垂体瘤术后患者自我管理行为障碍因素的质性研究

doi:10.3761/j.issn.0254-1769.2025.14.011

摘要/Abstract

摘要：

目的探讨垂体瘤患者术后自我管理行为的障碍因素，为制订针对性护理干预策略提供理论依据。方法采用目的抽样法，选取2024年7月—2025年1月郑州市某三级甲等医院收治的16例垂体瘤术后患者进行半结构式访谈，通过Colaizzi 7步分析法提炼访谈资料。结果共提炼出4个主题、12个亚主题：术后生理功能失衡（感官功能障碍、尿崩症管理困难、疲劳综合征困扰）；心理社会适应障碍（自我形象困扰、疾病复发恐惧、信息传递受限）；健康行为维持困难（环境与行为矛盾、用药与活动依从性不足、并发症管理薄弱）；支持系统不完善（术后指导不具体、沟通渠道不顺畅、医疗资源协同不足）。结论垂体瘤术后患者自我管理行为受多维度因素影响，需从生理、心理、行为及支持系统层面制订综合干预策略。

关键词: 垂体瘤, 自我管理行为, 障碍因素, 质性研究, 护理

Abstract:

Objective To explore the barriers to postoperative self-management behaviors in patients with pituitary adenoma and provide a theoretical basis for developing nursing intervention strategies. Methods Using a purposive sampling method，16 postoperative pituitary adenoma patients admitted to a tertiary hospital in Zhengzhou from July 2024 to January 2025 were selected for semi-structured interviews. The interview data were analyzed and refined through Colaizzi’s phenomenological analysis method. Results A total of 4 themes and 12 subthemes were extracted，including postoperative physiological dysfunction（sensory dysfunction，difficulty in managing diabetes insipidus，fatigue syndrome），psychosocial adaptation barriers（self-image distress，fear of disease recurrence，restricted information delivery），challenges in maintaining health behaviors（environment-behavior conflicts，insufficient adherence to medication and activity guidelines，inadequate complication management），deficiencies in support systems（non-specific postoperative guidance，poor communication channels，insufficient coordination of medical resources）. Conclusion Postoperative self-management behaviors in pituitary adenoma patients are influenced by multidimensional factors，necessitating comprehensive intervention strategies addressing physiological，psychological，behavioral，and systemic support levels.

Key words: Pituitary Adenoma, Self-Management Behavior, Barrier Factors, Qualitative Research, Nursing Care

王董慧, 傅慧琳, 潘圆圆. 垂体瘤术后患者自我管理行为障碍因素的质性研究[J]. 中华护理杂志, 2025, 60(14): 1730-1735.

WANG Donghui, FU Huilin, PAN Yuanyuan. A qualitative study on barriers to self-management behaviors in postoperative pituitary adenoma patients[J]. Chinese Journal of Nursing, 2025, 60(14): 1730-1735.

