心理干预对直肠癌肠造口患者的效果评价
发布时间：2018-09-18 11:42
【摘要】： 目的:通过对比不同处理组的量表评分包括焦虑自评量表(SAS)、抑郁自评量表(SDS)和直肠癌生存质量调查量表(QOL)及实验室指标包括T细胞亚群的CD3、CD4、CD8、CD4/CD8和自然杀伤细胞(NK Cell)数目及白细胞计数(WBC),观察心理干预对直肠癌肠造口患者的效果,探讨心理干预对直肠癌肠造口患者情绪、免疫功能及生活质量的意义,对促进直肠癌肠造口患者康复和提高生活质量具有实践意义。 方法:从山西省肿瘤医院肛肠科2008年5月至9月的现任住院病人中根据入组标准选取直肠癌术后肠造口患者共62例,以随机分组(随机数字表)的方法划分为干预组和对照组,干预组患者32例,对照组患者30例。对干预组施行常规治疗加心理干预三个月,在此期间对照组行常规治疗。干预前、后对比两组患者的量表评分和实验室指标及进行前—后测差值比较。 结果:(1)干预组和对照组患者干预前对比,在年龄、性别、职业、婚姻状况、经济状况、既往病史、造口时间、受教育程度方面均无统计学差异(P0.05),在量表评分和实验室指标方面亦无统计学差异(P0.05),可视为两组患者具有均衡性。两组患者SDS评分和SAS评分均高于国内常模,提示直肠癌肠造口患者存在焦虑、抑郁情绪。(2)干预组经心理干预,在量表评分和实验室指标方面与对照组均存在统计学差异。其SDS评分显著低于对照组(P0.01);其SAS评分显著低于对照组(P0.05);同时,干预组QOL总分显著高于对照组(P0.01),且心理因子评分和社会因子评分分别显著高于对照组(P0.05),提示心理干预可帮助改善肠造口患者的情绪状态和生活质量。CD3数量显著高于对照组(P0.01); CD4数目显著高于对照组(P0.05); CD8数目显著高于对照组(P0.05); NK Cell数量显著高于对照组(P0.01); WBC计数显著高于对照组(P0.05),提示心理干预有助于提高肠造口患者的免疫功能。(3)经心理干预,干预组前测—后测差值与对照组前测—后测差值存在显著性差异。在量表评分方面,干预组SDS差值与对照组相比具有显著性差异(P0.01),干预组SAS差值与对照组存在显著性差异(P0.05),提示是心理干预的效力使干预组患者自身焦虑、抑郁情绪降低,促进了情绪的改善。在实验室指标方面,干预组和对照组在CD3差值和CD8差值上有显著性差异(P0.01),且对照组差值显著高于干预组;两组患者在NK Cell差值上也存在显著性差异(P0.05),对照组差值显著高于干预组。以上结果提示,心理干预有效保护了干预组的免疫功能,而未经心理干预的对照组则更多地受到化疗副反应的影响,出现免疫功能的下降。(4)对具有显著性意义的差值进行多元逐步回归分析,SDS差值、SAS差值、CD3差值、CD8差值、NK Cell差值的主要相关因素为心理干预。 结论:直肠癌肠造口患者明显存在焦虑、抑郁情绪,免疫功能低下,长期处于这样的状态下,导致生活质量差,容易影响疾病的预后和转归。心理干预可有效改善直肠癌肠造口患者的焦虑、抑郁情绪,积极、健康的心理状况有助于纠正低下的免疫功能,进而提高患者生活质量,帮助和促进直肠癌肠造口患者康复乃至延长生存期。
[Abstract]:Objective: To observe the effect of psychological intervention on rectal cancer intestinal construction by comparing the scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), rectal cancer quality of life inventory (QOL) and laboratory indexes including CD3, CD4, CD8, CD4 / CD8, natural killer cell (NK cell) and white blood cell count (WBC) in different treatment groups. To explore the effect of psychological intervention on emotion, immune function and quality of life of patients with rectal cancer undergoing enterostomy, and to promote the rehabilitation and improve the quality of life of patients with rectal cancer undergoing enterostomy.
Methods: According to the admission criteria, 62 patients with rectal cancer undergoing enterostomy were selected from the current inpatients in Anorectal Department of Shanxi Cancer Hospital from May to September 2008. The patients were randomly divided into intervention group and control group, 32 patients in intervention group and 30 patients in control group. Three months after intervention, the control group received routine treatment. Before and after intervention, the scale scores, laboratory indexes and the difference between the two groups were compared.
