个案管理在早期乳腺癌患者康复期体重控制中的应用

发布时间：2018-06-01 11:14

本文选题：乳腺癌 + 康复期　；参考：《郑州大学》2017年硕士论文

【摘要】：研究目的探讨采用个案管理对控制早期乳腺癌患者康复期体重的效果,并观察体重控制对患者康复期血脂、血糖、血红蛋白及健康行为能力和生存质量的影响。研究方法本研究为类实验性研究。按照纳入排除标准,遴选郑州市某三级甲等综合医院乳腺外科进行保乳术或改良根治术、术后进行8个疗程化疗的早期乳腺癌患者30名为对照组,选取郑州市另一三级甲等综合医院乳腺外科进行保乳术或改良根治术、术后并进行8个疗程化疗的早期乳腺癌患者30名为干预组;对照组实行常规健康教育,干预组在常规健康教育基础上,实行基于个案管理模式的体重控制;两组分别于化疗前、化疗中期、化疗结束收集患者一般资料、体重、血糖血脂、血红蛋白、健康行为能力及生存质量状况并进行评估;采用IBM SPSS Statistics 20.0对数据进行统计分析,方法为:描述性分析、卡方检验、非参数检验、重复测量方差分析、t检验,检验水准为α=0.05,P0.05有统计学差异。研究结果1.至研究结束,共有55名患者纳入统计分析。两组一般资料对比无统计学差异(P0.05);干预前两组体重、BMI、血糖血脂、血红蛋白、健康行为能力得分及生存质量得分均无统计学差异(P0.05);两组具有可比性。2.化疗结束后干预组体重平均增加(0.82±2.37)kg;对照组体重平均增加(6.52±3.66)kg,对比有统计学差异(P0.05);体重变化分类及超重肥胖率对比有统计学差异(P0.05)。两组体重、BMI在化疗前、化疗中期、化疗结束三个时间点测量结果方差分析时间效应有统计学意义(P0.05),随化疗的进行,两组体重与BMI均有所增加;组别效应有统计学意义(P0.05),干预组体重、BMI状况优于对照组。3.两组患者的血糖、总胆固醇、甘油三脂、低密度脂蛋白、血红蛋白在化疗前、化疗中期、化疗结束三个时间点测量结果方差分析显示时间效应有统计学差异(均P0.05),随化疗的进行而变化;血糖、总胆固醇、低密度脂蛋白组间比较有统计学差异(均P0.05),干预组优于对照组。4.健康行为能力与生存质量方面,化疗结束后,两组患者健康行为能力总分及各维度得分上差异均有统计学意义(P0.05);生存质量总得分及生理状况、情感状况、功能状况、乳腺癌附加关注四个维度上得分差异有统计学意义P0.05)。结论1.以饮食运动为主要方式的个案管理能够在一定程度上控制乳腺癌患者康复期体重增加的趋势。2.体重控制可以在一定程度上改善患者化疗期间的血糖血脂水平。3.体重控制有利于患者养成良好的生活习惯,提高健康行为能力,维持较好的自我形象,改善生存质量。
[Abstract]:Objective to investigate the effect of case management on early breast cancer patients' recovery weight, and to observe the effects of weight control on blood lipid, blood glucose, hemoglobin, healthy behavior and quality of life. Methods this study is an experimental study. According to the exclusion criteria, 30 patients with early breast cancer who received 8 courses of chemotherapy were selected as the control group for breast surgery or modified radical mastectomy in a Grade 3A general hospital in Zhengzhou. Thirty patients with early breast cancer who underwent breast conservation or modified radical mastectomy in another Grade 3A general hospital in Zhengzhou were selected as the intervention group and the control group were given routine health education. On the basis of routine health education, the intervention group carried out the weight control based on the case management model, and the two groups collected the general data of patients before and during the middle stage of chemotherapy and the end of chemotherapy, including body weight, blood glucose, blood lipid, hemoglobin. IBM SPSS Statistics 20.0 was used to analyze the data. The methods were: descriptive analysis, chi-square test, nonparametric test, repeated measurement variance analysis. There was statistical difference in the test level of 伪 -0. 05 and 0. 05% (P < 0. 05). Results 1. By the end of the study, 55 patients had been included in the statistical analysis. There was no significant difference in general data between the two groups (P 0.05), and there was no significant difference in blood glucose, blood lipid, hemoglobin, health behavior ability and quality of life between the two groups before intervention (P 0.05). The time effect of ANOVA was statistically significant at three time points before and after chemotherapy in both groups. The weight and BMI of the two groups increased with the development of chemotherapy. The group effect was significantly higher than that of control group (P 0.05), and the BMI of intervention group was better than that of control group (P 0.05). The blood sugar, total cholesterol, triglyceride, low density lipoprotein, hemoglobin in both groups were before and during the middle stage of chemotherapy. The variance analysis of the three time points at the end of chemotherapy showed that there was a significant difference in time effect (all P 0.05), which varied with the course of chemotherapy, blood sugar, total cholesterol, blood glucose, total cholesterol, There was significant difference between the low density lipoprotein groups (all P 0.05), the intervention group was better than the control group. 4. In terms of health behavior ability and quality of life, after chemotherapy, there were significant differences in the total score and dimension scores of healthy behavior ability between the two groups (P 0.05), the total score of quality of life and physiological status, emotional status, functional status, and so on. There was significant difference in the score of breast cancer among the four dimensions (P 0.05). Conclusion 1. Diet exercise as the main mode of case management can to some extent control breast cancer patients during the recovery of weight gain trend. 2. Weight control can improve blood glucose and blood lipid level. 3. 3. Weight control can help patients to develop good living habits, improve healthy behavior, maintain a good self-image, and improve the quality of life.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473.73

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