人文关怀结合中医特色护理对晚期肝癌患者癌痛、心理应激、睡眠质量的影响

丁佳慧 解敏君 汤佳静 郑双

[摘要] 目的 探討人文关怀结合中医特色护理对晚期肝癌患者癌痛、心理应激、睡眠质量的影响。 方法 选取2018年2月至2020年3月本院96例晚期肝癌患者，随机分为A、B、C三组，每组各32例。A组给予人文关怀结合中医特色护理，B组给予中医特色护理，C组给予常规护理干预，比较三组患者不适症状、癌痛、心理应激、应对方式、睡眠质量。 结果 A组头晕乏力、睡眠困难、食欲减退症状发生率分别为15.63%、15.63%、9.38%，B组为15.63%、18.75%、12.50%，均低于C组的43.75%、46.88%、34.38%（P<0.05）;A组与B组干预后癌痛情况改善优于C组（P<0.05）;A组干预后SAS、SDS评分低于B组，B组低于C组（P<0.05）;A组干预后面对维度评分高于B组，B组高于C组，回避、屈服维度评分低于B组，B组低于C组（P<0.05）;A组患者干预后睡眠质量、入睡时间、睡眠障碍、睡眠时间、睡眠效率、催眠药物、日间功能评分低于B组，B组低于C组（P<0.05）。 结论 人文关怀结合中医特色护理可有效改善晚期肝癌患者不适症状，减轻患者癌痛和心理应激，加强积极应对疾病的心理，提高睡眠质量。

[关键词] 晚期肝癌;癌痛;心理应激;睡眠质量;中医特色护理;人文关怀

[中图分类号] R473          [文献标识码] B          [文章编号] 1673-9701（2021）30-0164-04

[Abstract] Objective To explore the effect of humanistic care combined with traditional Chinese medicine （TCM）-based nursing on cancer-related pain （CRP）， psychological stress and sleep quality in patients with advanced liver cancer. Methods Ninety-six patients with advanced liver cancer in our hospital from February 2018 to March 2020 were selected and they were randomly divided into three groups，A，B，and C，with 32 patients in each group. Group A was given humane care combined with TCM-based care， group B was given TCM-based nursing care and group C was given conventional nursing intervention. The discomfort symptoms，CRP，psychological stress，coping styles，and sleep quality were compared among three groups. Results The incidence of dizziness and fatigue，sleep difficulty，and loss of appetite in group A were 15.63%，15.63%，and 9.38%，respectively，and those of  group B were 15.63%，18.75%， and 12.50%， respectively， which were lower than those in group C（43.75%，46.88%，and 34.38%）（P<0.05）. The improvement of CRP in group A and B after intervention was better than that in group C （P<0.05）. After intervention in group A， SAS and SDS scores were lower than group B， and those of group B were lower than group C （P<0.05）. After intervention，the score of facing dimension in group A was higher than that in group B，and that in group B was higher than that in group C，while the score of avoidance and yield in group A was lower than that in group B， and those of group B were lower than group C（P<0.05）. The scores of sleep quality， time falling asleep， sleep disorder， sleep duration， sleep efficiency， hypnotic drugs， and daytime function of group A were lower than group B， and those of group B were lower than group C （P<0.05）. Conclusion Humanistic care combined with TCM-based nursing can effectively relieve the uncomfortable symptoms，reduce CRP and psychological stress， strengthen the psychology to actively deal with diseases，and improve the quality of sleep of patients with advanced liver cancer.

[Key words] Advanced liver cancer; Cancer-related pain; Psychological stress; Sleep quality; Traditional Chinese medicine-based nursing; Humanistic care

我国作为肝癌高发国家，肝癌发病率占全球40%～45%，据统计每年约有20余万人死于肝癌[1]。肝区疼痛是原发性晚期肝癌患者最主要的症状，严重影响患者生活质量水平，从生理、心理、精神等多个层面困扰患者。临床上由于患者自身需求和疾病治疗的需求，将缓解症状、减轻疼痛作为原发性肝癌晚期患者治疗的重点[2]。中医学认为，癌痛是由于人体正气虚弱，外邪热毒内侵，痰疲相结，阻塞经脉，不通则痛。……