植入式静脉输液港在乳腺癌患者中的应用

目的 探讨植入式静脉输液港(VPA)在乳腺癌患者中的应用效果以及其并发症发生情况.方法 对30例需化疗的乳腺癌患者植入VPA(VPA组),选择同期年龄及病期相当、行锁骨下静脉置管(CVC)的乳腺癌患者30例为对照(CVC组),分别统计置管成功率、留置时间、导管相关并发症的发生率.结果 VPA组置管成功率为100.0％(30例),CVC组为96.7％(29例)(x2=41.3,P＞0.05);VPA组留置时间半年以上的患者为30例,CVC组为24例(x2=51.7,P＜0.05);两组并发症发生率VPA组为6.7％(2例),CVC组为33.3％(10例)(x2=44.7,P＜0.05).结论 VPA组与CVC组置管成功率相当,但VPA组导管留置时间较CVC组长,并发症少,患者生活质量高.     

3 380例乳腺癌患者放置完全植入式静脉输液港化疗的并发症分析

目的探讨乳腺癌患者放置完全植入式静脉输液港(TIVAP)进行化疗时发生并发症的情况。 方法回顾性分析2013年7月至2018年4月在重庆医科大学附属第一医院成功置入TIVAP进行化疗的3 380例乳腺癌患者临床资料。统计患者并发症的发生率,并分析不同植入路径发生血栓的情况。运用拟合优度检验比较各类并发症(回抽无回血、无症状导管相关性血栓、有症状导管相关性血栓、导管相关性感染、港体外露、导管异位、药物外渗、导管破裂或脱落)构成比的差异,采用χ²检验比较不同植入路径血栓发生率的差异。 结果3 380例患者中,经颈内静脉置港3 255例、贵要静脉置港77例、腋静脉置港40例、锁骨下静脉和股静脉置港各4例;其中经左侧置港1 491例,右侧1 889例。患者留置导管时间为(136.6±39.1) d,时间范围为51.0～940.0 d。本组患者中共有1 588例发生并发症,总的并发症发生率为47.0%(1 588/3 380)。拟合优度检验结果显示,各类并发症不服从等比例分布,其中无症状导管相关性血栓占比最高(73.3%,1 164/1 588)(χ²＝5 590.217,P<0.001)。颈内静脉植入路径的血栓发生率为36.7%(1 195/3 255),贵要静脉和腋静脉植入路径的血栓发生率分别为3.9%(3/77)和2.5%(1/40),股静脉(n＝4)和锁骨下静脉(n＝4)植入路径均无血栓发生。不同植入路径血栓发生率的差异具有统计学意义(χ²＝74.460,P<0.001),其中颈内静脉植入路径血栓发生率明显高于贵要静脉和腋静脉植入路径(P均<0.050)。左、右颈内静脉植入路径血栓发生率分别为41.5%(594/1 433)和33.0%(601/1 822),两者对比,差异有统计学意义(χ²＝24.742,P<0.001)。 结论使用TIVAP进行化疗时导管相关性血栓并发症所占比例最高。为了降低导管相关性血栓的发生风险,若无禁忌证,可优先考虑贵要静脉和腋静脉植入路径。其次,经颈内静脉置入TIVAP进行化疗时植入路径优选右侧颈内静脉,且要警惕导管相关性血栓的发生。     

乳腺癌患者数字减影血管造影引导与超声实时引导植入静脉输液港的比较

目的探讨数字减影血管造影(DSA)与超声实时引导下对乳腺癌患者植入静脉输液港的有效性和安全性。方法选取2013年7月至2015年7月间桂林市妇女儿童医院收治的79例乳腺癌患者,采用随机数表法分为两组,一组40例患者实施DSA引导下植入输液港(DSA组);另一组39例患者实施超声实时引导下植入输液港(超声组)。分别统计两组患者的一次置管成功率和置管相关并发症的发生率。结果 DSA组一次置管成功率为75.0%,低于超声组的100.0%,差异有统计学意义(P<0.01)。置管相关并发症中,DSA组12.5%的患者误伤动脉导致血肿,超声组无,差异有统计学意义(P<0.05)。DSA组患者对导管末端位置均满意,超声组患者中有3例导管末端位置不理想。结论与DSA引导下植入输液港比较,超声实时引导下植入穿刺成功率高,并发症出现率低,但DSA引导的导管末端放置准确性高。     

