發(fā)布時間：2018-06-12 01:12

  本文選題：癌癥 + 創(chuàng)傷后應(yīng)激障礙　； 參考：《蘇州大學(xué)》2013年碩士論文

【摘要】：目的：本研究采用病例-對照的方法，探討癌癥相關(guān)創(chuàng)傷后應(yīng)激障礙（cancer-relatedPTSD）的發(fā)生率、臨床癥狀特征、心理社會影響因素、自主神經(jīng)功能變化，分析PTSD核心癥狀與心率變異性(HRV)的相關(guān)性，探討評價PTSD核心癥狀的客觀生物學(xué)指標(biāo)，為癌癥相關(guān)PTSD的早期識別、臨床診斷及干預(yù)治療提供依據(jù)。 方法：通過臨床用創(chuàng)傷后應(yīng)激障礙診斷量表(CAPS)對150例癌癥患者進行診斷性訪談，采用創(chuàng)傷后應(yīng)激障礙自評量表（PCL-C）對PTSD組（n=37）和對照組（n=30）進行PTSD嚴(yán)重程度評估，完成一般情況調(diào)查表、T型心理量表（TP）、癌癥應(yīng)對問卷（CCMQ）、領(lǐng)悟社會支持量表（PSSS）。采用生理相干與自主神經(jīng)平衡系統(tǒng)對PTSD組、對照組、健康組（n=30）進行心率變異性檢測，評定自主神經(jīng)功能，分析HRV相關(guān)指標(biāo)與PTSD核心癥狀的相關(guān)性。 結(jié)果：1.癌癥相關(guān)PTSD的臨床特征及心理社會影響因素：（1）癌癥相關(guān)PTSD的總體發(fā)生率為24.67%，不同癌癥類型的PTSD發(fā)生率在14.29%（食管癌）至57.14%（卵巢癌）之間，無明顯統(tǒng)計學(xué)差異（P0.05）；不同病程長短的PTSD發(fā)生率均為25%左右，無明顯統(tǒng)計學(xué)差異（P0.05）；復(fù)發(fā)或轉(zhuǎn)移患者PTSD的發(fā)生率（45.28%）顯著高于無復(fù)發(fā)或轉(zhuǎn)移者（13.40%）（P0.01）；（2）PTSD組三大核心癥狀：再體驗（16.78±2.32）、回避（20.92±3.51）、警覺增高（18.00±2.27）均顯著高于對照組（P0.01），三大核心癥狀中以警覺增高最為顯著；（3）通過單因素分析，負(fù)債的癌癥患者PTSD的發(fā)生率顯著高于無負(fù)債者（P0.01），經(jīng)多因素分析，復(fù)發(fā)或轉(zhuǎn)移是癌癥相關(guān)PTSD的危險因素；（4）PTSD組TP總分（2.38±0.33）、認(rèn)知習(xí)慣（2.64±0.35）、情緒表現(xiàn)（2.40±0.50）、個性特征（2.47±0.44）顯著高于對照組（P0.01），癌癥相關(guān)PTSD癥狀的嚴(yán)重程度與TP總分、認(rèn)知習(xí)慣、情緒表現(xiàn)、個性特征顯著正相關(guān)（r=0.655、0.559、0.461、0.703，P0.01或P0.05）；(5) PTSD組較少采取面對（1.95±0.45）的應(yīng)對方式，而多采用回避和壓抑（2.30±0.44）、屈服（2.45±0.72）、幻想（2.32±0.50）、發(fā)泄（2.16±0.53）的應(yīng)對方式（P0.01或P0.05），癌癥相關(guān)PTSD癥狀的嚴(yán)重程度與面對的應(yīng)對方式顯著負(fù)相關(guān)（r=-0.452，P0.01），與回避和壓抑、屈服、發(fā)泄顯著正相關(guān)（r=0.492、0.346、0.352，P0.01或P0.05）；（6）PTSD組PSSS總分（55.49±9.34）、家庭內(nèi)支持（20.73±3.85）和家庭外支持（34.76±6.30）明顯低于對照組（P0.01），癌癥相關(guān)PTSD癥狀的嚴(yán)重程度與PSSS總分、家庭內(nèi)支持、家庭外支持顯著負(fù)相關(guān)（r=-0.808、-0.673、-0.786，P0.01）。 2.癌癥相關(guān)PTSD患者的心率變異性：（1）平靜狀態(tài)下，PTSD組SDNN（61.54±13.10）和HF（50.69±13.10）顯著下降，LF/HF(7.70±3.34)顯著升高（P 0.01）；(2)應(yīng)激狀態(tài)下，PTSD組SDNN應(yīng)激差值（-4.32±3.52）明顯低于對照組（-10.00±3.94）（P0.01），HF和LF/HF應(yīng)激差值（-17.06±3.96、5.80±0.95）顯著高于對照組（-8.46±4.53、3.55±0.95）（P0.01）；(3) SDNN與PCL-L總分、再體驗、回避和警覺增高負(fù)相關(guān)（r=-0.741、-0.565、-0.672、-0.430，P0.01），LF與PCL-L總分、再體驗、回避正相關(guān)（r=0.464、0.359、0.449，P0.01或P0.05），HF與PCL-L總分、再體驗、回避和警覺增高負(fù)相關(guān)（r=-0.675、-0.475、-0.407、-0.746，，P0.01或P0.05），LF/HF與PCL-L總分、再體驗、回避和警覺增高正相關(guān)（r=0.719、0.466、0.553、0.651，P0.01）。(4)領(lǐng)悟社會支持總分、T型心理量表-個性特征、應(yīng)對方式-發(fā)泄、心率變異性-HF等4個自變量被選入影響PTSD嚴(yán)重程度總分的回歸方程。 結(jié)論：1.癌癥患者具有較高的PTSD發(fā)生率，三大核心癥狀中以警覺增高最為顯著；2.負(fù)債、癌癥復(fù)發(fā)或轉(zhuǎn)移的患者PTSD的發(fā)生率顯著增高；個性不健全、應(yīng)對方式不良、領(lǐng)悟社會支持低與癌癥相關(guān)PTSD的嚴(yán)重程度密切相關(guān)；3.癌癥相關(guān)PTSD患者的自主神經(jīng)系統(tǒng)功能紊亂，迷走神經(jīng)系統(tǒng)功能抑制，交感神經(jīng)系統(tǒng)功能增強；4.癌癥相關(guān)PTSD三大核心癥狀越嚴(yán)重，HRV指標(biāo)改變越明顯，HRV與癌癥相關(guān)PTSD的嚴(yán)重程度密切相關(guān)；5.癌癥相關(guān)PTSD的危險因素包含心理、社會、神經(jīng)生理等多方面，臨床上對癌癥相關(guān)PTSD患者應(yīng)采取生物心理社會綜合干預(yù)策略。
[Abstract]:Objective: To investigate the incidence of cancer related posttraumatic stress disorder (cancer-relatedPTSD), clinical symptoms, psychosocial factors, autonomic nervous function changes, analysis of the correlation between PTSD core symptoms and heart rate variability (HRV), and to explore the objective biological indicators for evaluating the core symptoms of PTSD. To provide evidence for early diagnosis, clinical diagnosis and intervention treatment of cancer-related PTSD.
Methods: 150 cases of cancer patients were interviewed by clinical use of posttraumatic stress disorder diagnostic scale (CAPS) and PTSD severity assessment was carried out in group PTSD (n=37) and control group (n=30) by posttraumatic stress disorder self rating scale (PCL-C). The general situation questionnaire, T mental scale (TP), cancer Coping Questionnaire (CCMQ), and understanding society were completed. The physiological coherence and autonomic nerve balance system was used to detect the heart rate variability in the PTSD group, the control group and the healthy group (n=30), to evaluate the autonomic nerve function and to analyze the correlation between the HRV related indexes and the PTSD core symptoms by the physiological coherence and autonomic nervous system (PSSS).
