循證護理干預應用在乳腺癌保乳手術圍手術期預防并發癥的效果

鄒瀅 孫婷婷 周太容 馮維恩

【摘要】 目的：觀察循證護理干預應用在乳腺癌保乳手術圍手術期預防并發癥的效果。方法：將在筆者所在醫院近年（2016年5月-2019年5月）收治的以乳腺癌為診斷擬行保乳手術患者60例，依據患者入院順序分為兩組。先入院的30例患者采用常規護理干預，設為對照組，后入院的30例患者采用循證護理干預，設為研究組。比較兩組護理前后負性情緒評分、圍手術期并發癥發生情況及護理滿意度。結果：護理后兩組患者SAS、SDS評分均明顯降低，且循證組明顯低于對照組，差異有統計學意義（P<0.05）。循證組患者圍手術期并發癥發生率為3.33%，明顯低于對照組的20.00%，差異有統計學意義（P<0.05）。循證組護理總滿意度為100%，明顯高于對照組的83.33%，差異有統計學意義（P<0.05）。結論：在乳腺癌保乳手術患者的護理中采取循證護理干預，可明顯降低患者負性情緒，明顯減少術后并發癥的發生，提高護理滿意度，效果理想。

【關鍵詞】 循證護理 乳腺癌保乳手術 圍手術期 并發癥預防

[Abstract] Objective： To observe the effect of evidence-based nursing intervention in preventing complications in perioperative period of breast conserving surgery for breast cancer. Method： A total of 60 breast conserving surgery patients with breast cancer were treated in our hospital in recent years （from May 2016 to May 2019） were divided into two groups according to the order of admission. The first 30 patients were treated with routine nursing intervention， which was set as the control group， and the second 30 patients were treated with evidence-based nursing intervention， which was set as the study group. Negative emotional scores before and after nursing， perioperative complications and nursing satisfaction were compared between the two groups. Result： After nursing， SAS and SDS scores of patients in both groups were significantly reduced， and the evidence-based group was significantly lower the control group， the differences were statistically significant （P<0.05）. The perioperative complication rate of the evidence-based group was 3.33%， which was significantly lower than 20.00% of the control group， and the difference was statistically significant （P<0.05）. The total nursing satisfaction in the evidence-based group was 100%， which was significantly higher than 83.33% in the control group， and the difference was statistically significant （P<0.05）. Conclusion： Evidence-based nursing intervention in the nursing of breast cancer patients with breast conserving surgery， can significantly reduce the negative emotions of patients， significantly reduce the occurrence of postoperative complications， improve the nursing satisfaction， the effect is ideal.

乳腺癌屬于常見疾病，是女性最常見的發生在乳腺上皮組織的惡性腫瘤，在女性惡性腫瘤疾病死亡中高居首位，嚴重威脅著患者的身體健康甚至危及其生命[1]。隨著篩查工作的不斷深入開展，早期患病比例增加，隨著醫療水平的不斷進步，乳腺癌手術中的保乳手術已經獲得了臨床對其療效的廣泛認可[2]。而在圍手術期間，患者因對疾病的恐懼、手術的負性情緒，增加了圍手術期并發癥的發生，增加了患者的痛苦[3]。常規護理干預多針對疾病本身，對患者個體較少進行過多的干預。而本研究運用循證護理，將針對可能出現并發癥的一系列問題進行循證，獲取最佳研究證據，進而提供更好的護理。

1 資料與方法

1.1 一般資料

將在筆者所在醫院近年（2016年5月-2019年5月）收治的以乳腺癌為診斷擬行保乳手術的60例患者作為研究對象，納入標準：經術后病理診斷符合乳腺癌標準;臨床資料完整;依從性良好[4]。排除標準：廣泛轉移;合并其他系統疾病;曾接受過類似護理干預;精神異常;溝通、認知障礙者[5]。依據患者入院順序將其分為兩組，先入院的30例患者采用常規護理干預，設為對照組，后入院的30例患者采用循證護理干預，設為研究組。對照組患病時間1.2～16.8個月，平均（5.8±0.6）個月;年齡34～68歲，平均（47.3±4.1）歲;12例浸潤性導管癌，9例浸潤性小葉癌，8例黏液腺癌，1例硬癌。循證組患病時間1.1～17.2個月，平均（6.1±0.7）個月;年齡31～69歲，平均（46.8±4.3）歲;12例浸潤性導管癌，8例浸潤性小葉癌，9例黏液腺癌，1例硬癌。兩組一般資料比較，差異無統計學意義（P>0.05），有可比性。患者均對本研究知情同意，本研究經醫學倫理委員會批準實施。