本文選題：惡性腫瘤 + 肺小結節(jié)�。� 參考：《山東大學》2017年碩士論文

【摘要】：背景介紹:因為目前環(huán)境的惡化等原因,惡性腫瘤已經成為常見并且危害人類健康和生命的重大疾病之一,而且逐漸成為我國城市居民死亡的重要原因之一[1]。隨著醫(yī)療技術以及科技的不斷發(fā)展、進步,現(xiàn)代醫(yī)學已經從"生物醫(yī)學模式"轉變?yōu)?生物-心理-社會醫(yī)學模式",惡性腫瘤與患者心理因素的關系逐漸被重視。經過多次調查統(tǒng)計之后發(fā)現(xiàn),在這些心理因素中,抑郁以及焦慮是病人最常出現(xiàn)的,這兩種心理癥狀被稱為病理性情緒反應,一般是因為病人在進行治療的過程中產生的副作用以及疾病復發(fā)或轉移所引起的[2]。有學者研究證實,抑郁情緒可是使惡性腫瘤患者的免疫功能受到抑制,能降低疼痛閾值,增加腫瘤惡化的風險,導致生活質量下降,并可使患者的預期生存期下降10到20個百分點,甚至導致有些惡性腫瘤患者的直接死亡原因可能不是腫瘤的惡化,而是抑郁狀態(tài)造成的[3]。隨著惡性腫瘤患者生存期的延長以及高分辨率CT的廣泛應用,目前惡性腫瘤合并肺小結節(jié)的出現(xiàn)越來越普遍,但目前惡性腫瘤合并肺小結節(jié)與心理因素關系的相關報道較少,而且以往其常被視為腫瘤晚期,多采用化療的治療方式,近年來有研究顯示,惡性腫瘤并多原發(fā)肺癌和結核的發(fā)病率逐漸升高,也有證據表明外科手術現(xiàn)己不再是肺轉移癌的絕對禁忌[4]。兩種治療方式各有利弊,兩者對于惡性腫瘤合并肺小結節(jié)的療效也尚無大量數(shù)據證實,近來有學者提出,評價腫瘤的治療方案是否有效的標準,不僅要看經治療后患者的生存期,還要看是否緩解了患者的癥狀,改善了生活質量。本文主要采用調查問卷的方式,調查惡性腫瘤合并肺小結節(jié)患者的心理狀況,觀察化療和手術治療對患者焦慮、抑郁情緒的短期和長期影響,并結合相關文獻內容,從改善患者生活質量等方面探討兩種治療方式的療效。研究對象與方法：選擇山東省千佛山醫(yī)院自2014年1月1日至2016年6月30日就診的40例惡性腫瘤合并肺小結節(jié)的患者,其中進行外科手術治療者22例,化療者18例。兩組患者總共進行4次焦慮自評量表(SAS)和抑郁自評量表(SDS)的問卷調查,并分別于治療后每3個月復查一次胸部CT,6個月后隨訪。對每人都進行4次焦慮和抑郁自評量表的調查。第1次焦慮和抑郁自評量表的問卷調查于治療前進行,第2、3、4次測量手術組于治療后1周、2個月、4個月,化療組于化療第1周期結束后1周,第2周期、第4周期后。問卷收回后仔細檢查防漏項,將每份問卷進行總分積累,分次分組進行平均分計算,并將所有結果應用SPSS19.0統(tǒng)計軟件進行比較分析。結果:本次研究共納入40例惡性腫瘤合并肺小結節(jié)的患者,分為手術組22例和化療組18例,兩組患者治療前在年齡、性別、SAS和SDS得上無差異(P0.05)。手術組和化療組患者焦慮自評量表、抑郁自評量表平均得分均超過正常范圍(SAS50,SDS40),得分普遍分布于中度的水平,且兩組得分相比差距不大,差異無統(tǒng)計學意義(P0.05)。治療后:治療后除第1次外,測量手術組的SAS、SDS得分均低于化療組(P0.05)。手術組SAS、SDS的在第2次測量時得分高于術前(P＜0.05),第3次得分與術前無并異(P0.05),第4次SAS、SDS得分低于手術前(P＜0.05)�；熃M第3、4次測量SAS、SDS得分均高于化療前(P＜0.05),化療后第1次評分比化療前低,但第3、4次評分又高于化療前。6個月復查時兩在新發(fā)結節(jié)數(shù)、死亡和放棄治療無差異(P0.05)。結論:惡性腫瘤合并肺小結節(jié)患者的焦慮、抑郁情緒處于中度水平。手術組與化療組比較,手術組可以明顯減輕患者的焦慮抑郁情緒,改善患者的生活質量,并且不會影響患者治療的依從性,患者復發(fā)率和死亡率較低,綜上所述,可以認為手術治療,在改善情緒和生活質量上與化療相比,對惡性腫瘤合并肺小結節(jié)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.

【學位授予單位】：山東大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R730.5

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