Application Of Management Strategy Based On Symptom Management Theory In High-dose Methotrexate Chemotherapy For Children With Acute Leukemia

Objective:To clarify the level of symptom burden in children with acute lymphoblastic leukemia in high-dose methotrexatechemotherapy.Based on the theory of symptom management,formulate a symptom management strategy with "knowledge + skills +support" as the core,and build a comprehensive and effective symptom management plan based on the needs of children and main caregivers.To evaluate the effect of symptom management strategies based on symptom management theory on the level of symptom burden and quality of life in children with acutelymphoblastic leukemia during high-dose methotrexate chemotherapy.Methods:In this study,children with acute lymphoblastic leukemia and their main caregivers who visited from January to September 2020 were selected as the research objects.The children were randomly divided into a control group and an intervention group by lottery,with 35 cases in each group,the control group Distribute the "Symptom Management Manual" and implement routine care before and after methotrexate chemotherapy,including basic knowledge of chemotherapy and guidance on diet,exercise,hygiene,and mood regulation.On the basis of routine care,the intervention group is based on the symptom management strategy of "knowledge +skills + support",consults the children’s blood disease care guide,consults children’s blood clinical experts,nursing experts,etc.,and formulates through pre-experiment based on symptom management theory Symptom management strategy.To evaluate the level of symptom burden and quality of life of the two groups of children on the day before chemotherapy;the chemotherapy cycle of the children was two months,and a total of 4 chemotherapy was performed.The blood concentration of methotrexate in the children was tested at the 42 th hour of each chemotherapy.The level of symptom burden of the two groups of children was evaluated on the 7th day after the end of chemotherapy;the quality of life of the two groups of children was evaluated after one month and two months of intervention.Results:A total of 70 study subjects were included in this study,and 4 children withdrew and were lost to follow-up during the study.Finally,there were 33 cases in the control group and the intervention group.There was no statistically significant difference between the two groups of children in general information,symptom burden level,quality of life level and other baseline comparisons(P>0.05).There was no statistical difference in the blood concentration of methotrexate between the two children in the first,second,and third laboratory tests(P>0.05).The symptom burden of the two groups of children was evaluated on the 7th day after the first and second chemotherapy Level,no statistical difference(P>0.05),the intervention group’s general quality of life scale school function and specific scale pain scores were better than the control group after 1 month of intervention(P<0.05),the intervention group’s quality of life after 2 months of intervention The score was better than that of the control group,and the difference was statistically significant(P<0.05).On the 7th day after the third and fourth chemotherapy,the intervention group’s symptom assessment scale score and the symptom incidence,frequency,severity,and distress score were better than those of the control group,and the blood concentration of methotrexate after the fourth chemotherapy The difference was statistically significant(P<0.05).Conclusions:Based on the symptom management theory,based on the "knowledge + skills +support" symptom management strategy,it can significantly reduce the level of symptom burden after high-dose methotrexate chemotherapy in children,improve the quality of life of the children,and at the same time reduce the level of methotrexate in children.The blood concentration of pterin has a certain synergistic effect.Symptom management strategies have important clinical practice significance in the management of high-dose methotrexate chemotherapy in children with acute lymphoblastic leukemia,and can be used as a new type of nursing program in the whole course of chemotherapy for children with leukemia.Symptom management strategies based on symptom management theory have been fully affirmed by the children and their main caregivers.