陈静 徐海萍 侯樱 史京萍 王梦兰

[摘要]目的：評估个案护理模式应用于乳腺癌患者乳房再造术后的临床效果，为临床应用提供科学依据。方法：选取2018年10月-2020年2月在笔者医院整形外科进行乳腺癌术后乳房再造术患者100例，将患者随机分为对照组和观察组，每组50例。对照组患者采用常规护理，观察组患者采用个案护理，两组均护理两周。比较两组患者护理满意度、不良反应发生率，护理干预3个月后生存质量分析、性调节及身体意向评分。结果：观察组患者总满意度100.00%高于对照组的90.00%，差异有统计学意义（P<0.05）。观察组患者不良反应发生率为6.00%低于对照组的20.00%，差异有统计学意义（P<0.05）。干预3个月后，两组患者生存质量各项评分、FACT-B总分均显著好转，且观察组均显著优于对照组，差异有统计学意义（P<0.05）。两组患者性调节影响评分均显著下降，身体意向评分均显著升高，且观察组均显著优于对照组，差异有统计学意义（P<0.05）。结论：乳腺癌患者乳房再造术后采用个案护理有助于提高患者总满意度、减轻不良反应发生率，同时有助于患者生理和心理状况的好转，值得在今后的临床工作中推广使用。

[关键词]个案护理;乳腺癌;乳房再造术;生存质量;满意度

[中图分类号]R473    [文献标志码]B    [文章编号]1008-6455（2021）04-0162-04

Application of Case Nursing Model in Breast Cancer Patients after Breast Reconstruction

CHEN Jing1，XU Hai-ping2，HOU Ying1，SHI Jing-ping1，WANG Meng-lan1

（1.Department of General Surgery;2.Department of Breast Surgery，Jiangsu Provincial People's Hospital，Nanjing 210000，Jiangsu，China）

Abstract： Objective  To evaluate the clinical effect of case nursing model in breast reconstruction for breast cancer patients and provide scientific basis for clinical application. Methods From October 2018 to February 2020， 100 patients underwent breast reconstruction after breast cancer surgery in our hospital were selected， and the patients were randomly divided into the control group and the observation group， with 50 patients in each group. Patients in the control group received routine nursing， patients in the observation group received case nursing， both groups were treated for two weeks. The nursing satisfaction， incidence of adverse reactions， and after 3 months of nursing intervention， quality of life analysis， psychological impact assessment， sexual adjustment and physical intention scores were compared of patients in the two groups. Results  The total satisfaction of the observation group was 100.00% higher than that of the control group（90.00%）， the difference was statistically significant（P<0.05）. The incidence of adverse reactions in the observation group was 6.00%， which was lower than that in the control group（20.00%， P<0.05）. After 3 months of intervention， the scores of quality of life and the total score of FACT-B in the two groups were significantly improved， and the observation group was significantly better than the control group（P<0.05）. The scores of sexual function influence in the two groups were significantly decreased， and the scores of body intention were all increased， and the observation group were significantly better than those in the control group（P<0.05）. Conclusion  Case nursing for breast cancer patients after breast reconstruction is helpful to improve the total satisfaction of patients， reduce the probability of adverse reactions， and improve the physiological and psychological status of patients. Therefore， It is worth popularizing in the future clinical work.

Key words： case nursing; breast cancer; breast reconstruction; quality of life; satisfaction

乳腺癌是女性常见恶性肿瘤疾病之一，且近年来发病率逐渐上升，患者群体的平均年龄范围呈下降趋势[1-2]。手术是临床上治疗乳腺癌的主要方式，乳房再造术是手术治疗乳腺癌的重要环节之一[3]。乳房再造能显著改善患者形体和躯体障碍，促进患者术后女性魅力的恢复，但术后来自家庭、社会的压力及手术并发症等均会给患者带来严重的心理负担，因此在治疗过程中患者极易出现抑郁、焦虑、压抑等负面情绪，对患者治疗依从性、术后恢复等均可产生不良影响[4]。随着社会的发展，医护人员对患者关注的重点除疗效外，还应对治疗过程中患者的心理、情绪状态变化等进行重点关注[5]。个案护理模式是根据国内乳腺癌的治疗现状总结国内外护理管理模式所形成的个性化和优质护理模式，强调了治疗过程中对患者的精神心理支持，能有效缓解患者压力，提高治疗依从性，自应用以来取得了良好的效果[6]。……