Roy适应模式护理干预对异基因造血干细胞移植受者自我感受负担及中性粒细胞植活时间的影响

目的观察Roy适应模式护理干预对异基因造血干细胞移植(allo-HSCT)受者自我感受负担(SPB)及中性粒细胞植活时间的影响。 方法选取2017年7月至2018年5月在陆军军医大学新桥医院处于治疗缓解期、行allo-HSCT的100例受者作为研究对象，随机分为观察组和对照组。进入层流仓后，对照组受者采用常规健康教育及心理护理方法，观察组在此基础上进行以Roy适应模式为框架的护理干预。受者进、出层流仓时填写SPB量表。采用成组t检验比较观察组和对照组受者年龄、SPB量表评分和中性粒细胞植活时间，采用配对t检验比较每组受者进、出层流仓时SPB量表评分。采用χ²检验比较两组受者性别、原发病诊断、供受者配型、供受者血缘关系、医疗保险类型和SPB发生率。P<0.05为差异有统计学意义。 结果进入层流仓时，观察组与对照组受者SPB量表评分分别为(31±5)分和(32±4)分，差异无统计学意义(t＝0.15，P>0.05)。出仓时，观察组受者SPB量表评分为(25±6)分，低于对照组(30±4)分，差异有统计学意义(t＝4.66，P<0.05)。观察组受者出仓时SPB量表评分低于进仓时，差异有统计学意义(t＝5.49，P<0.05)；对照组受者进、出层流仓时SPB量表评分差异无统计学意义(t＝1.71，P>0.05)。进仓时，观察组和对照组受者SPB发生率分别为92%(46/50)、96%(48/50)，差异无统计学意义(χ²＝0.71，P>0.05)。出仓时，观察组受者SPB发生率为74%(37/50)，低于对照组94%(47/50)，差异有统计学意义(χ²＝7.44，P<0.05)。观察组受者出仓时SPB发生率低于进仓时，差异有统计学意义(χ²＝5.74，P<0.05)；对照组受者进、出层流仓时SPB发生率差异无统计学意义(χ²＝0.21，P>0.05)。观察组受者中性粒细胞植活平均时间(12.2±2.6) d]显著低于对照组(17.1±2.7) d]，差异有统计学意义(t＝9.41，P<0.05)。 结论应用Roy适应模式护理干预可改善allo-HSCT受者SPB严重程度，提高适应性，缩短中性粒细胞植活时间，利于疾病恢复。

The effect of Roy adaptation model nursing intervention on self-perceived burden and neutrophil granulocyte implantation of recipients after allogeneic hematopoietic stem cell transplantation

ObjectiveTo observe the effect of Roy adaptation model nursing intervention on self-perceived burden (SPB) and neutrophil granulocyte implantation of recipients after allogeneic hematopoietic stem cell transplantation (allo-HSCT). MethodsOne hundred allo-HSCT recipients who got allo-HSCT in the Xinqiao Hospital of Army Medical University and in remission during July 2017 and May 2018 were enrolled and randomly divided into observation group and control group. After entering the laminar flow chamber, recipients in the control group adopted the routine health education and psychological nursing methods. Recipients in observation group were given Roy adaptation model intervention nursing based on the control group. Recipients filled the SPB scale when in and out of the laminar flow chamber. The group t test was used to compare the age, SPB score and neutrophil implantation time of recipients between the 2 groups, and the paired t test was used to compare the SPB score of recipients when in and out of the laminar flow chamber in each group. The χ² test was used to compare the gender, donor recipient matching type, donor recipient blood relationship, medical insurance type and incidence of SPB. P<0.05 was statistically significant. ResultsWhile entering the laminar flow chamber, the SPB scale scores of recipients in observation group and control group were (31±5) and (32±4) respectively, which had no significant difference (t=0.15, P>0.05). When left the laminar flow chamber, the SPB scale scores of recipients in observation group were (25±6), which were lower than that of the control group (30±4)(t=4.66, P<0.05). The SPB scale scores of recipients at the time of leaving the laminar flow chamber was lower than that at the time of entering in the observation group (t=5.49, P<0.05). No significant difference was found for the SPB scale scores of recipients between leaving and entering the laminar flow chamber in the control group (t=1.71, P>0.05). At the time of entering the laminar flow chamber, the incidence of SPB was 92% (46/50) in the observation group and 96% (48/50) in the control group respectively, which had no significant difference (χ²=0.71, P>0.05). When left the laminar flow chamber, the incidence of SPB was 94% (47/50) in the control group and 74% (37/50) in the observation group, which had significant difference (χ²=7.44, P<0.05). The incidence of SPB at the time of leaving the laminar flow chamber was lower than that at the time of entering in the observation group (χ²=5.74, P<0.05). No significant difference was found for the incidence of SPB between leaving and entering the laminar flow chamber in control group (χ²=0.21, P>0.05). The mean time of neutrophil implantation in the experimental group (12.2±2.6) days was significantly less than that in the control group (17.1±2.7) days (t=9.41, P<0.05). ConclusionsThe application of Roy adaptation model nursing intervention can alleviate the severity of SPB, improve the adaptability and shorten the time of neutrophil implantation.