Application Research Of Continuous Nursing Based On "Internet Plus" In Patients With Nasopharyngeal Carcinoma After Discharge

Objective:（1）To investigation and analysis of the status quo,influencing factors and main toxic and side effects of radiotherapy for patients with nasopharyngeal carcinoma discharged from hospital.（2）To explore the correlation between continuous nursing needs and quality of life of discharged patients with nasopharyngeal carcinoma.（3）Based on the needs of patients,this paper explores the application effect of continuous nursing services based on"Internet plus"in patients with nasopharyngeal carcinoma after discharge.Methods:（1）A total of 430 patients with nasopharyngeal carcinoma chemoradiotherapy who underwent outpatient review in the Department of Radiotherapy of the First Affiliated Hospital of Guangxi Medical University from April to July 2018 were selected as the research subjects,of which 100 cases were pre-investigated to test the reliability and validity of the scale,The official investigation was 330 cases.General Information Questionnaire,Questionnaire of Toxic Side Effects of Radiotherapy,Nasopharyngeal Carcinoma Patients Continuing Care Requirement Scale,Cancer Fatigue Scale,and Head and Neck Tumor Quality of Life Scale（EORTC QLQ H&N35 V1.0 Chinese version）were used for investigation.（2）From August 2018 to November 2019,116 patients with nasopharyngeal carcinoma who were discharged after 1 year of outpatient review in the radiotherapy department of the First Affiliated Hospital of Guangxi Medical University were randomly divided into intervention group and control group by random number table method.There were 58 cases in each group.The control group was given routine discharge guidance and discharge follow-up,that is,the follow-up team conducted a telephone follow-up every 3 months to understand the side effects of radiotherapy after discharge and remind patients to review on time;The intervention group gave continuous care intervention based on the Internet platform,that is,established a continuous care group,using the Internet platform based on"patient needs"and the mobile health education program developed for continuous care intervention.Regularly push patients about basic knowledge of nasopharyngeal carcinoma and functional exercise every 2 weeks,answer consultation questions at any time,meet their needs for assisted knowledge,encourage them to perform self-care,etc.,and remind patients to review on time.Before and after the intervention,the two groups of patients were evaluated for their quality of life,cancer fatigue scale,the occurrence of major side effects and compliance,and the intervention effect was evaluated,takeα=0.05 as the test level.Results:1.The total score of continuing care needs of patients discharged from nasopharyngeal carcinoma was（66.00±7.27）points,which was at a high level.The scores of each dimension are sorted by the average score of the items.From high to low,they are the basic knowledge of disease（3.72±0.51）,the needs of life care（3.41±0.59）,the needs of common symptoms（3.39±0.67）,and Nursing needs（3.28±0.74）points,Nursing needs for other symptoms（2.81±0.63）points.Among them,the total demand score of patients with nasopharyngeal carcinoma within 1 to 3 years after discharge was（64.53±7.23）points,which is still at a high level.The basic knowledge of disease（3.69±0.49）and the nursing of common symptoms（3.36±0.69）ranked first and second.2.Among the 10 complications investigated,dry mouth,nasal congestion,tinnitus,hearing loss,trismus,neck fibrosis,radiation dental caries,dizziness and headache,oral ulcers,radiation dermatitis are common side effects of radiotherapy after nasopharyngeal carcinoma discharge.The rates are 95.5%（315/330）,44.2%（146/184）,46.1%（152/330）,44.8%（148/330）,18.2%（60/330）,14.5%（48/330）,41.2%（136/330）,20.3%（67/330）,2.7%（9/330）,2.1%（7/330）.The incidence of dry mouth,tinnitus,and hearing loss in patients with nasopharyngeal cancer at different time periods after discharge was not statistically significant（P>0.05）.The incidence of nasal congestion and radiation dental caries decreased after the discharge time of nasopharyngeal carcinoma patients was increased.The incidence of trismus,neck fibrosis,and dizziness and headache increased,and the differences were statistically significant（P<0.05）.Within 1 to 3 years after discharge（chronic clinical period）,the patients were mainly dry mouth（94.1%）,tinnitus（41.5%）,hearing loss（44.1%）,nasal congestion（41.5%）,and radiation caries（38.1%）.The incidence of trismus and neck fibrosis increased significantly at this stage.3.The total fatigue of patients discharged from nasopharyngeal carcinoma was（26.87±5.83）points.Among them,26 were at low level（7.9%）,297 were at intermediate level（90%）,and 7 were at high level（2.1%）.Among them,the total fatigue Within 1 to 3 years after discharge was（25.51±5.61）points,and the highest average score was emotional fatigue（2.20±0.51）points,followed by cognitive fatigue（1.57±0.54）points.4.The main influencing factors of the total continuing care needs of patients discharged from nasopharyngeal cancer are:（1）Univariate analysis method:different cultural levels,symptoms,length of discharge,main caregiver and family history,family care satisfaction,whether patients’continuing care needs scores are different,and the differences are statistically significant（P<0.05）.（2）Variance trend test:Using the length of discharge as an independent variable,the variance trend test was performed on the total continuing care needs of patients with nasopharyngeal carcinoma discharged from hospital.（linear term F₁=2.656,P₁<0.001;Quadratic F₂=4.302,P₂<0.001）.（3）Independent sample t-test method:The score of the total continuing care needs of patients with dry mouth,nasal congestion,tinnitus,hearing loss,trismus,and dizziness and headache are higher than those without dry mouth,nasal congestion,tinnitus,hearing loss,trismus,and dizziness and headache,the difference was statistically significant（P<0.05）.（4）Spearson correlation analysis method:The patient’s cancer fatigue score was moderately positively correlated with the continuing care needs score,and the difference was statistically significant（P<0.05）.