恶性肿瘤放疗患者失眠评估和非药物干预最佳证据的循证实践  

Evidence-based practice for the best evidence of insomnia assessment and non-drug interventions in patients with malignant tumor radiotherapy

作　　者：胡宏玲 潘海卿[1] 盛晓雯 叶向红[1] 余雅荔 简二妹[1] 罗芳萍 胡雁[2] HU Hongling;PAN Haiqing;SHENG Xiaowen;YE Xianghong;YU Yali;JIAN Ermei;LUO Fangping;HU Yan(Jinhua Center Hospital,Jinhua 321000,Zhejiang,China;School of Nursing,Fudan University,Shanghai 200032,China)

机构地区：[1]金华市中心医院,浙江金华321000 [2]复旦大学护理学院,上海200032

出　　处：《护士进修杂志》2025年第8期851-856,862,共7页Journal of Nurses Training

基　　金：复旦大学循证护理中心证据转化与临床应用项目(编号:Fudanebn202304)。

摘　　要：目的 基于循证方法学,制定恶性肿瘤放疗患者失眠评估和非药物干预方案,并探讨其应用效果。方法 制订恶性肿瘤放疗患者失眠评估和非药物干预的最佳证据,并于2023年6—12月将该证据应用于临床,比较证据应用前后各审查指标执行情况、医护人员对睡眠卫生知识掌握情况及患者不同时期睡眠相关情况。结果 恶性肿瘤放疗患者失眠评估和非药物干预的方案包括失眠评估/工具、环境改造、失眠教育、放松疗法4个方面,共12条证据条目和9条审查指标。证据应用前,医护人员审查指标1、2、4、7、8、9执行率均为0,指标3、5、6的执行率分别为20.35%、20.35%、88.5%;证据应用后,审查指标2、3、5、7、8、9分别提升至89.34%、91.09%、96.21%、88.21%、98.13%、97.6%,且其余3条指标的执行率均达到了100%;证据应用后,医护人员睡眠卫生知识问卷各维度得分均较证据应用前有显著提高,差异均有统计学意义(P<0.001);证据应用后,患者匹兹堡睡眠质量指数量表得分在放疗中期和放疗结束时均有所下降,失眠严重指数量表得分在放疗中期也有所下降(P<0.05)。结论 恶性肿瘤放疗患者失眠评估和非药物干预最佳证据的临床应用,规范了护士失眠评估及非药物干预的护理行为,并优化了临床工作流程,从而有效改善了患者失眠情况,提高了患者就医体验及满意度。Objective To develop the program of insomnia assessment and non-drug intervention for patients with malignant tumor radiotherapy based on the evidence-based methodology,and to discuss its application effects.Methods The best evidence for insomnia assessment and non-drug intervention in patients with malignant tumor radiotherapy were formulated,and applied in clinical practice from June to December 2023,and the implementation of various review indicators before and after the application of evidence,medical staff's grasp of sleep health knowledge,and patients'sleep-related conditions in different periods were compared.Results The program of insomnia evaluation and nondrug intervention in patients with radiotherapy for malignant tumors included 4 aspects:Insomnia assessment/tools,environmental modification,insomnia education,and relaxation therapy,with a total of 12 evidence items and 9 review indicators.Before the application of evidence,the implementation rates of indicators 1,2,4,7,8,and 9 reviewed by medical staff were 0,and the implementation rates of indicators 3,5,and 6 were 20.35%,20.35%,and 88.5%,respectively.After the application of evidence,indicators 2,3,5,7,8,and 9 were increased to 89.34%,91.09%,96.21%,88.21%,98.13%and 97.6%,respectively,and the implementation rate of the other 3 indicators reached 100%.After the application of evidence,the scores of all dimensions of the sleep hygiene knowledge questionnaire in medical staff were significantly higher than those before the application of evidence,with statistical significance(P<0.001).After the application of evidence,the scores of the Pittsburgh sleep quality index were decreased at the middle and end of radiotherapy,and the scores of the insomnia severity index were also decreased at the middle of radiotherapy(P<0.05).Conclusion The clinical application of the best evidence of insomnia assessment and non-drug intervention in patients with malignant tumor radiotherapy standardizes the nursing behavior of nurses for insomnia assessment and non-drug int

关 键 词：恶性肿瘤 放疗 失眠评估 非药物干预 循证实践 

分 类 号：R473.73[医药卫生—护理学]