中重度癌痛患者居家止痛药物治疗依从性综合干预研究  

Comprehensive intervention study on medication compliance of analgesics in home-based patients with moderate and severe cancer pain

作　　者：付玲[1] 朱小平[1] 史崇清[2] Fu Ling;Zhu Xiaoping;Shi Chongqing(Hospice Unit of Zhongnan Hospital of Wuhan University, Wuhan 430071, China;Medical College, Wuhan University of Science and Technology, Wuhan 430065, China)

机构地区：[1]武汉大学中南医院宁养院,430071 [2]武汉科技大学医学院,430065

出　　处：《中国实用护理杂志》2019年第28期2190-2194,共5页Chinese Journal of Practical Nursing

基　　金：李嘉诚基金会全国宁养医疗服务计划(〔2019〕0902-265).

摘　　要：目的探讨居家癌症患者止痛药物治疗依从性综合干预方式,提高癌痛患者居家服药依从性。方法自行设计居家癌痛患者止痛药物服用影响因素调查问卷,便利选取2016年2月至2017年12月武汉大学中南医院宁养院收治的居家癌症中、重度疼痛患者143例。调查影响止痛药物服药依从性的主、客观因素和心理因素,开展健康教育、行为干预、认知干预,心理疏导等综合干预,干预前后采用Morisky服药依从性自我报告问卷、疼痛数字分级法(NRS评分)和疼痛缓解程度的划分进行评定。采用自身对照,比较干预前和干预8周后患者服用止痛药物完全依从和非依从的数量和依从性评分。比较综合干预8周后,完全依从和非依从患者的疼痛程度、疼痛缓解程度和疼痛缓解显效率。结果影响患者止痛药物治疗依从性的主要因素排在前3位的依次是:害怕吗啡成瘾(16.37%,37/226);用药单一,药量不足(15.93%,36/226);担心药物不良反应(13.72%,31/226)。不同影响因素数量的患者NRS评分下降分值比较差异有统计学意义(F=5.367,P=0.006)。综合干预前和干预8周后完全依从和非依从的患者数量及依从性差异有统计学意义(χ2=25.583,P=0.000;t=-7.387,P=0.000)。综合干预8周后完全依从和非依从患者的疼痛程度、疼痛缓解程度和疼痛缓解显效率,差异均有统计学意义(χ2=76.572、62.998,均P=0.000)。结论针对影响中重度癌痛患者居家止痛药物服药依从性的主观因素、客观因素和心理因素等进行止痛药物治疗依从性的综合干预,提高了中重度癌痛患者居家止痛药物治疗的依从性,缓解了疼痛。Objective To explore the comprehensive intervention mode of compliance with analgesics for home-based patients with moderate or severe cancer pain and to improve the medication compliance of home-based patients with cancer pain. Methods A self-designed questionnaire was designed to investigate the influencing factors of taking analgesics for home-based patients with moderate or severe cancer pain, 143 home-based patients with moderate to severe cancer pain were conveniently selected from Hospice Unit of Zhongnan Hospital of Wuhan University, from February 2016 to December 2017. To investigate the subjective, objective and psychological factors affecting patients' compliance with analgesics, comprehensive interventions such as health education, behavioral intervention, cognitive intervention and psychological counseling were carried out. Before and after the intervention, Morisky′s self-report questionnaire on medication compliance, pain digital grading (NRS score), and pain relief degree were assessed. Using self control design method and comparing the compliance of patients taking analgesics, number of complete compliance and non-compliance in patients taking analgesics and NRS score and pain relief before and after 8 weeks of intervention. Pain degree, pain relief degree and pain relief efficiency between patients with complete compliance and non-compliance after comprehensive intervention were evaluated. Results The main factors affecting patients' medication compliance with analgesics were fear of morphine addiction(16.37%, 37/226), single use of drugs and insufficient dosage (15.93%, 36/226), and fear of adverse drug reactions(13.72%, 31/226). The scores of NRS decrease in patients with different influencing factors were compared, with statistical difference (F=5.367, P=0.006). There were significant differences in the number and compliance of patients with complete compliance and non-compliance before and after 8-week-comprehensive intervention (χ2=25.583, P=0.000;t=-7.387, P=0.000). There were significa

关 键 词：服药依从性 综合干预 癌痛 镇痛 居家 

分 类 号：R473.73[医药卫生—护理学]