大剂量131I治疗致分化型甲状腺癌患者睡眠障碍的原因分析及护理体会

目的了解分化型甲状腺癌患者行^131Ⅰ治疗期间的睡眠质量及其影响因素,探讨提高患者睡眠质量的护理措施。方法将106位行大剂量^131Ⅰ治疗的分化型甲状腺癌患者随机分为干预组及对照组,对照组进行常规护理,干预组在对照组基础上进行护理干预,并对两组的睡眠质量及其影响因素采用匹兹堡睡眠质量指数（PSQI）量表和自行设计的睡眠影响因素调查表进行问卷调查。结果调查显示,出院时干预组与对照组睡眠情况比较,差异有统计学意义（P≤0.05）。影响睡眠的主要因素依次为心理因素（对癌症的悲观情绪、对疾病预后的担忧、对放射性治疗畏惧心理、隔离治疗期间孤独寂寞感等）、生理因素（颈部伤口不适、甲状腺功能低下、放射性副作用）、环境因素等。结论接受大剂量^131Ⅰ治疗的甲状腺癌患者普遍存在睡眠障碍,心理、生理和环境因素均可影响其睡眠质量,护理人员应采取针对性措施缓解患者的负性情绪及生理不适,尤其应加强疾病预后及放射性治疗相关知识宣教,同时提供良好的睡眠环境,以提高患者睡眠质量。

Analysis of the cause of High Doses of 131 Iodine Treatment Induced Sleep Disorders in Patients with Differentiated Thyroid Cancer and Nursing Experience

Objective To investigate the possible cause of the sleep disorders of patients with differentiated thyroid cancer after high-dose therapeutic ^131I administration and to explore care measures that may improve the sleep quality of those patients. Methods 106 patients with differentiated thyroid cancer treated with high-dose 131 Iodine were randomly and equally divided into intervention and control group. The control group was given routine nursing whereas intervention group received extra nursing intervention in addition to the same routine care as the control group. The Pittsburgh Sleep Quality Index（PSQI） scale was adapted for rating sleep quality and a self-designed questionnaire was used for the analysis of factors may contribute to sleep disorders. Results Our data show that there are significant differences between intervention comparison and control group on discharge（P≤0.05）. The main factors affecting sleep are psychological（pessimism over cancer, concerns about prognosis, fear of radioactive therapy, isolation during treatment, etc.）, physiological（pain of neck wound, hypothyroidism and side effects of radioactive therapy） or environmental. Conclusion Thyroid cancer patients received high-dose 131 Iodine treatment usually have sleep problems caused by various factors. We should take relevant measures to relieve physical discomforts and negative emotions from them and enhance their knowledge about prognosis and radiotherapy in particular; thus we could improve sleep quality of the patients.