鄒瀅 孫婷婷 周太容 馮維恩

【摘要】 目的：觀察循證護(hù)理干預(yù)應(yīng)用在乳腺癌保乳手術(shù)圍手術(shù)期預(yù)防并發(fā)癥的效果。方法：將在筆者所在醫(yī)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(shù)患者60例，依據(jù)患者入院順序分為兩組。先入院的30例患者采用常規(guī)護(hù)理干預(yù)，設(shè)為對(duì)照組，后入院的30例患者采用循證護(hù)理干預(yù)，設(shè)為研究組。比較兩組護(hù)理前后負(fù)性情緒評(píng)分、圍手術(shù)期并發(fā)癥發(fā)生情況及護(hù)理滿意度。結(jié)果：護(hù)理后兩組患者SAS、SDS評(píng)分均明顯降低，且循證組明顯低于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。循證組患者圍手術(shù)期并發(fā)癥發(fā)生率為3.33%，明顯低于對(duì)照組的20.00%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。循證組護(hù)理總滿意度為100%，明顯高于對(duì)照組的83.33%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論：在乳腺癌保乳手術(shù)患者的護(hù)理中采取循證護(hù)理干預(yù)，可明顯降低患者負(fù)性情緒，明顯減少術(shù)后并發(fā)癥的發(fā)生，提高護(hù)理滿意度，效果理想。

【關(guān)鍵詞】 循證護(hù)理 乳腺癌保乳手術(shù) 圍手術(shù)期 并發(fā)癥預(yù)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(fā)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(yán)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(yī)療水平的不斷進(jìn)步，乳腺癌手術(shù)中的保乳手術(shù)已經(jīng)獲得了臨床對(duì)其療效的廣泛認(rèn)可[2]。而在圍手術(shù)期間，患者因?qū)膊〉目謶?、手術(shù)的負(fù)性情緒，增加了圍手術(shù)期并發(fā)癥的發(fā)生，增加了患者的痛苦[3]。常規(guī)護(hù)理干預(yù)多針對(duì)疾病本身，對(duì)患者個(gè)體較少進(jìn)行過多的干預(yù)。而本研究運(yùn)用循證護(hù)理，將針對(duì)可能出現(xiàn)并發(fā)癥的一系列問題進(jìn)行循證，獲取最佳研究證據(jù)，進(jìn)而提供更好的護(hù)理。

1 資料與方法

1.1 一般資料

將在筆者所在醫(yī)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(shù)的60例患者作為研究對(duì)象，納入標(biāo)準(zhǔn)：經(jīng)術(shù)后病理診斷符合乳腺癌標(biāo)準(zhǔn);臨床資料完整;依從性良好[4]。排除標(biāo)準(zhǔn)：廣泛轉(zhuǎn)移;合并其他系統(tǒng)疾病;曾接受過類似護(hù)理干預(yù);精神異常;溝通、認(rèn)知障礙者[5]。依據(jù)患者入院順序?qū)⑵浞譃閮山M，先入院的30例患者采用常規(guī)護(hù)理干預(yù)，設(shè)為對(duì)照組，后入院的30例患者采用循證護(hù)理干預(yù)，設(shè)為研究組。對(duì)照組患病時(shí)間1.2～16.8個(gè)月，平均（5.8±0.6）個(gè)月;年齡34～68歲，平均（47.3±4.1）歲;12例浸潤(rùn)性導(dǎo)管癌，9例浸潤(rùn)性小葉癌，8例黏液腺癌，1例硬癌。循證組患病時(shí)間1.1～17.2個(gè)月，平均（6.1±0.7）個(gè)月;年齡31～69歲，平均（46.8±4.3）歲;12例浸潤(rùn)性導(dǎo)管癌，8例浸潤(rùn)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(tǒng)計(jì)學(xué)意義（P>0.05），有可比性?；颊呔鶎?duì)本研究知情同意，本研究經(jīng)醫(yī)學(xué)倫理委員會(huì)批準(zhǔn)實(shí)施。