团体电脑游戏版豁达治疗对肺癌的康复作用的研究

发布时间：2018-06-10 17:56

本文选题：团体电脑游戏版豁达治疗 + 肺癌　；参考：《广东药科大学》2017年硕士论文

【摘要】：背景:全球每年约有820万人死于癌症,肺癌约占全部癌症死亡的27.07%,是癌症死亡的首要原因,我国肺癌发病率和死亡率均居癌症之首。肺癌的治疗方式一直是国内外研究的热点,目前肺癌的主要治疗包括手术治疗、药物化学治疗、放射治疗、靶向治疗及联合治疗等,但肺癌仍然是全球范围内的难治性疾病。肺癌患者在经历各种治疗方式对身体削弱的同时,心理上也承受着巨大的折磨,出现不同程度的心理应激,有研究显示肺癌患者普遍存在焦虑、抑郁、失落等负性情绪。因此,研究适用于肺癌患者的心理干预方式以提高临床疗效和肺癌患者生存质量显得尤为重要。前期临床研究显示,团体电脑豁达治疗应用于乳腺癌患者,能够显著改善乳腺癌患者的应对方式和心理调节,为团体电脑游戏版豁达治疗对肺癌患者的康复作用的研究奠定了坚实的基础。目的:对肺癌住院患者进行团体电脑游戏版豁达治疗,并从心理状态、社会功能、潜意识、生理、免疫功能等多个维度对干预效果进行评价,为肺癌住院患者的心理、生理及社会康复提供理论与方法的实证资料。方法:1、汇同前期研究成果,制作完成改良团体电脑游戏版豁达治疗(Collective Computer Game-version Magnanimous Therapy,CCGMT)软件,在原有的电脑豁达治疗的基础上引入团体治疗和游戏治疗的形式,以丰富生动的游戏为载体增加治疗的趣味性、互动性,提高患者的依从性,以团体治疗的模式提高治疗效率、强化疗效,为患者提供社会支持和情感寄托、提升社会功能。2、对符合入组标准的72例肺癌住院患者按照匹配分组原则,分为CCGMT组36人和对照组36人。在常规肺癌治疗的基础上,将CCGMT组分为3-4人的团体治疗小组,给予团体电脑游戏版豁达治疗2周,每周4次,每次约40分钟;对照组仅按照常规肺癌临床治疗,不给予心理治疗。所有患者均在治疗前及2周后均通过癌症患者心身状态量表(Psychosomatic Statue Scale for Canner Patients,PSSCP)、T型心理量表(Tumour Psychological Scale,TPS)、癌症患者心理调节量表(Psychological Adjustment Scale for Cancer Patients,PASCP)、癌症应对问卷(Cancer Coping Modes Questionnaire,CCMQ)、进取豁达问卷(Enterprising and Magnanimous Questionnaire,EMQ)、癌症病人生活功能指标量表(Functional Living Index-Cancer,FLIC)、医院焦虑抑郁量表(Hospital Anxiety Depression,HAD)和潜意识绘画房-树-人测验,进行心理及社会功能的评价;采用生物反馈仪记录呼吸、心率、血压、脑电波值,静脉采血检查免疫细胞Ig A、Ig G、Ig M、NK值评价患者的生理指标。结果:1.完成改良版团体电脑游戏版豁达治疗(CCGMT)软件的制作。2.心理、社会指标结果(1)PSSCP评分:心理干预2周后,CCGMT组在“总分”、“心理”维度、“躯体”维度评分、“社会功能”维度、“心理行为可塑性”维度的评分均较入院时降低,差异有统计学意义(p0.05);对照组2周后“总分”、“躯体”维度评分、“心理可塑性”维度评分较入院时增高,差异有统计学意义(p0.05),“心理”维度、“社会功能”维度评分与入院时的差异无统计学意义(p0.05)。组间比较显示,CCGMT组与对照组2周前后的差值在“总分”、“心理”维度、“躯体”维度评分、“社会功能”维度、“心理行为可塑性”维度的差异均有统计学意义(p0.05).(2)TPS评分:两组2周后在总均分、“个性特点”维度、“认知习惯”维度、“情绪表现”维度和“潜意识”维度的评分与入院时相比,差异均无显著性(p0.05)。(3)PASCP评分:CCGMT组干预2周后总均分、“情绪/自尊”维度、“主观感觉”维度、“人际关系/社会生活”维度、“日常生活”维度和“其他”维度评分均高于入院时,差异有显著性(p0.05);对照组2周后总均分、“情绪/自尊”维度、“主观感觉”维度、“人际关系/社会生活”维度、“日常生活”维度和“其他”维度与入院时相比,均差异无显著性(p0.05)。组间比较显示,CCGMT组与对照组2周前后在的差值在“主观感觉”维度、“人际关系/社会生活”维度均有统计学意义(p0.05);两组2周前后差值在“总均分”、“情绪/自尊”维度、“日常生活”维度和“其他”维度无显著性差异(p0.05)。(4)CCMQ评分:CCGMT组在干预2周后的“面对”维度高于入院时,干预2周后“回避与压抑”和“屈服”维度低于入院时,差异有显著性(p0.05);而在“总均分”、“幻想”和“发泄”维度2周前后无显著性差异(p0.05);对照组2周后“总均分”、“面对”维度、“回避与压抑”维度、“屈服”维度、“幻想”维度、“发泄”维度与入院时相比,差异无统计学意义(p0.05)。组间比较结果为,CCGMT组与对照组2周前后在的差值在“面对”维度、“屈服”维度均有统计学意义(p0.01);两组2周前后差值在“回避与压抑”维度差异无显著性(p0.05)。(5)EMQ评分:CCGMT组干预2周后“积极进取”维度高于入院时(35.03±4.55),差异有统计学意义(p0.05);而在“总分”、“豁达宽容”维度与2周前相比,无显著性差异(p0.05);对照组2周后“总分”、“积极进取”维度、“豁达宽容”维度与入院时相比,差异均无显著性(p0.05)。组间比较显示,在“积极进取”维度CCGMT组与对照组2周前后差值的差异有统计学意义(p0.05)。(6)FLIC评分:CCGMT组干预2周后“总均分”、“躯体良好和能力”维度、“心理良好”维度、“社会良好”维度高于入院时,“因癌造成的艰难”维度低于入院时,差异有统计学意义(p0.05),而“恶心”维度在2周后较入院时降低,但差异无显著性(p0.05);对照组2周后“总均分”、“躯体良好和能力”维度、“心理良好”维度、“社会良好”维度低于入院时,“因癌造成的艰难”、“恶心”维度高于入院时,但差异无统计学意义(p0.05)。CCGMT组与对照组入院时在“总均分”、“躯体良好和能力”维度、“心理良好”维度、“因癌造成的艰难”、“社会良好”维度评分差异均无统计学意义(p0.05);组间比较显示,CCGMT组与对照组2周前后的差值在“躯体良好和能力”维度、“心理良好”维度、“社会良好”维度的差异均有统计学意义(p0.05).(7)HAD评分:CCGMT组干预2周后总分、焦虑评分、抑郁评分低于入院时,且具有显著性差异(p0.01);对照组2周后总分、焦虑评分、抑郁评分较入院时无显著性差异(p0.05)。CCGMT组与对照组入院时在总分、焦虑评分、抑郁评分差异均无统计学意义(p0.05);2周后两组在总分、焦虑评分、抑郁评分均有显著性差异(p0.01)。CCGMT组与对照组2周前后的差值在总分、焦虑评分、抑郁评分有显著性差异(p0.01).(8)房-树-人投射测验:CCGMT组经过2周的心理治疗后较入院时,画面内容更为丰富,房、树、人形态更饱满、更有生命力,画面整体的比例更协调,笔触流畅、清晰,无反复涂擦痕迹,断枝、将人或树涂黑、树干创伤、房屋缺损等消极投射点减少,房屋完整、树叶繁茂、人物带笑等积极投射点较多;对照组2周后,房-树-人绘画各部分内容仍为简单罗列,无附加物、无远近感,整体画面布局不协调,笔触犹豫、断续,有多处涂改痕迹,积极投射点较少,人物呆立、肢体不全等消极投射点较前增多。3.生理指标结果(1)CCGMT组干预2周后,收缩压值、心率值较入院时有所下降,差异具有显著性(p0.05),舒张压、呼吸数值2周前后差异无统计学意义(p0.05);对照组2周后,收缩压值、舒张压、心率和呼吸数值较入院时均无显著性差异(p0.05)。组间比较显示,CCGMT组与对照组2周前后心率的差值有显著性差异(p0.05)。(2)在干预2周后,CCGMT组皮电和θ波值较入院时降低,差异均具有显著性(p0.01);皮温、α波、β波、SMR波值较2周前降低,但差异无统计学意义(p0.05)。对照组2周后,β波、θ波值较前下降,皮电、皮温、α波和SMR波值较入院时升高,但差异均无统计学意义(p0.05)。组间比较显示,CCGMT组与对照组2周前后皮电、θ波数值的差值有显著性差异(p0.01)。(3)免疫球蛋白三项及NK细胞值比较:在进行团体电脑游戏版豁达治疗2周后,CCGMT组Ig A和NK细胞值较入院时升高,且差异具有显著性(p0.05),Ig G和Ig M值在2周前后差异无统计学意义(p0.05);对照组在常规肺癌治疗2周后,Ig G和NK细胞值较入院时降低,且差异有统计学意义(p0.05)。