（5）Multiple stepwise regression analysis:length of discharge,type of symptoms,satisfaction of home care,dry mouth,and total fatigue are the main independent influencing factors for the overall need for continued care of patients discharged from nasopharyngeal cancer（F=83.580,P<0.001）,which can explain nasal The total variation of continuing care needs of patients discharged from pharyngeal cancer was 55.60%.The regression equation is Y=35.682+2.359X₃+2.617X₆+4.228X₇+0.669X₁₃-0.812X₄.5.The scores of each symptom area of quality of life are basically positively related to the score of total continuing care needs,especially in the area of pain,swallowing function,sensory problems,difficulty eating,and dental problems,mouth problems,dry mouth problems,and saliva stickiness Problem,the difference is statistically significant（P<0.05）.days later,the levels of hemoglobin and prealbumin in the intervention group were higher than those in the control group,and the difference was statistically significant（P<0.05）.6.Application effect of continuous nursing based on"Internet plus"in patients with nasopharyngeal carcinoma after discharge:（1）There was no significant difference in compliance between the two groups of patients before the intervention（nasal irrigation,mouth opening exercise,neck rotation exercise）（P>0.05）.After 3 months of intervention,there was no statistically significant difference in compliance of nasal irrigation between the two groups（P>0.05）,and there was a statistically significant difference in compliance of open mouth exercise and neck exercise（P<0.05）.After 6 months of intervention and 1 year of intervention,there were statistically significant differences in compliance with nasal irrigation,mouth opening exercises,and neck rotation exercises（P<0.05）.（2）There was no significant difference in the incidence of side effects of radiotherapy（nasal congestion,dry mouth,tinnitus,difficulty in opening mouth,and fibrosis of the neck）before intervention between the two groups（P>0.05）.After 3 months of intervention,the severity of dry mouth,nasal congestion,tinnitus,trismus,and neck fibrosis of the intervention group after radiotherapy was compared with the control group,and there was no significant difference（P>0.05）.After 6 months and 1 year of intervention,the severity of dry mouth,nasal congestion,tinnitus,trismus,and neck fibrosis in the intervention group after radiotherapy were lower than those in the control group,and the differences were statistically significant（P<0.05）.（3）There was no significant difference in cancer fatigue（total fatigue,physical fatigue,emotional fatigue,cognitive fatigue）before intervention between the two groups（P>0.05）.After 6 months and 12months of intervention,The scores of the total fatigue,physical fatigue,emotional fatigue,and cognitive fatigue were all lower than those of the control group,and the difference was statistically significant（P<0.05）;the cancer fatigue of the two groups of patients before and after intervention was different in time,grouping,and interaction between the two It has statistical significance（P<0.05）.（4）There was no statistically significant difference in the scores of various symptom areas of quality of life between the two groups of patients before intervention（P>0.05）.After 6 months of intervention,the scores of eating problems,social problems,sexual function,mouth opening problems,dry mouth problems,cough scores were not statistically significant between the two groups of patients（P>0.05）;The patients in the intervention group had lower scores for head and neck pain,swallowing function,sensory problems,language problems,dental problems,saliva problems,and morbidity,the difference was statistically significant（P<0.05）.After 12 months of intervention,except for cough symptoms and language scores,the scores of the other areas of the intervention group were lower than the control group,the difference was statistically significant（P<0.05）;in the results of repeated measures analysis of variance,except for the difference in scores for cough and language problems,the scores of head and neck pain,swallowing function,sensory problems,eating difficulties,social difficulties,sex life scores in the symptom fields of the two groups of patients and the scores of dental problems,difficulty in opening mouth,dry mouth,thick saliva,and morbidity in the single symptom entries are all statistically significant in the effects of the groups,the interaction between time and groups（P<0.05）.Conclusion:1.The overall demand for continuing care after discharge of nasopharyngeal carcinoma patients is at a high level,and most hope to provide it through network communication,which needs to be met.Among them,the main nursing needs of nasopharyngeal carcinoma patients 1 year after discharge were basic health knowledge of the disease and nursing of common symptoms.2.Dry mouth,tinnitus,and hearing loss are toxic and side effects that basically exist in patients with nasopharyngeal cancer at each stage after discharge.Among the nasopharyngeal carcinoma patients who were discharged 1 year after discharge,the main side effects of radiotherapy were:dry mouth,tinnitus,hearing loss and nasal congestion,and radiation caries.In addition,according to the changing trend of toxic and side effects,we should also pay attention to preventive intervention on neck fibrosis and difficulty in opening mouth.3.The number of symptoms,length of discharge,family care satisfaction,total fatigue,and dry mouth are the main factors affecting the continued care needs of patients with nasopharyngeal carcinoma discharged from hospital.4.There is a significant correlation between quality of life and continuing care needs.The worse the quality of life,the higher the need for continuing care,meeting its dynamic needs,and improving the quality of life of patients.5.Implementing a continuous care plan centered on the needs of patients based on the"Internet plus"can improve patient compliance,reduce the incidence of toxic and side effects,improve patients’negative emotions,and thereby improve the quality of life.