图/表 1

参考文献 23

[1]	Price M, Ballard C, Benedetti J, et al. CBTRUS statistical report:primary brain and other central nervous system tumors diagno-sed in the United States in 2017-2021[J]. Neuro Oncol, 2024, 26(Suppl 6):vi1-vi85.
[2]	章翔, 章薇, 毛星刚, 等. 神经内窥镜在神经系统肿瘤手术中的应用[J]. 中华神经外科疾病研究杂志, 2024, 18(6):1-7.
	Zhang X, Zhang W, Mao XG, et al. Application of neuroendo-scopy in neurosurgical tumor surgery[J]. Chin J Neurosurg Dis Res, 2024, 18(6):1-7.
[3]	Fleseriu M, Hashim IA, Karavitaki N, et al. Hormonal replace-ment in hypopituitarism in adults:an endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2016, 101(11):3888-3921. DOI PMID
[4]	Zhou SM, Zeng Z, Chen M, et al. Incidence and influencing factors of olfactory dysfunction in patients 1 week after endo-scopic transsphenoidal resection of pituitary tumor:a cross-sec-tional study of 158 patients[J]. Front Neurol, 2024,15:1402626.
[5]	Zhang JJ, Wang Y, Xu XQ, et al. Postoperative complications and quality of life in patients with pituitary adenoma[J]. Gland Surg, 2020, 9(5):1521-1529. DOI PMID
[6]	丁乔, 石贵新, 杨开华. 不同微创手术方式经鼻蝶方案治疗老年垂体瘤疗效及对围术期指标和术后并发症的影响[J]. 中国老年学杂志, 2023, 43(14):3381-3384.
	Ding Q, Shi GX, Yang KH, et al. Efficacy of different mini-mally invasive surgical approaches via transsphenoidal ap-proach in treatment of elderly patients with pituitary tumors and effects on perioperative indicators and postoperative com-plications[J]. Chin J Gerontol, 2023, 43(14):3381-3384.
[7]	Ghiam MK, Chyou DE, Dable CL, et al. 30-day readmissions and coordination of care following endoscopic transsphenoidal pitui-tary surgery:experience with 409 patients[J]. J Neurol Surg B Skull Base, 2021, 83(Suppl 2):e410-e418.
[8]	金煜峰, 殷志雯, 石卫琳, 等. 70例经鼻蝶窦入路手术库欣病患者的多学科融合模式护理[J]. 复旦学报(医学版), 2021, 48(5):703-706.
	Jin YF, Yin ZW, Shi WL, et al. Multidisciplinary integrated nursing model for 70 patients with Cushing’s disease under-going transnasal transsphenoidal approach surgery[J]. Fudan Univ J Med Sci, 2021, 48(5):703-706.
[9]	梁秀平. 医护一体化临床护理路径对垂体瘤切除术后患者心理弹性及生存质量的影响[J]. 中华养生保健, 2024(6):145-148.
	Liang XP. Effect of integrated clinical nursing path on psy-chological resilience and quality of life of patients after pitui-tary adenoma resection[J]. Chin Health Care, 2024(6):145-148.
[10]	张立平, 陈向明. 质性研究的迷思与澄清[J]. 中国远程教育, 2024, 44(2):62-78.
	Zhang LP, Chen XM. Myths and clarification of qualitative research[J]. China Distance Educ, 2024, 44(2):62-78.
[11]	刘均娥, 王莹, 孙柳. 质性研究护理论文的撰写与质量评价[J]. 中华护理杂志, 2024, 59(3):276-280. DOI
	Liu JE, Wang Y, Sun L. Writing and quality evaluation of qualitative research papers in nursing[J]. Chin J Nurs, 2024, 59(3):276-280. DOI
[12]	刘明. Colaizzi七个步骤在现象学研究资料分析中的应用[J]. 护理学杂志, 2019, 34(11):90-92.
	Liu M. Using an example to illustrate Colaizzi’s phenome-nological data analysis method[J]. J Nurs Sci, 2019, 34(11):90-92.
[13]	Hsu PY, Hsieh LC, Wang YH, et al. Olfactory outcomes after middle turbinate resection in endoscopic transsphenoidal sur-gery:a prospective randomized study[J]. Otolaryngol Head Neck Surg, 2022, 167(6):964-970.
[14]	陈靖媛, 张雅娜, 黄雪琨, 等. 慢性鼻窦炎嗅觉障碍评估方法研究进展[J]. 国际耳鼻咽喉头颈外科杂志, 2023, 47(5):299-304.
	Chen JY, Zhang YN, Huang XK, et al. Research progress on assessment methods of olfactory dysfunction in chronic rhino-sinusitis[J]. Int J Otolaryngol Head Neck Surg, 2023, 47(5):299-304.
[15]	Anaka H, Mori E, Yonezawa N, et al. Efficacy of Normalising Serum Zinc Level for Patients with Olfactory Dysfunction and Zinc Deficiency[J]. ORL J Otorhinolaryngol Relat Spec, 2024, 86(2):73-81.
[16]	Naseem A, Habib R, Naz T, et al. Novel Internet of Things based approach toward diabetes prediction using deep learning models[J]. Front Public Health, 2022,10:914106.
[17]	张露露, 陈欢, 罗欢, 等. 基于健康测量工具的共识标准对癌症复发恐惧评估工具的系统评价[J]. 中国全科医学, 2023, 26(17):2138-2146. DOI
	Zhang LL, Chen H, Luo H, et al. Fear of cancer recurrence assessment tools based on COSMIN:a systematic review[J]. Chin Gen Pract, 2023, 26(17):2138-2146.
[18]	孙超, 奚桓, 李峥, 等. 老年患者出院准备服务专家共识(2019版)[J]. 中华护理杂志, 2020, 55(2):220-227. DOI
	Sun C, Xi H, Li Z, et al. Expert consensus on the discharge planning for hospitalized elderly patients(version 2019)[J]. Chin J Nurs, 2020, 55(2):220-227.
[19]	Song SY, Liu ZX, Zhang QY. Application of virtual reality technology in postoperative rehabilitation following total knee arthroplasty:a scoping review[J]. Int J Orthop Trauma Nurs, 2024,54:101124.
[20]	陈一萌, 郭银宁, 朱涵菲, 等. 家庭支持视角下萨提亚沟通模式在护理领域中的应用进展[J]. 中华护理杂志, 2024, 59(19):2413-2419. DOI
	Chen YM, Guo YN, Zhu HF, et al. Application progress of Satir communication model in nursing from the perspective of family support[J]. Chin J Nurs, 2024, 59(19):2413-2419. DOI
[21]	马媛. 基于CUBI用户体验模型的老年人智能药盒设计研究[D]. 北京: 北方工业大学, 2024.
	Ma Y. Research on the design of intelligent medicine box for the elderly based on CUBI user experience model[D]. Bei-jing: North China University of Technology, 2024.
[22]	Gao TY, Ren H, He S, et al. Development of an interpretable machine learning-based intelligent system of exercise prescri-ption for cardio-oncology preventive care:a study protocol[J]. Front Cardiovasc Med, 2023,9:1091885.
[23]	王青, 丁晓彤, 罗忠琛, 等. 人工智能在护理质量管理中的应用进展[J]. 中华护理杂志, 2024, 59(23):2933-2939. DOI
	Wang Q, Ding XT, Luo ZC, et al. Advances of artificial intel-ligence in nursing quality management[J]. Chin J Nurs, 2024, 59(23):2933-2939.