组间比较显示,CCGMT组与对照组2周后在的差值在Ig A和NK细胞值有统计学意义(p0.05)。4.临床定性评价团体电脑游戏版豁达治疗结合电脑豁达治疗、团体治疗和游戏心理治疗的优势,得到了临床肺癌患者的一致肯定,认为其生动有趣、简单易行、交互性强、富含哲理,能有效帮助患者改善不良情绪、调整应对方式、提高心理调节能力,使患者在心身得到愉悦的同时促进了患者与患者之间、医生与患者之间的关系良好发展,形成和谐的治疗氛围,为患者提供社会支持、改善社会功能,提高临床抗肿瘤治疗效果和肺癌患者的生存质量,得到了广泛认可。结论:团体电脑游戏版豁达治疗对肺癌住院患者的心身状态、社会功能及生存质量均有积极的作用。本治疗通过简单有趣、贴近生活、交互性强的电脑游戏的方式,将积极乐观、理解接受、平衡包容、平静愉悦、放旷自如的人生态度渗透到每一次治疗中,帮助患者调节紧张、焦虑、悲观、抑郁等负性情绪,改善患者心理调节能力和心理应对能力,并对血压、心率、皮电、脑电波、Ig A及NK细胞值能生理指标都有明显的改善。通过房-树-人投射测验可以观察到,在接受治疗后肺癌患者的潜意识出现一定程度的良性变化。肺癌患者普遍认为接受治疗能使心身愉悦,明显提高生活质量,改善医生与患者、患者与患者之间的关系,提高临床抗肿瘤治疗的积极性和疗效。团体电脑游戏版豁达治疗作为一种有效的心理治疗方式,有利于临床肺癌患者心理、生理、社会功能、临床疗效及生存质量的改善,为临床肿瘤的综合治疗提供了实证依据。
[Abstract]:Background: about 8 million 200 thousand people die from cancer every year around the world. Lung cancer accounts for about 27.07% of all cancer deaths. It is the leading cause of cancer death. The incidence and mortality of lung cancer in China are the first. The treatment of lung cancer has always been a hot spot at home and abroad. The main treatment of lung cancer includes surgical treatment, chemical therapy, radiation treatment. Treatment, targeted therapy and combined therapy, but lung cancer is still a global refractory disease. Lung cancer patients suffer from a variety of treatment methods to weaken the body, while the psychological also bear a huge torment, there are different degrees of psychological stress, there is a research show that the lung cancer patients generally have anxiety, depression, loss and other negative emotions. Therefore, it is very important to study the psychological intervention for patients with lung cancer in order to improve the clinical effect and the quality of life of the patients with lung cancer. The earlier clinical study showed that the application of group computer immunity to breast cancer patients could significantly improve the coping style and psychological adjustment of the breast cancer patients, and the group computer game version was treated with open-minded therapy. The study of the rehabilitation of lung cancer patients has laid a solid foundation. Objective: to carry out the group computer game therapy of lung cancer patients and evaluate the intervention effect from the psychological state, social function, subconscious, physiological and immune function, and provide the theory of psychological, physiological and social rehabilitation for the hospitalized patients with lung cancer. Methods: 1, 1, remittance with the previous research results, the completion of the improved group computer game version of open-minded therapy (Collective Computer Game-version Magnanimous Therapy, CCGMT) software, based on the original computer open-minded treatment based on the introduction of group therapy and game therapy in the form of rich and vivid games for the carrier. With the interest, interaction, improvement of patient compliance, group treatment to improve the efficiency of treatment, strengthen the curative effect, provide social support and emotional support for the patients, improve the social function.2, 72 cases of lung cancer patients who conform to the standard of the group are divided into 36 group and 36 control group according to the matching division principle, in the routine lung. On the basis of cancer treatment, group CCGMT was divided into group treatment group of 3-4 people, which was given group computer game version of open-minded therapy for 2 weeks, 4 times a week, about 40 minutes each time. The control group was only treated with conventional lung cancer, and no psychotherapy was given. All patients passed the heart and body state scale (Psychosomatic Sta) before and after 2 weeks. Tue Scale for Canner Patients, PSSCP), T type psychological scale (Tumour Psychological