Results: (1) There was no significant difference in age, sex, occupation, marital status, economic status, previous medical history, stoma time, education level between the intervention group and the control group before intervention (P The scores of SDS and SAS were significantly lower than those of the control group (P 0.01), and the scores of SAS were significantly lower than those of the control group (P 0.05). The total score of OL was significantly higher than that of the control group (P 0.01), and the scores of psychological factors and social factors were significantly higher than those of the control group (P 0.05), suggesting that psychological intervention can help improve the emotional state and quality of life of patients with enterostomy. The number of NK Cells in the intervention group was significantly higher than that in the control group (P 0.05), and the WBC count was significantly higher than that in the control group (P 0.05), suggesting that psychological intervention can improve the immune function of patients with enterostomy. The difference of SAS between intervention group and control group was significant (P 0.01), suggesting that the effect of psychological intervention could reduce the anxiety and depression of intervention group, and promote the improvement of emotion. The difference was significant (P 0.01), and the difference between the control group and the intervention group was significantly higher. The difference between the two groups was also significant (P 0.05). The difference between the control group and the intervention group was significantly higher. (4) Multivariate stepwise regression analysis was used to analyze the significant difference. The main related factors of SDS difference, SAS difference, CD3 difference, CD8 difference and NK Cell difference were psychological intervention.
Conclusion: Anxiety, depression and low immune function exist in rectal cancer patients with enterostomy, which lead to poor quality of life and prognosis of the disease. Psychological intervention can effectively improve the anxiety, depression, positive and healthy psychological status of rectal cancer patients with enterostomy. Immune function, and then improve the quality of life of patients, help and promote rectal cancer patients with enterostomy rehabilitation and even prolong survival.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R735.37;R395.5
[Abstract]:Objective: To observe the effect of psychological intervention on rectal cancer intestinal construction by comparing the scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), rectal cancer quality of life inventory (QOL) and laboratory indexes including CD3, CD4, CD8, CD4 / CD8, natural killer cell (NK cell) and white blood cell count (WBC) in different treatment groups. To explore the effect of psychological intervention on emotion, immune function and quality of life of patients with rectal cancer undergoing enterostomy, and to promote the rehabilitation and improve the quality of life of patients with rectal cancer undergoing enterostomy.
Methods: According to the admission criteria, 62 patients with rectal cancer undergoing enterostomy were selected from the current inpatients in Anorectal Department of Shanxi Cancer Hospital from May to September 2008. The patients were randomly divided into intervention group and control group, 32 patients in intervention group and 30 patients in control group. Three months after intervention, the control group received routine treatment. Before and after intervention, the scale scores, laboratory indexes and the difference between the two groups were compared.
Results: (1) There was no significant difference in age, sex, occupation, marital status, economic status, previous medical history, stoma time, education level between the intervention group and the control group before intervention (P The scores of SDS and SAS were significantly lower than those of the control group (P 0.01), and the scores of SAS were significantly lower than those of the control group (P 0.05). The total score of OL was significantly higher than that of the control group (P 0.01), and the scores of psychological factors and social factors were significantly higher than those of the control group (P 0.05), suggesting that psychological intervention can help improve the emotional state and quality of life of patients with enterostomy. The number of NK Cells in the intervention group was significantly higher than that in the control group (P 0.05), and the WBC count was significantly higher than that in the control group (P 0.05), suggesting that psychological intervention can improve the immune function of patients with enterostomy. The difference of SAS between intervention group and control group was significant (P 0.01), suggesting that the effect of psychological intervention could reduce the anxiety and depression of intervention group, and promote the improvement of emotion. The difference was significant (P 0.01), and the difference between the control group and the intervention group was significantly higher. The difference between the two groups was also significant (P 0.05). The difference between the control group and the intervention group was significantly higher. (4) Multivariate stepwise regression analysis was used to analyze the significant difference. The main related factors of SDS difference, SAS difference, CD3 difference, CD8 difference and NK Cell difference were psychological intervention.
Conclusion: Anxiety, depression and low immune function exist in rectal cancer patients with enterostomy, which lead to poor quality of life and prognosis of the disease. Psychological intervention can effectively improve the anxiety, depression, positive and healthy psychological status of rectal cancer patients with enterostomy. Immune function, and then improve the quality of life of patients, help and promote rectal cancer patients with enterostomy rehabilitation and even prolong survival.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2009
【分类号】：R735.37;R395.5
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