调查恶性肿瘤并肺小结节患者的心理状况并探讨手术和化疗的影响

发布时间：2018-04-20 14:37

本文选题：恶性肿瘤 + 肺小结节　；参考：《山东大学》2017年硕士论文

【摘要】：背景介绍:因为目前环境的恶化等原因,恶性肿瘤已经成为常见并且危害人类健康和生命的重大疾病之一,而且逐渐成为我国城市居民死亡的重要原因之一[1]。随着医疗技术以及科技的不断发展、进步,现代医学已经从"生物医学模式"转变为"生物-心理-社会医学模式",恶性肿瘤与患者心理因素的关系逐渐被重视。经过多次调查统计之后发现,在这些心理因素中,抑郁以及焦虑是病人最常出现的,这两种心理症状被称为病理性情绪反应,一般是因为病人在进行治疗的过程中产生的副作用以及疾病复发或转移所引起的[2]。有学者研究证实,抑郁情绪可是使恶性肿瘤患者的免疫功能受到抑制,能降低疼痛阈值,增加肿瘤恶化的风险,导致生活质量下降,并可使患者的预期生存期下降10到20个百分点,甚至导致有些恶性肿瘤患者的直接死亡原因可能不是肿瘤的恶化,而是抑郁状态造成的[3]。随着恶性肿瘤患者生存期的延长以及高分辨率CT的广泛应用,目前恶性肿瘤合并肺小结节的出现越来越普遍,但目前恶性肿瘤合并肺小结节与心理因素关系的相关报道较少,而且以往其常被视为肿瘤晚期,多采用化疗的治疗方式,近年来有研究显示,恶性肿瘤并多原发肺癌和结核的发病率逐渐升高,也有证据表明外科手术现己不再是肺转移癌的绝对禁忌[4]。两种治疗方式各有利弊,两者对于恶性肿瘤合并肺小结节的疗效也尚无大量数据证实,近来有学者提出,评价肿瘤的治疗方案是否有效的标准,不仅要看经治疗后患者的生存期,还要看是否缓解了患者的症状,改善了生活质量。本文主要采用调查问卷的方式,调查恶性肿瘤合并肺小结节患者的心理状况,观察化疗和手术治疗对患者焦虑、抑郁情绪的短期和长期影响,并结合相关文献内容,从改善患者生活质量等方面探讨两种治疗方式的疗效。研究对象与方法：选择山东省千佛山医院自2014年1月1日至2016年6月30日就诊的40例恶性肿瘤合并肺小结节的患者,其中进行外科手术治疗者22例,化疗者18例。两组患者总共进行4次焦虑自评量表(SAS)和抑郁自评量表(SDS)的问卷调查,并分别于治疗后每3个月复查一次胸部CT,6个月后随访。对每人都进行4次焦虑和抑郁自评量表的调查。第1次焦虑和抑郁自评量表的问卷调查于治疗前进行,第2、3、4次测量手术组于治疗后1周、2个月、4个月,化疗组于化疗第1周期结束后1周,第2周期、第4周期后。问卷收回后仔细检查防漏项,将每份问卷进行总分积累,分次分组进行平均分计算,并将所有结果应用SPSS19.0统计软件进行比较分析。结果:本次研究共纳入40例恶性肿瘤合并肺小结节的患者,分为手术组22例和化疗组18例,两组患者治疗前在年龄、性别、SAS和SDS得上无差异(P0.05)。手术组和化疗组患者焦虑自评量表、抑郁自评量表平均得分均超过正常范围(SAS50,SDS40),得分普遍分布于中度的水平,且两组得分相比差距不大,差异无统计学意义(P0.05)。治疗后:治疗后除第1次外,测量手术组的SAS、SDS得分均低于化疗组(P0.05)。手术组SAS、SDS的在第2次测量时得分高于术前(P＜0.05),第3次得分与术前无并异(P0.05),第4次SAS、SDS得分低于手术前(P＜0.05)。化疗组第3、4次测量SAS、SDS得分均高于化疗前(P＜0.05),化疗后第1次评分比化疗前低,但第3、4次评分又高于化疗前。6个月复查时两在新发结节数、死亡和放弃治疗无差异(P0.05)。结论:恶性肿瘤合并肺小结节患者的焦虑、抑郁情绪处于中度水平。手术组与化疗组比较,手术组可以明显减轻患者的焦虑抑郁情绪,改善患者的生活质量,并且不会影响患者治疗的依从性,患者复发率和死亡率较低,综上所述,可以认为手术治疗,在改善情绪和生活质量上与化疗相比,对恶性肿瘤合并肺小结节的患者更有效。
[Abstract]:Background: because of the deterioration of the environment and other reasons, malignant tumor has become one of the major diseases which are common and harmful to human health and life. And it has gradually become one of the important reasons for the death of urban residents in our country [1]., with the continuous development and progress of medical technology and technology, modern medicine has changed from "biomedical model". As a "biological psycho social medical model", the relationship between malignant tumor and psychological factors of patients is gradually paid attention. After many investigations and statistics, it is found that depression and anxiety are the most common in these psychological factors. These two psychological symptoms are called pathological emotional reactions, usually because patients are undergoing treatment. The side effects produced in the course and the [2]. study caused by the recurrence or metastasis of the disease have confirmed that depression can inhibit the immune function of patients with malignant tumor, reduce the threshold of pain, increase the risk of cancer deterioration, lead to a decline in the quality of life, and reduce the expected life of the patients by 10 to 20 percentage points, or even guide the patients. The cause of direct death in some patients with malignant tumor may not be the deterioration of the tumor, but the depression caused by the [3]. with the prolongation of the survival time of the patients with malignant tumor and the wide application of the high resolution CT. At present, the occurrence of malignant tumor with small pulmonary nodules is becoming more and more common, but the malignant tumors are combined with small pulmonary nodules and psychological causes. There are few reports on the relationship between the elements, and they are often regarded as late tumor and often treated with chemotherapy. In recent years, studies have shown that the incidence of malignant tumors and multiple primary lung cancer and tuberculosis is increasing gradually, and there is evidence that surgery is no longer an absolute taboo [4]. for lung metastasis, and the two treatments have advantages and disadvantages. The curative effect of both malignant tumor and small pulmonary nodule has not yet