薛薇薇　成威　奚艳

【摘要】 目的：探讨叙事护理在老年头颈部恶性肿瘤放疗患者口腔功能锻炼中的应用价值。方法：回顾性分析2016年9月-2018年3月于笔者所在科室进行放疗的65例老年头颈部恶性肿瘤患者，随机分为对照组和试验组，对照组35例采用常规护理，试验组30例在常规护理基础上采取叙事护理。比较两组功能锻炼动作掌握程度、功能锻炼依从性及严重并发症发生率。结果：试验组出院时、放疗后6个月功能锻炼动作掌握程度、功能锻炼依从性均显著优于对照组（P<0.05）;试验组放疗后6个月严重并发症发生率显著低于对照组（P<0.05）。结论：老年头颈部恶性肿瘤患者在放疗过程中采取叙事护理干预，可提高功能锻炼动作掌握程度及依从性，并有利于减少并发症。

【关键词】 叙事护理 头颈部恶性肿瘤 放疗 口腔功能锻炼

doi：10.14033/j.cnki.cfmr.2020.18.036 文献标识码 B 文章编号 1674-6805（2020）18-00-03

Value of Narrative Nursing on Oral Function Exercise of Elderly Patients with Head and Neck Malignant Tumors after Radiotherapy/XUE Weiwei， CHENG Wei， XI Yan. //Chinese and Foreign Medical Research， 2020， 18（18）： -87

[Abstract] Objective： To explore the value of narrative nursing on oral function exercise of elderly patients with head and neck malignant tumors after radiotherapy. Method： Totally 65 elderly patients with head and neck malignant tumors who underwent radiotherapy in our department from September 2016 to March 2018 were analyzed retrospectively. They were randomly divided into the control group and the experimental group， and 35 cases in the control group adopted routine nursing， and 30 cases in the experimental group adopted narrative nursing on the basis of routine nursing. The mastery degree of function exercise， compliance of function exercise and incidence of serious complications were compared between the two groups. Result： In the experimental group， the mastery degree of function exercise and compliance of function exercise at the time of discharge and 6 months after radiotherapy were significantly better than those of the control group （P<0.05）. And 6 months after radiotherapy， the incidence of serious complications in the experimental group was significantly lower than that of the control group （P<0.05）. Conclusion： Narrative nursing intervention for elderly patients with head and neck malignant tumors during radiotherapy can improve the mastery degree and compliance of function exercise， and it is beneficial to reduce the complications.

[Key words] Narrative nursing Head and neck malignant tumors Radiotherapy Oral function exercise

First-authors address： The Second Peoples Hospital of Lianyungang， Lianyungang 222023， China

放射治療是头颈部恶性肿瘤综合治疗中极为重要的手段，受老年患者身体功能下降等影响，放射性涎腺损伤、舌和咀嚼肌功能障碍、张口困难、颈肩活动障碍等头颈部肿瘤放疗并发症发生率较高[1-2]。张口困难可严重影响患者的生活质量，尚无有效治疗方法。目前，公认的张口锻炼可预防张口困难，并能延缓病情进展[3]。由于老年患者常伴基础疾病和认知能力下降，对其实施常规护理和健康教育并不能有效改善放疗后张口困难、颈肩部活动障碍等严重并发症[4]。此外，由于老年患者的依从性较差，严重影响治疗效果和预后[5]。叙事护理是近年来护理学领域借鉴叙事医学而形成的人文护理模式，通过加强护理人员与患者的沟通，倾听患者的心声，引导患者宣泄情感，理解并发现患者的护理需求，进一步实施针对性、人性化的护理措施[6]。……