植入式静脉输液港预防恶性肿瘤化疗患者并发症的效果

目的探讨植入式静脉输液港预防恶性肿瘤化疗患者并发症的效果。方法选取2011年10月至2014年10月间收治的106例肿瘤化疗患者,根据随机数字表法分为观察组和对照组,每组各53例。观察组患者行植入式静脉输液港治疗,对照组患者行外周静脉置入中心静脉导管治疗,比较两组患者的并发症发生情况。结果观察组患者导管堵塞发生率为(0.0%)、导管相关性感染发生率为(3.8%)、药液外渗发生率为(1.9%)、导管脱落或断裂发生率为(0.0%)、血栓发生率为(0.0%)、Pinch-off综合征发生率为(0.0%)均明显低于对照组(分别为7.5%、17.0%、13.2%、7.5%、9.4%和7.5%),差异均有统计学意义(均P<0.05)。结论植入式静脉输液港可显著降低肿瘤化疗患者并发症发生率,值得临床推广使用。     

植入式静脉输液港在肿瘤化疗中的应用及常见并发症的护理

目的 分析植入式静脉输液港(central verlous port Access system,VAP)临床应用并发症发生的原因,探讨处理及预防措施.方法 回顾性分析87例肿瘤患者进行VAP植入化疗,并行局部护理和管腔通畅护理等,总结并发症例数及原因.结果 87例患者中,植入置管失败2例,置管成功率为97.70%.1...     

集束化护理预防对乳腺癌患者输液港并发症的效果

目的：探讨集束化护理对乳腺癌患者输液港并发症的预防效果。方法选择同期手术的乳腺癌患者60例为观察组,在常规护理干预的基础上采用集束化护理模式;选择择期手术的乳腺癌患者60例为对照组,采用常规护理干预方法。比较两组患者的并发症发生情况,生命质量及护理满意度。结果护理干预后观察组出现1例回抽无血,2例继发感染,1例静脉血栓,无导管堵塞,1例药液外渗,无导管脱落或断裂者;对照组出现7例回抽无血,9例继发感染,7例静脉血栓,6例导管堵塞,8例药液外渗,4例导管脱落或断裂者,两组比较差异均具有统计学意义（P﹤0.05）。观察组患者的生命质量高于对照组,差异具有统计学意义（P﹤0.05）。观察组患者对护理的总满意度为100.0%,高于对照组的80.0%,差异具有统计学意义（P﹤0.01）。结论对应用输液港的乳腺癌患者采用集束化护理模式,能减少输液港并发症的发生,提高患者的生命质量和满意度。     

植入式静脉输液港在肿瘤化疗中的应用及常见并发症的护理

目的分析植入式静脉输液港（central verlous port Access system,VAP）临床应用并发症发生的原因,探讨处理及预防措施。方法回顾性分析87例肿瘤患者进行VAP植入化疗,并行局部护理和管腔通畅护理等,总结并发症例数及原因。结果 87例患者中,植入置管失败2例,置管成功率为97.70%。17例出现并发症,发生率为19.54%。近期并发症4例,其中术后气胸1例、切口感染1例、局部血肿1例、导管锁松脱致局部渗液1例;远期并发症13例,其中输液障碍7例、导管相关性感染3例、导管夹闭综合征3例。结论加强医务人员规范化培训、穿刺植入前对患者进行全面评估和提高置管医生的穿刺技术有利于减少VAP近期并发症的发生;植入后的精心护理可有效减少VAP临床应用远期并发症的发生。     

