本文關鍵詞：穩(wěn)定化技術對食管癌患者圍手術期心理應激的干預研究　出處：《中國人民解放軍軍醫(yī)進修學院》2012年碩士論文　論文類型：學位論文

  更多相關文章： 穩(wěn)定化技術 食管癌 圍手術期 心理應激 心理干預

【摘要】：研究目的 探討食管癌患者圍手術期的心理應激特征，評價穩(wěn)定化技術對食管癌患者圍手術期心理應激的干預作用，為制定食管癌患者圍手術期心理干預方案提供科學依據。 研究方法 選擇2011年5月-2012年5月期間，在我院經病理學診斷為食管鱗形細胞癌住院病例67例，，隨機均分為對照組32例和干預組35例，另選65名健康人作為健康對照組。健康對照組僅做心理狀況評估；對照組患者接受手術治療和常規(guī)護理；干預組患者在對照組治療方案的基礎上，采用一系列穩(wěn)定化技術進行圍手術期全程心理干預。干預組和對照組分別于手術前及手術后，采用漢密頓抑郁量表(HAMD)、漢密頓焦慮量表(HAMA)和匹茲堡睡眠質量指數(shù)（PSQI）量表進行評定；干預組和對照組分別于手術后7天按照國內制定的腫瘤患者生活質量評分方法評價患者的生活質量，選擇食欲評分、疼痛評分、家庭理解與配合和疾病認識四個維度；比較干預組和對照組手術后使用止痛劑時間、手術后自行排痰時間、臥床時間、住院時間和手術后并發(fā)癥的發(fā)生率。所獲得的計量數(shù)據使用spssl7.0軟件進行統(tǒng)計分析。 研究結果 食管癌患者手術前HAMD和HAMA評分均高于健康對照組，其差異有統(tǒng)計學意義（P0.05），干預組與對照組比較，HAMD和HAMA評分手術前無顯著性差異（P0.05）；干預組和對照組患者手術后HAMD和HAMA評分比較，干預組顯著低于對照組（P0.05）；干預組手術前后比較，HAMD和HAMA評分均具有顯著性差異（P0.05）；對照組手術前后比較，HAMD評分無顯著性差異(P0.05)，HAMA評分具有顯著性差異（P0.05）。 食管癌患者手術前PSQI評分高于健康對照組，其差異具有統(tǒng)計學意義(P0.05)；手術前PSQI各分量表評分比較，干預組和對照組患者均無顯著性差異(P0.05)，手術后兩組評分比較，除“催眠藥物”和“日間功能障礙”2個因子外，其它各因子評分干預組均顯著低于對照組(P0.05)；干預組手術前后睡眠質量各因子評分比較，除“催眠藥物”和“日間功能障礙”2個因子外，其它各因子評分手術后均顯著低于手術前(P0.05)，對照組手術前后睡眠質量各因子評分比較，均無顯著性差異(P0.05)。 干預組手術后使用止痛劑時間明顯短于對照組，統(tǒng)計檢驗具有顯著性差異(P0.01)；干預組患者手術后自行排痰時間顯著短于對照組，其中干預組82．8％的患者在48小時內自行排痰，對照組28.1％的患者在48小時內自行排痰，差異具有顯著性(P0.01)；干預組手術后臥床時間、住院時間均顯著短于對照組(P0.01)。 比較手術后7天時干預組和對照組患者在食欲、疼痛、家庭理解與配合和疾病認識四個維度的評分，結果均具有顯著性差異(P0.05)。 干預組手術后并發(fā)癥6例，發(fā)生率17.1％，對照組手術后并發(fā)癥12例，發(fā)生率37.5％。兩組手術后并發(fā)癥發(fā)生率無顯著性差異(P0.05)。 結論 食管癌患者在圍手術期心理應激過程中表現(xiàn)出較高的焦慮、抑郁水平和睡眠障礙。穩(wěn)定化技術可以顯著改善患者的心理應激狀況和手術后康復狀況，包括降低焦慮、抑郁水平，改善睡眠質量，減少使用止痛劑時間，促進患者自行排痰，縮短臥床時間和住院時間，并通過增強食欲、緩解疼痛、增進家庭的理解和配合及提高對疾病的認識改善手術后生活質量。穩(wěn)定化技術對手術后食管癌患者并發(fā)癥的發(fā)生率無顯著影響。
[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.

【學位授予單位】：中國人民解放軍軍醫(yī)進修學院
【學位級別】：碩士
【學位授予年份】：2012
【分類號】：R735.1;R395

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