been confirmed. Recently, some scholars have suggested that the evaluation of the effective standard of the treatment plan of the tumor should not only look at the survival time of the patients after the treatment, but also see whether the symptoms of the patients are relieved and the quality of life is improved. This article mainly adopts the questionnaire method to improve the quality of life. To investigate the psychological status of patients with malignant tumor with small pulmonary nodules, observe the short-term and long-term effects of chemotherapy and surgical treatment on patients' anxiety and depression, and discuss the effect of the two ways of treatment in terms of improving the quality of life in patients with related literature. The subjects and methods of study were selected from Qianfo Hill hospital in Shandong province from 1 in 2014. 40 cases of malignant tumor with small pulmonary nodules were treated from 1 to June 30, 2016, of which 22 cases were treated with surgical treatment and 18 patients with chemotherapy. The two groups were investigated with 4 times of anxiety self rating scale (SAS) and self rating Depression Scale (SDS), and the chest CT was reviewed every 3 months after treatment, and followed up for 6 months. Each person carried out a survey of 4 self rating anxiety and depression scales. First times of anxiety and depression questionnaire were conducted before treatment, and the 2,3,4 group was measured at 1 weeks, 2 months, 4 months after treatment. The chemotherapy group had 1 weeks after the end of the first cycle of chemotherapy, second cycles, and fourth weeks. The volume was accumulated, the average score was calculated by the sub group and all the results were compared with the SPSS19.0 software. Results: 40 cases of malignant tumor combined with small pulmonary nodules were included in this study, which were divided into 22 cases in the operation group and 18 cases in the chemotherapy group. The two groups had no difference in age, sex, SAS and SDS before treatment (P0.05). The self rating anxiety scale of the patients in the operation group and the chemotherapy group were all higher than the normal range (SAS50, SDS40), and the scores were generally distributed in the moderate level, and the difference was not significant between the two groups, and the difference was not statistically significant (P0.05). After treatment, the SAS of the operation group was measured, and the scores of SDS were lower than those in the chemotherapy group (P 0.05). The score of SAS, SDS in the operation group was higher than that before the operation (P < 0.05), the third score and the preoperative no different (P0.05), fourth times SAS, and SDS score lower than before the operation (P < 0.05). The score of the chemotherapy group was higher than that before the chemotherapy (P < 0.05), and the first times after chemotherapy were lower than that before the chemotherapy, but the second grade was higher than that before the chemotherapy. There was no difference in the number of new hair nodules at the time of 6 months reexamination, and there was no difference between the death and the abandonment treatment (P0.05). Conclusion: the anxiety and depression of the patients with malignant tumor combined with small pulmonary nodules were in moderate level. Compared with the chemotherapy group, the operation group can obviously reduce the anxiety and depression of the patients, improve the quality of life of the patients, and do not affect the treatment of the patients. The compliance of the treatment, the rate of recurrence and mortality of patients is low. In summary, surgical treatment is considered to be more effective in improving mood and quality of life than chemotherapy and for patients with malignant tumors with small pulmonary nodules.

【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R730.5

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