胡岑 李书玲 袁柳

[摘要] 目的 探討动机性访谈联合信息知识信念行为（IKAP）模式对晚期胃癌癌性疼痛老年患者遵医行为及生活质量的影响。 方法 选择2015年5月～2017年6月解放军第一六一医院69例老年晚期胃癌癌性疼痛患者，按照随机数字表法分为两组，对照组（34例）给予常规护理干预，观察组（35例）于常规护理基础上加用动机性访谈联合IKAP模式护理干预，干预3个月后观察比较两组癌性疼痛缓解情况、控制情况及遵医行为，并统计两组护理满意度及生活质量（QOL）评分。 结果 观察组总缓解率为91.43%（32/35），高于对照组（67.65%，23/34），差异有统计学意义（P < 0.05）；干预后观察组担心麻醉止痛成瘾、疼痛无法控制、药物耐药、副作用及医生治疗评分均低于对照组，QOL评分高于对照组，差异有统计学意义（P < 0.05）；观察组总依从率为88.57%（31/35），高于对照组（67.65%，23/34），差异有统计学意义（P < 0.05）；观察组护理满意率为85.71%（30/35），高于对照组（64.71%，22/34），差异有统计学意义（P < 0.05）。 结论 IKAP模式配合动机性访谈可提高老年晚期胃癌癌性疼痛患者遵医行为，减轻其疼痛程度，有助于改善患者生活质量，且护理满意度高。

[关键词] 晚期；胃癌癌性疼痛；动机性访谈；IKAP模式；遵医行为；生活质量

[中图分类号] R441.1 [文献标识码] A [文章编号] 1673-7210（2018）04（a）-0177-05

[Abstract] Objective To explore the effect of the motivational interview combined with the information knowledge attitude and practice （IKAP） model on the compliance behavior and the quality of life in elderly patients with advanced cancerous pain of gastric cancer. Methods From May 2015 to May 2017， in 161st Hospital of PLA， 69 elderly patients with advanced cancerous pain of gastric cancer were selected， according to random number table， they were divided into two groups， the control group （34 cases） was given routine nursing intervention， observation group （35 cases） was given motivational interview combined with IKAP model on the basis of routine nursing. After 3 months of intervention， the remission， control status of cancer pain and compliance behavior were observed and compared in the groups. The nursing satisfaction and quality of life （QOL） scores of two groups were recorded. Results The total remission rate of the observation group was 91.43% （32/35）， it was higher than that of the control group （67.65%， 23/34）， the difference was statistically significant （P < 0.05）. After the intervention， the degree of worrying about the addiction of anesthesia analgesia， out-of-control pain， drug resistance and side effects and the doctors' treatment score of the observation group were lower than those of the control group， and the QOL score was higher than that of the control group， the differences were statistically significant （P < 0.05）. The total compliance rate of the observation group was 88.57% （31/35）， it was higher than that of the control group （67.65%） （23/34）， the difference was statistically significant （P < 0.05）. The nursing satisfaction rate of the observation group was 85.71% （30/35）， it was higher than that of the control group （64.71%， 22/34）， the difference was statistically significant （P < 0.05）. Conclusion IKAP model combined with motivational interview can improve the compliance behavior of elderly patients with advanced cancerous pain of gastric cancer， reduce the degree of pain， and it contributes to improve the quality of life， and it has high degree of nursing satisfaction.

[Key words] Advanced； Cancerous pain of gastric cancer； Motivational interview； IKAP model； Compliance behavior； Quality of life

胃癌为全球范围内常见恶性肿瘤疾患，发病率较高，居消化道恶性肿瘤首位，且每年新增2万胃癌患者，其早期症状无特异性，导致多数患者确诊时已是晚期，只能以综合性化疗延长其生存时间[1-3]。晚期胃癌患者周围神经组织在肿瘤压迫下易引发不同程度的癌性疼痛，有资料显示在癌症患者中高达30%～50%存在癌性疼痛症状，晚期癌症患者更是高至60%～90%，增加治疗难度，提高病死率[4-5]。胃癌癌性疼痛不仅给患者机体带来巨大痛苦，且其易引发一系列并发症，诱发抑郁、焦虑等不良心理情绪，严重影响患者生命健康及生活质量。有学者指出护理干预可缓解患者疼痛程度，提高其机体免疫，改善患者负性心理情绪及整体状态[6]。动机性访谈可通过针对性指导，疏导患者自身心理矛盾，纠正其不良行为习惯，促使其自觉进行有利于康复的健康行为，降低并发症发生率，改善预后[7]。……