稳定化技术对食管癌患者围手术期心理应激的干预研究

发布时间：2017-12-31 15:44

本文关键词：稳定化技术对食管癌患者围手术期心理应激的干预研究　出处：《中国人民解放军军医进修学院》2012年硕士论文　论文类型：学位论文

【摘要】：研究目的探讨食管癌患者围手术期的心理应激特征，评价稳定化技术对食管癌患者围手术期心理应激的干预作用，为制定食管癌患者围手术期心理干预方案提供科学依据。研究方法选择2011年5月-2012年5月期间，在我院经病理学诊断为食管鳞形细胞癌住院病例67例，，随机均分为对照组32例和干预组35例，另选65名健康人作为健康对照组。健康对照组仅做心理状况评估；对照组患者接受手术治疗和常规护理；干预组患者在对照组治疗方案的基础上，采用一系列稳定化技术进行围手术期全程心理干预。干预组和对照组分别于手术前及手术后，采用汉密顿抑郁量表(HAMD)、汉密顿焦虑量表(HAMA)和匹兹堡睡眠质量指数（PSQI）量表进行评定；干预组和对照组分别于手术后7天按照国内制定的肿瘤患者生活质量评分方法评价患者的生活质量，选择食欲评分、疼痛评分、家庭理解与配合和疾病认识四个维度；比较干预组和对照组手术后使用止痛剂时间、手术后自行排痰时间、卧床时间、住院时间和手术后并发症的发生率。所获得的计量数据使用spssl7.0软件进行统计分析。研究结果食管癌患者手术前HAMD和HAMA评分均高于健康对照组，其差异有统计学意义（P0.05），干预组与对照组比较，HAMD和HAMA评分手术前无显著性差异（P0.05）；干预组和对照组患者手术后HAMD和HAMA评分比较，干预组显著低于对照组（P0.05）；干预组手术前后比较，HAMD和HAMA评分均具有显著性差异（P0.05）；对照组手术前后比较，HAMD评分无显著性差异(P0.05)，HAMA评分具有显著性差异（P0.05）。食管癌患者手术前PSQI评分高于健康对照组，其差异具有统计学意义(P0.05)；手术前PSQI各分量表评分比较，干预组和对照组患者均无显著性差异(P0.05)，手术后两组评分比较，除“催眠药物”和“日间功能障碍”2个因子外，其它各因子评分干预组均显著低于对照组(P0.05)；干预组手术前后睡眠质量各因子评分比较，除“催眠药物”和“日间功能障碍”2个因子外，其它各因子评分手术后均显著低于手术前(P0.05)，对照组手术前后睡眠质量各因子评分比较，均无显著性差异(P0.05)。干预组手术后使用止痛剂时间明显短于对照组，统计检验具有显著性差异(P0.01)；干预组患者手术后自行排痰时间显著短于对照组，其中干预组82．8％的患者在48小时内自行排痰，对照组28.1％的患者在48小时内自行排痰，差异具有显著性(P0.01)；干预组手术后卧床时间、住院时间均显著短于对照组(P0.01)。比较手术后7天时干预组和对照组患者在食欲、疼痛、家庭理解与配合和疾病认识四个维度的评分，结果均具有显著性差异(P0.05)。干预组手术后并发症6例，发生率17.1％，对照组手术后并发症12例，发生率37.5％。两组手术后并发症发生率无显著性差异(P0.05)。结论食管癌患者在围手术期心理应激过程中表现出较高的焦虑、抑郁水平和睡眠障碍。稳定化技术可以显著改善患者的心理应激状况和手术后康复状况，包括降低焦虑、抑郁水平，改善睡眠质量，减少使用止痛剂时间，促进患者自行排痰，缩短卧床时间和住院时间，并通过增强食欲、缓解疼痛、增进家庭的理解和配合及提高对疾病的认识改善手术后生活质量。稳定化技术对手术后食管癌患者并发症的发生率无显著影响。
[Abstract]:research objective
Objective to explore the characteristics of psychological stress in patients with esophageal cancer during perioperative period, and to evaluate the intervention effect of stabilization technology on perioperative psychological stress in esophageal cancer patients, so as to provide scientific basis for formulating psychological intervention program for esophageal cancer patients during perioperative period.
research method
In May 2011 -2012 year in May period in our hospital diagnosed by pathology of esophageal squamous cell carcinoma 67 cases, were randomly divided into control group of 32 cases and 35 cases in the intervention group, another 65 healthy people as control group. The control group only do psychological health assessment; control group patients received surgical treatment the intervention group and routine nursing care; patients in the control group based on the treatment, using a series of stabilization technology during operation. Psychological intervention during the intervention group and control group respectively before and after operation, using the Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA) and sleep quality index in Pittsburgh (PSQI) scale was evaluated; the intervention group and control group respectively in 7 days after surgery in cancer patients' quality of life score method to develop domestic evaluation of the quality of life of patients, choice of appetite score, pain score, family understanding The four dimensions of cooperation and cognition of disease were compared. The time of postoperative pain relief, the time of sputum excretion after operation, the time of lying in bed, the time of hospitalization and the incidence of postoperative complications were compared between the intervention group and the control group. The data obtained were statistically analyzed by spssl7.0 software.
Research results
