摘要
目的:乳腺癌患者生活质量受到不同程度的影响,包括身体功能状况、情感状况、社会关系、性功能。观察术后半年乳腺癌患者生活质量与康复指导教育的作用。方法:于2003-01/2005-01选择哈尔滨医科大学附属肿瘤医院内科收治行手术治疗的乳腺癌女性患者90例为观察对象,年龄29～65岁,平均43岁。纳入标准:经临床、影像学和病理检查确诊的乳腺癌患者,行手术治疗的患者。排除标准:有智力或认知障碍患者,有精神疾病或精神疾病阳性家族史者。随机数字表法分为干预组和对照组,每组45例,观察从诊断至术后半年的生活质量。两组均给予康复指导教育,干预组在术前及术后进行心理干预和康复指导,制定锻炼计划,医护及家属督促共同完成,对照组按患者及家属意愿定(有些家属不同意或者患者因自身情况未坚持)。康复指导教育内容包括:①疾病知识宣传教育:正确地对乳腺癌的认知。②心理干预:疾病诊断时、入院治疗过程中、放化疗过程中、康复出院后及乳腺癌患者家属的心理干预。③康复知识教育包括肢体功能恢复、饮食指导及性生活。评定指标:①心理干预后精神与情绪状态,术后恢复状况(一般状态以及有无并发症),化疗的消化道反应情况(严重程度)。②生活质量评估使用乳腺癌生活质量测评量表对两组患者进行随访和生活质量评估。癌症治疗功能评价系统共分身体状况、社会/家庭状况、与医生的关系、情感状况、功能状况和其他因素(乳腺癌特异条目)6个部分。该量表的可靠性、有效性、内部连贯性均较好,且容易被患者接受。将患者在每个部分选择条目得分相加得出总分,得分越高表示生活质量越好。结果:纳入患者90例,均进入结果分析。①干预组患者在精神与情绪状态、术后恢复状况、化疗的消化道反应情况方面好于对照组(分别为39,26例;43,36例;14,24例,P<0.05)。②干预组上肢功能恢复满意及生活质量评分≥41分的患者多于对照组,差异均有显著性意义(分别为24,15例;25,13例,P<0.05)。结论:乳腺癌患者在诊断和治疗后生活质量受到较大的影响,完整系统的康复指导教育可以明显提高乳腺癌术后患者的生活质量和患肢功能满意程度,值得临床医生将其列为术后治疗方法之一。
AIM： The postoperative patients with breast cancer have obvious psychological and physiological obstacles, body image, relationship, sexual function and coping strategies were related to almost all quality of life （QOL）domains. To observe effects of health education on QOL in postoprative patients with breast cancer in half a year after operation.
METHODS： Ninety postoperative patients with breast cancer aged between 29 and 65 years at diagnosis with a mean of 43 years, who were hospitalized in the Department of Internal Medicine, Tumor Hospital Affiliated to Harbin Medical University from January 2003 to January 2005, Were enrolled in this study. All the patients were in accordance with the inclusive criteria of patients with breast cancer treated by operation and diagnosed by clinical syndrome, imaging examination and pathology, while exclusive criteria： those with cognitive handicap and mental disorder or family medical history. The patients were randomly divided into intervention group （n=45） and control group （n=45） to compare the QOL in them in half a year after operation. The patients in both two groups received health education. The patients in intervention group received mental intervention and rehabilitation instruction, formulating exercise plan, they must do completely through supervised by doctors and nurses, how the other group did depended on the willings of patients and families （for example, the families did not agree with the exercise plan or the patients could not do well by themselves）. Health education included： ① publicizing disease information： right cognition and attitude to disease of breast cancer, ②mental intervention： during the process of the beginning of disease diagnosis, therapy process in hospital, during radiotherapy and chemiotherapy, after rehabilitation discharge and the families members of patients with breast cancer, ③rehabilitation knowledge education included limbs functional recovery, food and drink guidance and sex life. Evaluation index： ① compared mental and emotional state, rehabilitation states after operation （general body state and complication）, the grade of side effects caused by chemotherapy （severity）; ②The Functional Assessment of Cancer Therapy-Breast Cancer （FACT-B） was used to assess health-related QOL and follow-up. The FACT-B consisted of the following subscales： physical well-being, social/family well-being, relationship with doctors, emotional well-being, functional well-being, and other factors （breast cancer-specific concerns）. The checklist had well documented reliability, validity, internal consistency and was acceptable to patients. Score of each item in each part was added to obtain the total score. The higher the scores, the better their quality of life was.
RESULTS： Totally 90 included patients were involved in the result analysis. ①Mental and emotional status, rehabilitation states and the side effects caused by chemotherapy were better in the intervention group than in the control group （39 vs 26, 43 vs 36, 14 vs 24, respectively, P 〈 0.05）.②The number of patients with at least 41 points of quality of life and functional recovery were higher in the intervention group than in the control group, and the difference was significant （24 vs 15, 25 vs 13, respectively, P 〈 0.05）.
CONCLUSION： Patients with breast cancer are affected after diagnosis and treatment in QOL. Complete rehabilitative education can improve the postoperative QOL and satisfactory degree of injured limbs in the patients with breast cancer. It is worth of close attention of clinical doctors to line it as one of the post-operative therapeutic methods.
出处
《中国临床康复》
CAS
CSCD
北大核心
2006年第42期28-30,共3页
Chinese Journal of Clinical Rehabilitation
作者简介
董海鹰，女，1974年生，黑龙江省伊春市人，汉族，哈尔滨医科大学在读博士，主治医师，主要从事乳腺癌的基础与临床的研究。