银离子水凝胶对乳腺癌患者输液港植入术后皮下淤血的疗效观察

目的探讨银离子水凝胶对乳腺癌患者输液港植入术后皮下淤血的疗效观察。方法选取2015年3月至2018年3月间哈尔滨医科大学附属肿瘤医院收治的4 000例需要植入输液港并行化疗治疗的乳腺癌患者,按照入院顺序分为银离子水凝胶组和常规护理组,每组2 000例。两组患者均植入输液港行化疗治疗,常规护理组患者采用常规护理,银离子水凝胶组患者在常规护理组基础上加用银离子水凝胶,比较两组患者皮下淤血发生率、淤血直径范围和淤血消退时间。结果银离子水凝胶组患者皮下淤血发生率为3. 0%,低于常规护理组的10. 6%,两组比较,差异有统计学意义(P <0. 05)。常规护理组患者发生直径2cm皮下淤血71人,3～4cm 119人,5cm以上21人;银离子水凝胶组患者发生直径2cm皮下淤血33人,3～4cm 23人,5cm以上4人,两组比较,差异有统计学意义(P <0. 05)。银离子水凝胶组患者淤血消退各时间比率均快于常规护理组,差异有统计学意义(P <0. 05)。结论乳腺癌患者输液港植入术后使用银离子水凝胶可减少皮下淤血发生率,加快淤血消散,值得临床推广实施。     

延续性护理对乳腺癌根治术后患者癌因性疲乏预后的影响

目的探讨延续性护理对乳腺癌根治术后患者癌因性疲乏预后的作用。方法选取2015年3月至2016年12月间临朐县人民医院收治的90例乳腺癌患者,均经乳腺癌改良根治术后,诊断为癌因性疲乏。采用随机数表法分为观察组和对照组,每组45例,观察组患者采用延续性护理,对照组患者采用院内一般护理。比较两组患者出院时和出院后12周的癌因性疲乏程度、疼痛程度和生活质量情况,比较出院12周时并发症的发生情况。结果出院时,两组患者癌因性疲乏程度、疼痛程度评分和生活质量评分比较,差异均无统计学意义(均P>0.05)。出院12周时,观察组患者癌因性疲乏评分中无疲乏比例为26.7%,疼痛优良率为86.7%,总生活质量评分为(15.41±3.24)分,并发症发生率为4.4%;对照组患者分别为6.7%、55.6%、(12.31±3.32)分和20.0%。两组比较,差异均有统计学意义(均P<0.05)。结论延续护理可明显减轻乳腺癌改良根治术患者合并癌因性疲乏的疲乏程度,缓解术后疼痛程度,有效预防并发症发生,改善患者生活质量,对预后有积极的影响。     

居家护理指导对乳腺癌化疗患者化疗依从性和生活质量的影响

目的探讨居家护理指导对乳腺癌化疗患者的应用效果。方法选取2014年5月至2015年5月南京医科大学附属南京医院收治的160例乳腺癌化疗患者,采用随机数字表法随机分为观察组和对照组,每组80例。两组患者住院时护理方法相同。出院后对照组患者不进行院外指导,观察组患者给予居家护理指导,比较两组患者化疗3个月的化疗依从性、化疗效果和生活质量。结果观察组患者的化疗依从性的优良率和客观缓解率高于对照组患者,差异均有统计学意义(均P<0.05)。观察组患者干预后3个月时,生理状况、社会/家庭状况和情感状况等生活质量评分均高于对照组,差异均有统计学意义(均P<0.05)。结论居家护理指导能够提高乳腺癌患者化疗的依从性和化疗效果,改善患者生活质量。     

连续性护理支持对乳腺癌根治术患者的影响

目的探讨连续性护理支持对于乳腺癌根治术患者的影响。方法将2011年12月至2012年12月间收治的102例乳腺癌根治术者患者随机分为实验组和对照组,每组51例。实验组者患采取连续性护理支持,对照组患者采取常规护理方法进行护理。实验期结束后,比较两组患者的护理效果。结果实验组患者的轻度焦虑由22例上升为34例,中度焦虑由16例下降为12例,重度焦虑由13例下降为5例。对照组患者轻度焦虑由21例上升为27例,中度焦虑由27例下降为15例,重度焦虑由13例下降为9例。两组间差异有统计学意义（P〈0．05）。结论相对于常规护理措施,连续性护理支持能够更加有效地促进乳腺癌根治术患者的术后恢复,改善患者的术后生活质量。     

