姑息护理干预对晚期肿瘤患者癌性疼痛及生活质量的影响研究

Study on the Effect of Palliative Care Intervention on Cancer Pain and Quality of Life in Patients with Advanced Tumors

摘要: 目的：探究姑息护理模式应用于晚期肿瘤患者临床照护的实际成效，分析该干预方案对患者癌性疼痛、心理状态及生活质量的改善作用，为临床优化晚期肿瘤安宁疗护方案、完善癌痛规范化管理措施提供循证依据。方法：选取本院临终关怀科2024年5月~2025年5月收治的86例晚期肿瘤患者作为研究对象。基于两样本均数比较的样本量计算公式，设α = 0.05，检验效能1 − β = 0.80，结合预试验结果(观察组VAS均值2.50 ± 0.70，对照组3.80 ± 0.90)，估算每组至少37例，考虑15%脱落率，最终每组纳入43例。采用随机数字表法(由SPSS 26.0生成)将患者按1:1比例分为对照组与观察组，各43例。分组结果置于密封不透明信封中，由不参与临床护理的独立研究人员在患者入组时开启并分配。对照组实施肿瘤晚期常规护理服务，观察组在常规护理基础上叠加系统化姑息护理干预。持续干预4周后，对比两组患者疼痛视觉模拟评分(VAS)、疼痛控制有效率、生活质量各维度评分、焦虑自评量表(SAS)与抑郁自评量表(SDS)评分，以及护理满意度。所有结局指标由不参与干预实施且不知分组情况的独立评估人员进行测评，数据分析阶段对分组变量进行编码处理，实现评估者及分析者双盲。结果：最终对照组42例、观察组41例完成全程研究(对照组1例因病情恶化转院脱落，观察组2例脱落，其中1例主动退出、1例因病情恶化死亡)，两组脱落率分别为2.33%和4.65%，差异无统计学意义(P > 0.05)。干预后，观察组VAS评分显著低于对照组(2.13 ± 0.62 vs. 4.26 ± 0.85)，组间差异具有统计学意义(t = 13.265, P < 0.001)；观察组疼痛控制总有效率为92.68% (38/41)，显著高于对照组的71.43% (30/42)，组间差异有统计学意义(χ² = 6.162, P = 0.013)；观察组躯体功能(78.62 ± 3.85 vs. 62.35 ± 4.52)、心理功能(76.95 ± 4.26 vs. 60.18 ± 5.12)、社会功能(77.85 ± 4.12 vs. 63.26 ± 4.85)及总体生活质量(78.26 ± 3.95 vs. 61.58 ± 4.66)评分均优于对照组(P均 < 0.001)；观察组SAS评分(40.25 ± 4.15 vs. 52.16 ± 5.32)及SDS评分(39.85 ± 4.02 vs. 51.32 ± 5.26)均显著低于对照组(P均 < 0.001)；观察组护理满意度为97.56% (40/41)，高于对照组的83.33% (35/42)，组间差异有统计学意义(χ² = 4.602, P = 0.032)。结论：对晚期肿瘤患者实施系统性姑息护理干预，能有效缓解癌性疼痛，改善焦虑、抑郁等负性情绪，全面提升终末期生活质量，并构建和谐护患关系。该模式契合安宁疗护核心理念，具有显著的临床推广应用价值。

Abstract: Objective: To explore the practical effect of the palliative-care model for clinical nursing of patients with advanced tumors, analyze its influences on cancer‑related pain, psychological status and quality‑of‑life (QoL), and provide evidence‑based references for optimizing clinical hospice‑care strategies and standardizing cancer‑pain management for terminally‑ill cancer patients. Methods: A total of 86 patients with advanced tumors admitted to the Department of Hospice Care of our hospital from May 2024 to May 2025 were enrolled. The sample‑size formula for comparing the means of two‑sample populations was adopted with α = 0.05 and test power (1 − β) = 0.80. According to preliminary trial outcomes (the Visual Analogue Scale (VAS) score of the observation group: 2.50 ± 0.70 versus 3.80 ± 0.90 in the control group), at least 37 subjects were required for each group. Considering a 15% loss‑to‑follow‑up rate, 43 patients were finally included in each group. Participants were allocated at a 1:1 ratio by the random‑number table generated via SPSS 26.0. Grouping results were sealed in opaque envelopes and assigned by independent researchers who took no part in nursing implementation upon enrollment. The control group received routine nursing for advanced‑cancer patients, while the observation group was given standardized palliative‑care interventions on the basis of conventional nursing. After four‑week continuous intervention, the VAS scores, overall response rate of pain control, scores of each QoL dimension, Self‑Rating Anxiety Scale (SAS), Self‑Rating Depression Scale (SDS) and nursing‑satisfaction levels were compared between the two groups. All outcome indicators were evaluated by blinded assessors without intervention‑related participation. Group‑assignment data were coded during statistical analysis to achieve double‑blind status for evaluators and analysts. Results: Ultimately, 42 patients in the control group and 41 cases in the observation group completed the whole research. One patient was transferred owing to disease deterioration in the control group; two patients dropped out in the observation group including one voluntary withdrawal and one death from disease progression. The loss‑to‑follow‑up rates were 2.33% and 4.65% respectively with no statistically significant difference (P > 0.05). After intervention, the VAS score of the observation group was markedly lower than that of the control group (2.13 ± 0.62 vs. 4.26 ± 0.85, t = 13.265, P < 0.001). The overall effective rate of pain‑relief reached 92.68% (38/41) in the observation group, which was significantly higher than 71.43% (30/42) in the control group (χ² = 6.162, P = 0.013). Compared: with the control group, the observation‑group patients obtained higher scores in physical function (78.62 ± 3.85 vs.62.35 ± 4.52), psychological function (76.95 ± 4.26 vs.60.18 ± 5.12), social function (77.85 ± 4.12 vs.63.26 ± 4.85) and overall quality‑of‑life (78.26 ± 3.95 vs.61.58 ± 4.66) (all P < 0.001). Besides, the observation‑group showed decreased SAS (40.25 ± 4.15 vs.52.16 ± 5.32) and SDS scores (39.85 ± 4.02 vs.51.32 ± 5.26) (all P < 0.001). Nursing‑satisfaction rate of the observation group was 97.56% (40/41), higher than 83.33% (35/42) in the control group (χ² = 4.602, P = 0.032). Conclusion: Systematic palliative‑care interventions can effectively relieve cancer‑related pain, mitigate anxiety and depression, improve overall quality‑of‑life and promote harmonious nurse‑patient relationships for patients with advanced tumors. Consistent with core concepts of hospice-care, this model is worthy of extensive clinical application.