Results: 1. the clinical and psychosocial factors of cancer related PTSD were: (1) the overall incidence of cancer related PTSD was 24.67%, the incidence of PTSD in different cancer types was between 14.29% (esophageal cancer) and 57.14% (ovarian cancer), there was no significant difference (P0.05), and the incidence of PTSD in different course of disease was about 25%, and no significant statistics were found. The incidence of PTSD (P0.05) in patients with recurrent or metastatic (45.28%) was significantly higher than that of those without relapse or metastasis (13.40%) (P0.01); (2) three core symptoms in group PTSD: re experience (16.78 + 2.32), avoidance (20.92 + 3.51), increased vigilance (18 + 2.27) significantly higher than that of the control group (P0.01), and the most significant increased vigilance among the three core symptoms (3); (3) Through single factor analysis, the incidence of PTSD in cancer patients was significantly higher than that of non indebted persons (P0.01). After multiple factors analysis, recurrence or metastasis was a risk factor for cancer related PTSD; (4) the total score of TP in group PTSD (2.38 + 0.33), cognitive habit (2.64 + 0.35), emotional expression (2.40 + 0.50), and personality characteristics (2.47 + 0.44) were significantly higher than that of the control group (P0.01). The severity of cancer related PTSD symptoms was significantly correlated with the total score of TP, cognitive habits, emotional expression, and personality traits (r=0.655,0.559,0.461,0.703, P0.01 or P0.05); (5) the group PTSD had less to face (1.95 + 0.45) coping styles, but more use of avoidance and depression (2.30 + 0.44), yield (2.45 + 0.72), fantasy (2.32 + 0.50), and venting (2.16 + 0.53). Coping style (P0.01 or P0.05), the severity of cancer related PTSD symptoms was significantly negatively correlated with coping styles (r=-0.452, P0.01), significantly positively correlated with avoidance and depression, yield, and venting (r=0.492,0.346,0.352, P0.01 or P0.05), (6) PSSS total in the PTSD group (55.49 + 9.34), family support (20.73 + 3.85) and external support (34.76 + 6.). 30) significantly lower than the control group (P0.01), and the severity of cancer related PTSD symptoms was significantly negatively correlated with PSSS total, family support, and external support (r=-0.808, -0.673, -0.786, P0.01).
2. the heart rate variability of patients with cancer related PTSD: (1) in the calm state, SDNN (61.54 + 13.10) and HF (50.69 + 13.10) decreased significantly in group PTSD, and LF/HF (7.70 + 3.34) significantly increased (P 0.01). (2) the difference of SDNN stress (-4.32 + 3.52) in PTSD group was lower than that of the control group (-10.00 + 3.94) (P0.01), and the difference between HF and stress stress (P0.01) was significantly lower than that of the control group (P0.01). + 0.95) was significantly higher than that of the control group (-8.46 + 4.53,3.55 + 0.95) (P0.01); (3) SDNN and PCL-L total score, re experience, avoidance and alertness increased negative correlation (r=-0.741, -0.565, -0.672, -0.430, P0.01), LF and PCL-L total, re experience, avoidance and total score, re experience, avoidance and heighten negative correlation ( R=-0.675, -0.475, -0.407, -0.746, P0.01 or P0.05), LF/HF and PCL-L total score, re experience, avoidance and vigilance positive correlation (r=0.719,0.466,0.553,0.651, P0.01). (4) comprehend social support total score, T type psychological scale - personality characteristics, coping style - vent, heart rate variability -HF, and other 4 independent variables were selected to influence the total score of the severity of the regression Equation.
Conclusion: 1. the incidence of PTSD in cancer patients is higher, and the three core symptoms are most significantly increased in vigilance; 2. liabilities, and the incidence of PTSD in patients with cancer recurrence or metastasis is significantly higher; personality is unsound, coping style is poor, social support is low and the severity of cancer related PTSD is closely related; 3. cancer related PTSD patients The dysfunction of the autonomic nervous system, the function inhibition of the vagus nerve system, and the enhancement of the sympathetic nervous system function; 4. the more serious the PTSD three core symptoms of cancer related, the more obvious the changes of the HRV index, and the close correlation between the HRV and the severity of the cancer related PTSD; 5. the risk factors for cancer related PTSD include psychological, social, neurophysiology and many other factors. Clinically, cancer related PTSD patients should adopt a biopsychosocial intervention strategy.
【學(xué)位授予單位】：蘇州大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2013
【分類號】：R749.5

