1、黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2白血病是由造血干细胞恶性克隆引起的疾病，对患者身体健康具有极大影响，严重者会威胁生命1。白血病终末期患者是一类特殊群体，不但要面对病痛，还要面临精神折磨，承担心理和生理的双重折磨。对于此类人群，正确予以人文关怀和护理，可提高患者生活质量。常规护理兼顾生命体征、生活指导等，但无针对性，对患者心理状态改善不够重视。安宁疗护是一种新型的护理模式，常应用于各种终末期及恶性疾病，以人文关怀为理念，对无治白血病终末期患者应用安宁疗护对负性情绪的影响翟岩郑州大学附属肿
2、瘤医院血液七病区，河南郑州450000摘要目的：探究白血病终末期患者应用安宁疗护对负性情绪的影响。方法：选取2018年2月2020年9月郑州大学附属肿瘤医院收治的68例白血病终末期患者作为研究对象，按入院时间先后分为常规组和安宁疗护组，每组各34例。常规组实施常规护理干预，安宁疗护组在常规护理的基础上实施安宁疗护干预。比较两组患者抑郁自评量表（SDS）评分、焦虑自评量表（SAS）评分、舒适度评分、癌症患者自我感受负担量表（SPBS-CP）评分及护理满意度。结果：干预前，两组患者SDS、SAS评分比较，差异无统计学意义（t=0.881、0.324，P0.05）；干预后，两组患者SDS、SAS评分
3、均低于干预前，且安宁疗护组低于常规组，差异有统计学意义（t=5.607、6.469，P0.05）。干预前，两组患者Kolcaba评分比较，差异无统计学意义（t=1.190，P0.05）；干预后，两组患者Kolcaba评分均高于干预前，且安宁疗护组高于常规组，差异有统计学意义（t=5.764，P0.05）。干预前，两组患者SPBS-CP 评分比较，差异无统计学意义（t=0.536、0.534、0.193、1.082、0.821，P0.05）；干预后，两组患者SPBS-CP评分均低于干预前，且安宁疗护组低于常规组，差异有统计学意义（t=6.174、7.352、7.657、2.137、4.304，P
4、0.05）。安宁疗护组护理满意度为91.18%，高于常规组的70.59%，差异有统计学意义（2=4.660，P0.05）。结论：安宁疗护应用于白血病终末期患者临床护理中，可改善负性情绪，提升舒适度，减轻自我感受负担，提高护理满意度。关键词白血病；安宁疗护；负性情绪；舒适度doi10.3969/j.issn.1004-5775.2023.02.029学科分类代码320.71中图分类号R473.5文献标识码BEffect of Hospice Care on Negative Emotion in Patients with End-stage Leukemia/ZHAI Yan/The Seve
5、nth Ward ofHematology,The Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou,Henan,450000,ChinaAbstract Objective:To explore the effect of hospice care on negative emotion in patients with end-stage leukemia.Methods:A total of 68 patients with end-stage leukemia who were admitted to the hos
6、pital from February 2018 to September2020 were selected as the research subjects,and divided into the routine group and the palliative care group according to the timeof admission,with 34 cases in each group.Routine nursing intervention was implemented in the routine group,and palliativenursing inte
7、rvention was implemented on the basis of routine nursing in the hospice care group.The self-rating depression scale(SDS)score,self-rating anxiety scale(SAS)score,comfort score,cancer patient self-perceived burden scale(SPBS-CP)score andnursing satisfaction were compared between the two groups.Result
8、s:Before intervention,there was no statistically significantdifference in SDS and SAS scores between the two groups(t=0.881,0.324,P0.05).After the intervention,the SDS and SASscores of the two groups were lower than those before the intervention,and the palliative care group was lower than the routi
