中国妇幼保健

目的 探讨基于循证构建的阶梯式干预方案对乳腺癌化疗患者癌因性疲乏和睡眠障碍的影响。方法 选取2023年1月—2025年1月杭州市临平区妇幼保健院收治的110例乳腺癌化疗女性患者作为研究对象，采用随机数字表法分为对照组(采用常规干预方法)和循证组(在对照组基础上采用基于循证构建的阶梯式干预方案)，每组各55例。观察两组患者干预前、后癌因性疲乏程度[Piper疲乏修订量表(中文版)(RPFS)评分]、睡眠质量[匹兹堡睡眠质量指数(PSQI)评分]、自尊水平[状态自尊量表(SSES)评分]、自我管理能力[健康促进策略量表(SUPPH)评分]及生活质量[乳腺癌患者生存质量测定量表(FACT-B)评分]指标的差异。结果 干预前，两组各观察指标比较差异均无统计学意义(均P>0.05)。干预后，循证组患者RPFS总分为(9.57±1.44)分、PSQI总分为(8.82±1.32)分，均低于对照组的(10.28±1.53)分、(10.02±1.50)分，SSES评分中行为自尊评分为(23.91±4.08)分、外表自尊评分为(19.65±3.91)分、社会自尊评分为(22.12±3.31)分、SUPPH总分为(82.52±12.38 )分、FACT-B总分为(98.12±7.73 )分，均高于对照组的(21.78±3.27 )分、(17.52±2.63)分、(20.84±3.11)分、(74.67±11.21)分及(90.61±6.59)分，组间比较，差异均有统计学意义(t_RPFS总分=2.506,t_PSQI总分=4.454,t_{SSES行为自尊评分}=3.021,t_{SSES外表自尊评分}=3.352,t_{SSES社会自尊评分}=2.090,t_SUPPH总分=3.486,t_FACT-B总分=5.483，均P<0.05)。结论 在常规干预基础上采用基于循证构建的阶梯式干预方案可有效降低乳腺癌化疗患者癌因性疲乏程度，改善睡眠障碍，显著提升患者自尊水平、自我管理能力及整体生活质量，值得临床推广使用。

Objective To investigate the effect of an evidence-based stepped intervention protocol on cancer-related fatigue and sleep disturbance in breast cancer patients undergoing chemotherapy. Methods A total of 110 female breast cancer patients receiving chemotherapy at Hangzhou Linping District Maternal and Child Health Care Hospital from January 2023 to January 2025 were enrolled and randomly divided into a control group(routine care) and an evidence-based group(evidence-based stepped intervention plus routine care),with55 cases in each group. The levels of cancer-related fatigue(Revised Piper Fatigue Scale,RPFS),sleep quality(Pittsburgh Sleep Quality Index,PSQI),self-esteem(State Self-Esteem Scale,SSES),self-management ability(Strategies Used by People to Promote Health,SUPPH),and quality of life(Functional Assessment of Cancer Therapy-Breast,FACT-B) were compared between the two groups before and after intervention. Results No significant differences were observed in all indicators between the two groups at baseline(all P>0. 05).After intervention,the evidence-based group had lower total RPFS score(9. 57±1. 44) and total PSQI score(8. 82±1. 32) than the control group(10. 28±1. 53,10. 02±1. 50),the evidence-based group also achieved higher scores in SSES subscales(behavioral self-esteem:23. 91±4. 08; appearance self-esteem: 19. 65± 3. 91; social self-esteem: 22. 12± 3. 31),total SUPPH score(82. 52± 12. 38),and total FACT-B score(98. 12±7. 73) compared with the control group(21. 78±3. 27,17. 52±2. 63,20. 84±3. 11,74. 67±11. 21,90. 61±6. 59,respectively),all intergroup differences were statistically significant(t_RPFS= 2. 506,t_PSQI= 4. 454,t_{SSES-behavior}= 3. 021,t_{SSES-appearance}=3. 352,t_SSES-social= 2. 090,t_SUPPH= 3. 486,t_FACT-B= 5. 483,all P < 0. 05). Conclusion On the basis of routine care,the evidence-based stepped intervention can effectively alleviate cancer-related fatigue,improve sleep disturbance,and significantly enhance self-esteem,selfmanagement ability and overall quality of life in breast cancer patients undergoing chemotherapy,which was worthy of clinical application and promotion.