Effect of nursing care given at home on the quality of life of patients with stomach cancer and their family caregivers’ nursing care

In Turkey, the high incidences of stomach and oesophageal cancers in East and high incidence of stomach cancer in Northeast regions are remarkable. This study was conducted to identify homecare needs of patients with stomach cancer and their caregivers and the effect of family supportive nursing care on the quality of life of patients and families. The patient and his/her caregiver were assessed with respect to their daily life activities and NANDA was used for the identified nursing diagnoses, NIC for the appropriate interventions and NOC for assessment of the results. This study was conducted in a pre‐test, post‐test, controlled trial model to identify. The sample of the investigation consisted of 72 patients and 72 caregivers. As a data‐collecting instrument, the Quality of Life Scale and Caregiver Quality of Life Index‐Cancer were used. The overall quality of life, global health status and emotional and cognitive functions of the patients in the experimental group improved after the interventions. The overall quality of life and global health status was found to be poorer in the control group patients at post‐test as compared to pre‐test and their physical, role and social functions deteriorated. The caregivers’ quality of life in the control group was affected more negatively with respect to the “Disruption in Daily Life” subscale as compared to pre‐test values.     

A randomized clinical trial of home nursing care for lung cancer patients

A randomized clinical trial was conducted to assess the effects of home nursing care for patients with progressive lung cancer. One hundred sixty-six patients were assigned to either an oncology home care group (OHC) that received care from oncology home care nurses, a standard home care group (SHC) that received care from regular home care nurses, or an office care group (OC) that received whatever care they needed except for home care. Patients were entered into the study 2 months after diagnosis and followed for 6 months. Patients were interviewed at 6-week intervals across five occasions. At the end of the study, there were no differences in pain, mood disturbance, and concerns among the three groups. There were significant differences in symptom distress, enforced social dependency, and health perceptions. The two home nursing care groups had less distress and greater independence 6 weeks longer than the office care group. In addition, the two home nursing care groups steadily reported worse health perceptions over time. Thus, it was remarkable that the office care group, which indicated more symptom distress and social dependency with time, also indicated perceptions of improved health with time. These results suggest that home nursing care assists patients with forestalling distress from symptoms and maintaining their independence longer in comparison to no home nursing care. Home care may also include assisting patients in acknowledging the reality of their situation.     

基于微信平台提供的延续性护理对癌痛患者疼痛及生活质量的影响

目的:探讨延续性护理对于癌痛患者NRS评分、服药依从性、QOL及SAS评分的影响。方法:选取84例入院时均需服用阿片类药物治疗的重度癌痛患者,随机分为对照组和观察组,每组各42例,对照组实施常规护理及出院指导,观察组在此基础上同时进行院外延续性护理,比较两组患者出院4周后服药依从性及疼痛控制程度以及QOL评分的差异。结果:观察组患者服药完全依从率明显高于对照组完全依从率;部分依从及不依从率,均明显低于对照组的部分依从及不依从率;观察组疼痛完全缓解率、部分缓解率高于对照组的完全缓解率及部分缓解率,而观察组的疼痛无效率低于对照组;观察组患者的QOL评分改善大于对照组;治疗后观察组的SAS评分低于对照组。结论:院外延续性护理可提高癌痛患者的服药依从性;缓解患者疼痛症状;提高患者生活质量,减轻患者抑郁状态。     

