护士进修杂志, 2016, 31(11):963-967.
	Ji YB, Xu CP, Sun FF, et al. Establishment of Self-Rating Scale for Cancer Related Fatigue and its reliability and validity test[J]. J Nurses Train, 2016, 31(11):963-967.
[16]	Klassen RM, Klassen JRL. Self-efficacy beliefs of medical students:a critical review[J]. Perspect Med Educ, 2018, 7(2):76-82. DOI URL
[17]	戴晗青, 马灵草, 陈海芳. 自我效能理论在喉鳞状细胞癌患者术后管理中的应用[J]. 癌症进展, 2021, 19(8):852-855.
	Dai HQ, Ma LC, Chen HF. Application of self-efficacy theory in postoperative management of patients with laryngeal squamous cell carcinoma[J]. Oncol Prog, 2021, 19(8):852-855.
[18]	Westergren A, Norberg E, Hagell P. Diagnostic performance of the Minimal Eating Observation and Nutrition Form-Version Ⅱ(MEONF-Ⅱ) and Nutritional Risk Screening 2002(NRS 2002) among hospital inpatients-a cross-sectional study[J]. BMC Nurs,2011, 10:24. DOI URL
[19]	Zhang XS, Liu YH, Zhang Y, et al. Handgrip strength as a predictor of nutritional status in Chinese elderly inpatients at hospital admission[J]. Biomed Environ Sci, 2017, 30(11):802-810.
[20]	Cong MH, Wang JJ, Fang Y, et al. A multi-center survey on dietary knowledge and behavior among inpatients in oncology department[J]. Support Care Cancer, 2018, 26(7):2285-2292. DOI URL
[21]	Wu PH, Chen SW, Huang WT, et al. Effects of a psychoeducational intervention in patients with breast cancer undergoing chemotherapy[J]. J Nurs Res, 2018, 26(4):266-279. DOI URL
[22]	Barrera R. Nutritional support in cancer patients[J]. J Parenter Enter Nutr, 2002, 26:S63-S71.
[23]	Arribas L, Hurtos L, Sendros MJ, et al. NUTRISCORE:a new nutritional screening tool for oncological outpatients[J]. Nutrition, 2017, 33:297-303. DOI PMID