Before HAMD and HAMA esophageal surgery cancer patients were higher than that of the healthy control group, the difference was statistically significant (P0.05) group, the intervention group and the control, HAMD and HAMA score before surgery had no significant difference (P0.05); the intervention group and the control group of patients with postoperative HAMD and HAMA score of intervention group was significantly lower than the compared. The control group (P0.05); the intervention group before and after surgery, HAMD score and HAMA score were significant difference (P0.05); the control group before and after surgery, HAMD score was no significant difference (P0.05), the HAMA score had significant difference (P0.05).
In patients with esophageal cancer PSQI score higher than that of the control group, the difference was statistically significant (P0.05); PSQI before operation of each subscale scores between the intervention group and the control group had no significant difference (P0.05). The score of the two groups after surgery, in addition to the "hypnotic" and "daytime dysfunction" 2 factor, other factor scores of intervention group were significantly lower than the control group (P0.05); the intervention group before and after surgery, the sleep quality factor scores were compared, in addition to the "hypnotic" and "daytime dysfunction" 2 factor, other factor scores were significantly lower than that before surgery after surgery (P0.05), the control group before and after surgery to sleep the quality of each factor were compared, there was no significant difference (P0.05).
The intervention group after surgery analgesic time was shorter than the control group, statistical significant difference (P0.01); the intervention group patients after surgery to expectoration time was significantly shorter than the control group, the intervention group of 82.8% patients in 48 hours by sputum, the control group of 28.1% patients in 48 hours to row the sputum, the difference was significant (P0.01); the intervention group after the surgery bed time, hospitalization time was significantly shorter than the control group (P0.01).
On the 7 day after operation, the scores of appetite, pain, family understanding and cooperation and disease cognition in four dimensions of intervention group and control group were significantly different (P0.05).
In the intervention group, there were 6 cases of postoperative complications, the incidence rate was 17.1%. There were 12 cases of postoperative complications in the control group, the incidence was 37.5%.. There was no significant difference in the incidence of postoperative complications between the two groups (P0.05).
conclusion
Esophageal cancer patients showed higher anxiety in psychological stress during perioperative period, depression and sleep disorder. The stabilization technology can significantly improve the rehabilitation status of patients with psychological stress and after surgery, including lower anxiety and depression levels, improve sleep quality, reduce the use of analgesics, promote patients to sputum, shorten the stay in bed and hospitalization time, and by enhancing the appetite, relieve pain, promote family understanding and cooperation and improve understanding of the disease and improve the quality of life after surgery. The stabilization technology on postoperative esophageal cancer patients and the incidence of complications had no significant effect.

【学位授予单位】：中国人民解放军军医进修学院
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R735.1;R395

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