【參考文獻】

相關(guān)期刊論文 前7條

1 陳博;崔麗霞;;癌癥患者創(chuàng)傷后應(yīng)激障礙的研究進展[J];第四軍醫(yī)大學(xué)學(xué)報;2008年01期

2 鄢利福;施琪嘉;于世英;褚倩;周娟;鄔曉艷;陳鳳菊;馮麗娟;楊笑梅;劉小紅;賀戀秋;陳陽陽;;住院癌癥患者創(chuàng)傷后應(yīng)激障礙發(fā)病率及影響因素[J];神經(jīng)損傷與功能重建;2011年01期

3 劉冰;邱菊香;潘梅;陳俊霞;;癌癥患者創(chuàng)傷后應(yīng)激障礙的發(fā)病率及影響因素[J];山東醫(yī)藥;2011年12期

4 王暉;;喉癌手術(shù)病人創(chuàng)傷后應(yīng)激障礙相關(guān)因素分析及護理[J];護理研究;2008年08期

5 楊智輝;王建平;;205名癌癥病人創(chuàng)傷后應(yīng)激障礙癥狀分析[J];中國臨床心理學(xué)雜志;2007年01期

6 黃雪薇;郭寶江;王秀利;張瑛;呂保祥;;癌癥應(yīng)對問卷的編制與測評[J];中國心理衛(wèi)生雜志;2007年08期

7 楊智輝;王建平;;應(yīng)對策略和社會支持對癌癥病人創(chuàng)傷后應(yīng)激障礙癥狀的影響[J];中國心理衛(wèi)生雜志;2007年08期

本文編號：2007556