施海燕 张晨

【摘要】 目的：探討全面护理干预对分化型甲状腺癌（DTC）术后大剂量核素131I治疗患者遵医行为及生活质量的影响。方法：选择2018年1-12月笔者所在医院收治的DTC术后服用131I治疗的患者90例，随机分为试验组和对照组，各45例。对照组实施常规护理，试验组在对照组基础上实施全面护理干预，干预时间为入院到出院后1个月;对两组心理状态、遵医行为及生活质量进行比较。结果：入院时两组消极心理检出率比较差异无统计学意义（P>0.05），出院时及出院1个月后试验组患者消极心理检出率（31.11%、4.44%）均低于对照组（55.56%、51.11%），差异均有统计学意义（P<0.05）。干预后对照组遵医行为总分为（9.26±1.17）分，低于试验组的（11.56±1.42）分，差异有统计学意义（P<0.05）。干预后试验组躯体功能、角色功能、认知功能、情绪功能、社会功能评分、总评分均高于对照组，差异均有统计学意义（P<0.05）。结论：全面护理干预能减轻甲状腺癌术后大剂量核素131I治疗患者的消极心理，提高了遵医行为，改善生活质量，值得推广和应用。

【关键词】 分化型 甲状腺癌 131I 遵医行为 生活质量

doi：10.14033/j.cnki.cfmr.2019.30.040 文献标识码 B 文章编号 1674-6805（2019）30-00-03

[Abstract] Objective： To explore the effect of comprehensive nursing intervention on compliance behavior and quality of life of patients with differentiated thyroid cancer （DTC） treated with high dose 131I after operation. Method： Ninety patients treated with 131I after DTC in our hospital from January to December 2018 were randomly divided into the experimental group and the control group with 45 cases in each group. The control group was given routine nursing， while the experimental group was given comprehensive nursing intervention on the basis of the control group. The intervention time was one month after admission and discharge. The psychological distress， compliance behavior and quality of life of the two groups were compared. Result： There was no significant difference in the negative psychological detection rate between the two groups at admission （P>0.05）. The negative psychological detection rate of the experimental group （31.11%， 4.44%） was lower than that of the control group （55.56%， 51.11%） at discharge and one month after discharge （P<0.05）. After intervention， the total score of compliance behavior in the control group was （9.26±1.17） points， which was lower than that in the experimental group （11.56±1.42） points， the difference was statistically significant （P<0.05）. After intervention， the scores of physical function， role function， cognitive function， emotional function， social function and total score in the experimental group were significantly higher than those in the control group （P<0.05）. Conclusion： Comprehensive nursing intervention can alleviate the psychological pain of patients with thyroid cancer treated with high-dose 131I after operation， improve the compliance behavior， improve the quality of life， and is worthy of promotion and application.

[Key words] Differentiated type Thyroid cancer 131I Medical compliance behavior Quality of life

First-authors address： First Affiliated Hospital of Nanjing Medical University， Nanjing 210029， China

近年来，全球甲状腺癌发病率和死亡率呈逐年上升趋势，严重影响人类健康[1-2]。术后放射性核素131I治疗是抑制分化型甲状腺癌（differentiated thyroid carcinoma，DTC）复发及转移的有效方法[3]。但由于131I具有放射性，在患者体内的滞留可能会对患者自身、周围环境和人群造成一定程度的辐射危害，因此，需隔离观察。李一璐等[4]报道显示，进行治疗的DTC患者不良心理显著高于健康人群。国外报道显示将恶性肿瘤患者可能发生的一系列心理问题归结为恶性肿瘤相关的消极心理，消极心理对患者的治疗效果、遵医行为、生活质量均有较大影响[5]。因此，如何满足DTC131I治疗患者对信息及心理支持的全面需求，实现系统的、个性化的、患者积极配合的干预模式具有重要意义。本研究对DTC术后131I治疗患者实施全面综合护理模式，现将具体内容及效果报道如下。