摘要
目的基于行为改变轮理论构建全喉切除术后患者食管语康复方案,并探讨其应用效果。方法多学科团队基于行为改变轮理论、结合文献回顾,构建全喉切除术后患者食管语康复方案初稿,采用专家会议修订康复方案形成方案终稿。采用类实验研究,便利抽样法选取首都医科大学附属北京同仁医院护理门诊2023年2—5月就诊的35例全喉切除术后患者为对照组,2023年6—9月就诊的35例全喉切除术后患者为试验组。对照组接受常规护理,试验组在常规护理的基础上应用基于行为改变轮理论的全喉切除术后患者食管语康复方案。比较2组患者干预前和干预后1、3、6个月的语言康复训练现状、生命质量、行为状态及焦虑抑郁状态。结果2组患者均完成研究。对照组男29例,女6例,年龄(54.63±10.44)岁;试验组男34例,女1例,年龄(55.17±10.67)岁。2组患者干预前语言康复训练现状、生命质量、行为状态及焦虑抑郁状态比较差异均无统计学意义(均P>0.05)。试验组干预后1、3、6个月语音康复训练现状总分分别为(32.80±2.49)、(39.80±2.75)、(51.91±4.20)分,高于对照组的(23.40±3.42)、(24.40±3.42)、(25.80±3.42)分,差异均有统计学意义(t=14.53、23.44、32.70,均P<0.05)。试验组干预后1、3、6个月生命质量总分分别为(98.91±8.49)、(134.66±11.31)、(157.97±13.97)分,高于对照组的(67.06±7.64)、(72.16±7.64)、(99.46±8.09)分,差异均有统计学意义(t=17.53、30.16、21.45,均P<0.05)。试验组干预后1、3、6个月社交场合饮食、言语被理解程度得分分别为(40.41±13.94)、(40.43±24.08)、(40.60±18.56)分和(43.71±12.26)、(47.40±17.09)、(52.50±13.82)分,高于对照组的(30.59±15.98)、(30.57±18.28)、(27.21±15.27)分和(27.29±15.13)、(23.60±14.78)、(19.50±12.78)分,差异均有统计学意义(t值为-6.88~-2.16,均P<0.05)。试验组干预后1、3、6个月焦虑抑郁状态总分分别为(23.74±2.73)、(14.89±3.89)、(12.11±3.14)分,低于对照组的(32.63±1.85)、(30.63±1.85)、(24.80±2.75)分,差异均有统计学意义(t=-19.55、-27.10、-17.97,均P<0.05)。结论基于行为改变轮理论的全喉切除术后患者食管语康复方案具有科学性、可行性,能改善患者的食管语表达能力、生命质量、焦虑抑郁情绪及社会行为状态,为临床护理提供参考。
Objective To construct an esophageal language rehabilitation program for patients after total laryngectomy(TL)based on the behavioral change wheel theory and exploring its application effects.MethodsThe multidisciplinary team constructed the first draft of the esophageal language rehabilitation program for patients after TL based on the behavioral change wheel theory,combined with a literature review,and used an expert meeting to revise the rehabilitation program to form the final draft of the program.Adopting experimental research,35 patients after TL who attended the nursing outpatient clinic of Beijing Tongren Hospital,Capital Medical University from February 2023 to May 2023 were selected as the control group by convenience sampling method,and 35 patients after TL who attended the nursing outpatient clinic from June 2023 to September 2023 were selected as the experimental group.The experimental group applied the TL postoperative patients′esophageal language rehabilitation program based on the behavioral change wheel theory on the basis of conventional nursing measures,and the control group received conventional nursing care.The status of language rehabilitation training,quality of life,social behavioral status,and anxiety and depression status before intervention,1,3,6 months after intervention were compared between the two groups.ResultsBoth groups of patients completed the study.There were 29 males and 6 females in the control group,with an age of(54.63±10.44)years old.There were 34 males and 1 female in the experimental group,with an age of(55.17±10.67)years old.There was no statistically significant difference in the language rehabilitation training status,quality of life,social behavior status,and anxiety and depression status between the two groups before intervention(all P>0.05).The total scores of speech rehabilitation training in the experimental group at 1,3,and 6 months after intervention were(32.80±2.49),(39.80±2.75),(51.91±4.20)points,respectively,which were higher than those in the control group(23.40±3.42),(24.40±3.42),(25.80±3.42)points,and the differences were statistically significant(t=14.53,23.44,32.70,all P<0.05).The total scores of quality of life in the experimental group at 1,3,and 6 months after intervention were(98.91±8.49),(134.66±11.31),(157.97±13.97)points,respectively,which were higher than those in the control group(67.06±7.64),(72.16±7.64),(99.46±8.09)points,and the differences were statistically significant(t=17.53,30.16,21.45,all P<0.05).The scores for social occasion diet and language comprehension in the experimental group at 1,3,and 6 months after intervention were(40.41±13.94),(40.43±24.08),(40.60±18.56),and(43.71±12.26),(47.40±17.09),(52.50±13.82),respectively,which were higher than those in the control group(30.59±15.98),(30.57±18.28),(27.21±15.27),and(27.29±15.13),(23.60±14.78),(19.50±12.78),and the differences were statistically significant(t values were-6.88-2.16,all P<0.05).The total scores of anxiety and depression in the experimental group at 1,3,and 6 months after intervention were(23.74±2.73),(14.89±3.89),(12.11±3.14)points,respectively,which were lower than those in the control group(32.63±1.85),(30.63±1.85),(24.80±2.75)points,and the differences were statistically significant(t=-19.55,-27.10,-17.97,all P<0.05).ConclusionsThe esophageal language rehabilitation program for patients after TL based on the behavioral change wheel theory in this study is scientific,feasible,and can improve the patients′esophageal language expression,quality of life,anxiety and depression,and social behavioral status,which can provide a reference for clinical care.
作者
李莉
刘永玲
张洋
田梓蓉
李秀雅
金晓婷
任晓波
南方
贺怡然
Li Li;Liu Yongling;Zhang Yang;Tian Zirong;Li Xiuya;Jin Xiaoting;Ren Xiaobo;Nan Fang;He Yiran(Department of Otolaryngology,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China;Department of Nursing,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)
出处
《中国实用护理杂志》
2025年第7期487-497,共11页
Chinese Journal of Practical Nursing
基金
北京市科技计划(Z221100007422045)。
关键词
喉肿瘤
全喉切除术
无喉志愿者
食管语
语音康复
循证护理
Laryngeal neoplasms
Total laryngectomy
Patients without larynx
Esophageal speech
Speech rehabilitation
Evidence-based nursing