Scale, TPS), cancer patient psychological adjustment scale, cancer coping questionnaire, enterprising and open-minded questionnaire Functional Living Index-Cancer (FLIC), the hospital anxiety and Depression Scale (Hospital Anxiety Depression, HAD) and the subconscious painting room tree man test, the evaluation of psychological and social functions, and the biological feedback instrument to record the respiratory, heart rate, blood pressure, brain wave value, and venous blood sampling to check the immune cell Ig. A, Ig G, Ig M, NK value to evaluate the physiological indicators of patients. Results: 1. complete the improved version of the group computer game version of open-minded therapy (CCGMT) software for the production of.2. psychology, social indicators (1) PSSCP score: after 2 weeks of psychological intervention, the CCGMT group in the "total score", "psychological" dimension, "body" dimension score, "social function" dimension, "psychological behavior can be" The score of plastic dimension was lower than that of admission, and the difference was statistically significant (P0.05). After 2 weeks, the score of "total score", "body" dimension, and "psychological plasticity" score were higher than that of admission. The difference was statistically significant (P0.05). The "psychological" dimension, "social function" dimension score and the difference of admission were not statistically significant. Meaning (P0.05). The difference between group CCGMT and control group showed that the difference between 2 weeks before and after the control group was in "total score", "psychological" dimension, "body" dimension score, "social function" dimension, "psychological behavior plasticity" dimension difference were statistically significant (P0.05). (2) TPS score: two groups after 2 weeks in the total average, "personality characteristics" dimension, "recognition". The score of knowledge and habit dimension, emotional expression dimension and subconscious dimension were not significant compared with admission (P0.05). (3) PASCP score: the total score of group CCGMT after 2 weeks, "emotion / self-esteem" dimension, "subjective sense" dimension, "interpersonal relationship / social life" dimension, "daily life" dimension and "other" The difference was significantly higher than that of admission (P0.05); the total average score of the control group 2 weeks later, "emotion / self-esteem", "subjective sense", "interpersonal relationship / social life", "daily life" and "other" dimensions were not significantly different from that of admission (P0.05). The comparison between groups showed that the CCGMT group and the pair were the same. The difference between the 2 weeks before and after 2 weeks in the "subjective sense" dimension, "interpersonal relationship / social life" dimension had statistical significance (P0.05); the difference between the two groups and the 2 weeks before and after the "total average", "emotion / self-esteem" dimension, "daily life" dimension and "other" dimension no significant difference (P0.05). (4) CCMQ score: group CCGMT after 2 weeks of intervention When the "face" dimension was higher than that of admission, after 2 weeks of intervention, the dimension of "avoidance and depression" and "yield" dimension were significantly lower than that of admission (P0.05), while there was no significant difference between the "total average", "fantasy" and "venting" dimensions before and after 2 weeks (P0.05); the control group was "total equal", "face" dimension, "avoidance and depression" after 2 weeks. There was no significant difference in dimension, "yield" dimension, "fantasy" dimension, and "vent" dimension compared with admission (P0.05). The results of comparison between group CCGMT and