9、negroup,and the difference was statistically significant(t=5.607,6.469,P0.05).Before intervention,there was no statisticallysignificant difference in Kolcaba score between the two groups(t=1.190,P0.05).After the intervention,the Kolcaba scores of thetwo groups were higher than those before the inter
10、vention,and the palliative care group was higher than the routine group,thedifference was statistically significant(t=5.764,P0.05).Before intervention,there was no statistically significant difference inSPBS-CP scores between the two groups(t=0.536,0.534,0.193,1.082,0.821,P0.05).After the interventi
11、on,the SPBS-CPscores of the two groups were lower than those before the intervention,and the palliative care group was lower than the routinegroup,and the differences were statistically significant(t=6.174,7.352,7.657,2.137,4.304,P0.05).The nursing satisfaction ofthe palliative care group was 91.18%
12、,which was higher than 70.59%of the routine group,and the difference was statisticallysignificant(2=4.660,P0.05).Conclusion:The application of palliative care in the clinical care of patients with end-stageleukemia can improve negative emotions,enhance comfort,reduce self-perceived burden,and improv
13、e nursing satisfaction.Keywords Leukemia;Hospice care;Negative emotion;Comfort225黑龙江医学2023年1月25日第47卷第2期HEILONGJIANG MEDICAL JOURNALJan.25,2023Vol.47No.2愈希望患者实施生理及心理双向兼顾，尽可能减轻心理应激反应，且具有科学性与全面性2-3。基于此，本研究选取郑州大学附属肿瘤医院收治的68例白血病终末期患者作为研究对象，旨在探讨安宁疗护在临床护理中对负性情绪的影响，现将结果报告如下。1资料与方法1.1一般资料选取2018年2月2020年9月郑州大学
14、附属肿瘤医院收治的68例白血病终末期患者作为研究对象，按入院时间先后分为常规组和安宁疗护组，每组各34例。常规组中男18例，女16例；年龄3459岁，平均年龄（43.491.56）岁；文化程度为小学及以下12例，初中13例，高中及以上9例；身体质量指数 1725 kg/m2，平均身体质量指数（22.430.87）kg/m2。安宁疗护组中男21例，女13例；年龄2559岁，平均年龄（42.961.13）岁；文化程度为小学及以下13例，初中10例，高中及以上11例；身体质量指数1725 kg/m2，平均身体质量指数（22.000.97）kg/m2。两组患者一般资料具有可比性（P0.05）。本研究获
15、样本医院医学伦理委员会审核批准。1.2入选标准（1）纳入标准：经X线、CT等影像学技术确诊白血病终末期。经血常规等检查，显示患者白细胞10109/L。骨髓常规显示，原始细胞占有核细胞超过30%。无先天性心脏病病史。（2）排除标准：意识模糊、精神失常。合并凝血异常。合并严重感染性疾病。1.3方法常规组实施常规护理干预。实时监测患者心跳、呼吸、血氧等生命体征指标，面对突发异常情况及时冷静处理，对患者进行日常饮食、生活、清洁、运动锻炼等指导，有利于患者身心健康。安宁疗护组在常规护理的基础上予以安宁疗护干预。（1）心理社会照护。在护理干预前，采用抑郁自评量表（SDS）、焦虑自评量表（SAS），了解确定
16、患者心理水平；可通过安宁疗护调查问卷，包含患者病史、对安宁疗护的需求以及知晓情况，患者或家属对终末期治疗方案选择以及哀伤辅导需求等，明确患者、家属面对死亡的接受程度以及应对能力；对患者及家属开展专业的疏导及干预，若患者心理状态较差，以目的性沟通明确患者真实心理状态，针对患者主诉采取适合的心理疏导方法，若患者有心愿未完成，可协助家属将其完成，为患者提供道谢、道爱、道歉的机会，最大限度满足患者或家属的情感需求。（2）营养支持。若患者进食较少，可使用口鼻饲或静脉营养等方式给予患者一定营养供给，避免患者恶心呕吐等胃肠道症状所致无法进食产生较重营养不良，且严格控制每次营养量，贯彻少量多餐的原则。（3）症状控制。根据视觉模拟评分量表评估患者疼痛程度，若评分超过5分，使用镇痛药物需遵照医嘱，若评分35分，可给予患者适当按摩，缓解疼痛，若评分3分，可播放1015 min轻音乐，分散注意力，也可结合自我暗示法、注意力分散法等；依据患者病情指导患者采取合适体位卧床，确保患者呼吸道的通畅，若患者无力将黏稠痰液咳出，可予以雾化吸入、机械吸痰的方式，辅助患者将痰液排出，并指导患者正确且有效的呼吸肌功能训练；若患