针对性护理干预对乳腺癌经外周静脉置入中心静脉导管置管化疗患者的影响

目的探讨针对性护理干预对乳腺癌经外周静脉置入中心静脉导管(PICC)置管化疗患者并发症发生率、心理状态及依从性的影响。方法选取2018年2月至2019年2月间青岛中心(肿瘤)医院收治的118例女性乳腺癌化疗患者,采用随机数表法分为研究组和对照组,每组59例。研究组患者采用针对性护理,对照组患者采用常规护理,比较两组患者的遵医嘱依从性、并发症、自我护理能力及心理负性情绪变化。结果护理后,研究组患者遵医嘱依从性为96. 6%,高于对照组的62. 7%;研究组患者导管移位或脱出、感染、穿刺点渗液和穿刺点出血发生率均低于对照组,差异均有统计学意义(均P <0. 05)。护理后,两组患者自护能力均提升,且研究组患者各项自护能力评分及总评分均高于对照组,差异均有统计学意义(均P <0. 05)。护理后,两组患者抑郁自评量表(SDS)和焦虑自评量表(SAS)评分均降低,且研究组患者SDS和SAS评分均低于对照组,差异均有统计学意义(均P <0. 05)。结论乳腺癌PICC置管化疗患者采用针对性护理干预,可提高患者遵医嘱依从性和自我护理能力,降低并发症发生风险,缓解心理负性情绪,改善术后治疗效果,提高生活质量,值得推广应用。     

围术期护理对乳腺肿瘤患者负面情绪和生活质量的影响

目的探讨围术期护理对乳腺肿瘤患者负面情绪和生活质量的影响。方法选取2012年1月至2015年12月间四川省彭州市人民医院收治的144例乳腺肿瘤患者,采用随机数表法分为观察组与对照组,每组72例。对照组患者采用常规手术、药物治疗及护理,观察组患者在此基础上予以围术期护理,比较两组患者围术期的情绪和生活质量情况。结果护理后,观察组患者焦虑自评量表评分为(41.59±1.98)分,明显低于对照组患者的(54.34±2.47)分;观察组患者抑郁自评量表评分为(51.01±1.23)分,明显低于对照组患者的(62.19±2.31)分,两组比较,差异均有统计学意义(均P<0.05)。观察组患者生活质量评分为(69.77±5.98)分,明显高于对照组患者的(50.32±5.69)分,两组比较,差异有统计学意义(P<0.05)。结论围术期护理能够改善乳腺肿瘤患者的焦虑、抑郁情况,提高患者生活质量,值得临床推广。     

Effects of advanced nursing care on quality of life and cost outcomes of women diagnosed with breast cancer

PURPOSE/OBJECTIVES: To evaluate quality of life (QOL) and cost outcomes of advanced practice nurses' (APNs') interventions with women diagnosed with breast cancer. DESIGN: Randomized clinical trial. SETTING: Integrated healthcare system in a midwestern suburban community. SAMPLE: 210 women with newly diagnosed breast cancer with an age range of 30-85 years. METHODS: The control group (n = 104) received standard medical care. The intervention group (n = 106) received standard care plus APN interventions based on Brooten's cost-quality model and the Oncology Nursing Society's standards of advanced practice in oncology nursing QOL was measured using the Functional Assessment of Cancer Therapy, Mishel Uncertainty in Illness Scale and Profile of Mood States at seven intervals over two years. Information about costs (charges and reimbursement) was collected through billing systems. MAIN RESEARCH VARIABLES: Uncertainty, mood states, well-being, charges, and reimbursement. FINDINGS: Uncertainty decreased significantly more from baseline in the intervention versus control group at one, three, and six months after diagnosis (p = 0.001, 0.026, and 0.011, respectively), with the strongest effect on subscales of complexity, inconsistency, and unpredictability. Unmarried women and women with no family history of breast cancer benefited from nurse interventions in mood states and well-being. No significant cost differences were found. CONCLUSIONS: APN interventions improved some QOL indicators but did not raise or lower costs. IMPLICATIONS FOR NURSING PRACTICE: The first six months after breast cancer diagnosis is a critical time during which APN interventions can improve QOL outcomes. More research is necessary to define cost-effective interventions.