control group were statistically significant (P0.01) in "face" dimension, and the difference between the two groups and 2 weeks before and after 2 weeks was in the dimension of "avoidance and depression". There was no significant difference (P0.05). (5) EMQ score: the dimension of "positive and enterprising" in group CCGMT was higher than that of admission (35.03 + 4.55) after 2 weeks of intervention (P0.05), but there was no significant difference between the "total score" and the "open-minded tolerance" dimension compared with 2 weeks before (P0.05); the control group was "total score", "positive enterprising" dimension, "Huo Dakuan" after 2 weeks. The difference was not significant (P0.05). The difference between the "aggressive" dimension CCGMT group and the control group was statistically significant (P0.05). (6) the FLIC score: the CCGMT group intervened 2 weeks after 2 weeks, "the body good and the ability" dimension, the "good psychological" dimension, "the social good". "Good" dimension is higher than admission, "the difficulty caused by cancer" dimension is lower than admission, the difference is statistically significant (P0.05), but the "nausea" dimension after 2 weeks is lower than the admission, but the difference is not significant (P0.05); the control group after 2 weeks "total equal", "body good and ability" dimension, "good psychological" dimension, "good society" When the dimensions were lower than the admission, the "nausea" dimension was higher than that of admission, but the difference was not statistically significant (P0.05) in the.CCGMT group and the control group, the scores of "total equality", "good body and ability", "good psychological" dimension, "hardship made by cancer", and "good social" dimension score were all indifferent. Study significance (P0.05); the difference between group CCGMT and control group showed that there were significant differences in "good body and ability" dimension, "good psychological" dimension and "good social" dimension (P0.05). (7) HAD score: the total score, anxiety score, and depression score of group CCGMT were lower than that of admission, and the score of depression was lower than that of admission, and it was significant and significant. There was no significant difference in total score, anxiety score and depression score in the control group after 2 weeks (P0.05). There was no significant difference between the.CCGMT group and the control group at the total score, the anxiety score and the depression score (P0.05) in the.CCGMT group and the control group (P0.05); the two groups in the total score, the anxiety score and the depression score were significantly different (P0.01).CCGMT and the control group after the admission. The difference between the 2 weeks before and after the total score, the anxiety score and the depression score had significant difference (P0.01). (8) the room tree man projection test: after 2 weeks of psychological treatment, the CCGMT group was more rich in the content of the picture, the room, the tree, the human form were more full, more vitality, the proportion of the whole painting was more coordinated, the strokes were fluent, clear, and no repeated smear marks, After 2 weeks of the control group, the contents of the house - tree - man painting are still simple, no appendages, no distant sense, uncoordinated layout of the whole picture, hesitancy of strokes, intermittent, and multiple marks. The negative projection points were less than those of the previous increase of.3. physiological indexes (1) after the intervention of CCGMT group, the systolic pressure and heart rate decreased after 2 weeks, and the difference was significant (P0.05), diastolic pressure and respiratory value before and after 2 weeks (P0.05), and the contractile pressure of the control group after 2 weeks, the systolic pressure value, There was no significant difference in diastolic pressure, heart rate and respiratory value (P0.05). The difference between group CCGMT and control group was significant (P0.05). (2) after 2 weeks of intervention, the values of skin and theta in CCGMT group were lower than those at admission (P0.01), and the values of skin temperature, alpha, beta, SMR wave were lower than that of 2 weeks. Low, but the difference was not statistically significant (P0.05). After 2 weeks in the control group, the values of beta wave and theta wave were lower than before, and the values of skin electricity, skin temperature, alpha and SMR were higher than those at admission, but the difference was not statistically significant (P0.05). The difference between group CCGMT and the control group was significant (P0.01). (3) three items of immunoglobulin (3) three items of immunoglobulin. Compared with NK cell value: after 2 weeks of group computer game, the value of Ig A and NK cells in group CCGMT was higher than that of admission, and the difference was significant (P0.05). There was no statistical difference between Ig G and Ig M values before and after 2 weeks (P0.05). Study significance (P0.05). The difference between group CCGMT and control group showed that the difference between 2 weeks and the control group was statistically significant at Ig A and NK cell values (P0.05).4. clinical qualitative evaluation group computer game version of open-minded therapy combined with computer immunity, group therapy and game psychotherapy, and got the consistent affirmation of the clinical lung cancer patients. Lively and interesting, simple and easy to interact, rich in philosophy, can effectively help the patient to improve the bad mood, adjust the coping style, improve the psychological adjustment ability, make the patient in the heart and body pleasing, and promote the patient and patient, the good development of Guan Xiliang between the doctor and the patient, form a harmonious treatment atmosphere and provide the society for the patient. Support, improve social function, improve the effect of clinical antitumor treatment and the quality of life of lung cancer patients, it has been widely recognized. Conclusion: the group computer game version of open-minded therapy has a positive effect on the psychosomatic state, social function and quality of life of the patients with lung cancer. The way of brain games will be positive and optimistic, understanding acceptance, balance and tolerance, calm and pleasing, and an open and happy life attitude permeating every treatment, helping patients adjust the negative emotions such as tension, anxiety, pessimism, depression, and improve the patient's psychological adjustment and psychological coping ability, and the blood pressure, heart rate, skin electricity, brain wave, Ig A and NK cell values. There is a significant improvement in the physiological index. Through the house tree man projection test, it is observed that the subconsciousness of the lung cancer patients has a certain degree of benign change after the treatment. The lung cancer patients generally believe that the treatment can make the heart and body happy, improve the quality of life obviously, improve the relationship between the medical students and the patients, the relationship between the patients and the patients, and the improvement of the relationship between the patients and the patients. The initiative and efficacy of clinical antitumor therapy is an effective way of psychotherapy.
【学位授予单位】：广东药科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R734.2

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