【摘要】：目的：為惡性腫瘤病人提供心理干預(yù),對其因疾病本身引起的情緒困擾及相關(guān)因素導(dǎo)致的生活質(zhì)量重大改變都具有可推測的意義及合理性。然而目前,與此相關(guān)的國內(nèi)外研究存在一定分歧,為嘗試解決爭議,并更好地評價(jià)心理干預(yù)的效果,筆者利用循證醫(yī)學(xué)系統(tǒng)評價(jià)的方法,綜合1980至2015年間有關(guān)心理干預(yù)影響惡性腫瘤患者生存質(zhì)量以及情緒困擾的中英文文獻(xiàn)進(jìn)行系統(tǒng)綜述及meta分析,全面評價(jià)心理干預(yù)的效果,以期為臨床干預(yù)的應(yīng)用及療效分析提供數(shù)據(jù)參考及科學(xué)依據(jù)。方法：根據(jù)Cochrane評價(jià)手冊,利用計(jì)算機(jī)檢索英文數(shù)據(jù)庫Cochrane、Embase、 Ovid、CINAHL、Pub Med、Web of Science,中文數(shù)據(jù)庫CNKI、CBM disc、VIP、 Sino Med、WanFang數(shù)據(jù)庫,檢索截止到2015年4月國內(nèi)外公開發(fā)表的關(guān)于心理干預(yù)惡性腫瘤患者的隨機(jī)對照試驗(yàn),根據(jù)Cochrane手冊提供的文獻(xiàn)質(zhì)量標(biāo)準(zhǔn)篩選文獻(xiàn),對符合既定納入標(biāo)準(zhǔn)的文獻(xiàn)進(jìn)行量化的Meta分析。使用統(tǒng)一的文獻(xiàn)信息表提取各種文獻(xiàn)的原始數(shù)據(jù),應(yīng)用Revman5.0軟件對數(shù)據(jù)進(jìn)行Meta分析。結(jié)果：經(jīng)過各種篩選后,本次研究共納入41篇文獻(xiàn)進(jìn)入量性的Meta分析(中文12篇,英文29篇)。心理干預(yù)能夠有效提高惡性腫瘤患者的生存質(zhì)量(平均提高5.31個(gè)百分點(diǎn),MD=5.31,95%CI (2.99,7.63), Z=4.49, P0.00001),降低惡性腫瘤患者的焦慮水平(平均降低10.75個(gè)百分點(diǎn),MD=-10.75,95%CI(-15.59,-5.90), Z=4.35, P0.0001),降低惡性腫瘤患者的抑郁水平(平均降低9.85個(gè)百分點(diǎn),MD=-9.85,95% CI (-11.35,-8.35), Z=12.86, P0.00001),以及整體情緒困擾水平(平均降低10.07個(gè)百分點(diǎn),MD=-20.13 (2個(gè)T分),95% CI (-25.35,-14.91), Z=7.75, P0.00001);長期的心理干預(yù)對于提高惡性腫瘤患者的生存質(zhì)量效果要優(yōu)于短期心理干預(yù)(短期：MD=-0.63,95CI(-3.72,2.47),Z=0.40,P=0.69；長期：MD=7.93,95CI (3.75,12.12), Z=3.71, P=0.0002),短期的心理干預(yù)對于降低惡性腫瘤患者的焦慮水平效果要優(yōu)于長期心理干預(yù)(短期：MD=-13.98,95% CI (-23.73,-4.23),1=2.81, P=0.005;長期:MD=-6.01, 95CI%(-9.07,-2.95), Z=3.85, P=0.0001),短期的心理干預(yù)對于降低惡性腫瘤患者的抑郁水平效果要優(yōu)于長期心理干預(yù)(短期：MD=-13.10,95%CI (-16.99,-9.22),Z=6.61,P0.00001；長期：MD=-7.86,95CI%(-9.30,-6.42), Z=10.72,P0.00001),短期的心理干預(yù)對于降低惡性腫瘤患者的整體情緒困擾水平效果要優(yōu)于長期心理干預(yù)(短期：MD=-29.32,95%CI (-38.76,-19.88), Z=6.09,P0.00001；長期：MD=-12.37, 95CI%(-16.24, -8.5), Z=6.27, P0.00001)。另外,住院心理干預(yù)對于提高惡性腫瘤患者生存質(zhì)量的效果要優(yōu)于門診心理干預(yù)(住院：MD=8.78, 95CI%(4.74, 12.82), Z=4.26, P.0.001,門診：MD=3.11, 95CI%(0.62, 5.60), Z=2.45, P=0.01),住院心理干預(yù)對于降低惡性腫瘤患者整體情緒困擾的效果優(yōu)于門診心理干預(yù)(住院：MD=-22.09, 95CI%(-26.99,-17.2),Z=2.36,P=0.02；門診：MD=-16.23, 95CI%(-29.70, 2.76), Z=2.36,P=0.02)；團(tuán)體心理治療對于提高惡性腫瘤患者的生存質(zhì)量的效果優(yōu)于個(gè)人心理治療(團(tuán)體：MD=8.41, 95CI%(6.62, 10.20), Z=9.21, PO.0000;個(gè)人: MD=4.64, 95CI%(2.03, 7.25), Z=3.48, P=0.0005),個(gè)人心理治療對于緩解惡性腫瘤患者的整體情緒困擾的效果優(yōu)于團(tuán)體治療(團(tuán)體：MD=-I6.32, 95CI%(-18.77,-4.81), 2=3.31, PO.00001; 個(gè)人: MD=-23.62, 95CI%(-29.59, -17.64), Z=7.75, P0.0001 )結(jié)論：綜合中英文文獻(xiàn),心理干預(yù)能夠有效提高惡性腫瘤患者的生存質(zhì)量和降低他們的情緒困擾水平,但心理干預(yù)的效果受到干預(yù)時(shí)間、干預(yù)地點(diǎn)以及干預(yù)人員的影響。在本次meta分析的結(jié)果中顯示,短期的心理干預(yù)對于緩解患者情緒困擾的效果優(yōu)于提高其生存質(zhì)量,而長期心理干預(yù)則有助于提高患者遠(yuǎn)期的生活質(zhì)量；另外,本次meta分析提示,患者接受住院接受心理干預(yù)的效果(生存質(zhì)量以及情緒困擾)要優(yōu)于門診部開展的心理干預(yù)；團(tuán)體治療在提高患者生存質(zhì)量方面的效果要優(yōu)于一對一的個(gè)人治療,而一對一的個(gè)人治療在緩解情緒困擾方面優(yōu)于團(tuán)體治療；綜上所述,我們建議患者接受短期住院式一對一的個(gè)人心理干預(yù)(急性期)配合長期的門診團(tuán)體心理干預(yù)(慢性期),這樣對于提高他們的生存質(zhì)量以及降低情緒困擾水平有更為明顯的效果,同時(shí)可以節(jié)約醫(yī)療成本,適時(shí)、高效分配醫(yī)療資源,從而產(chǎn)生更高的醫(yī)療價(jià)值。
[Abstract]:Objective: To provide psychological intervention for patients with malignant tumors, which is of conjectural significance and rationality for their emotional distress caused by the disease itself and significant changes in quality of life caused by related factors. Results: Using the method of Evidence-based Medicine Systematic Assessment, the author made a systematic review and meta-analysis of the Chinese and English literatures on the influence of psychological intervention on the quality of life and emotional distress of patients with malignant tumors from 1980 to 2015, and comprehensively evaluated the effect of psychological intervention, in order to provide data reference and department for the application and effect analysis of clinical intervention. Methods: According to the Cochrane evaluation manual, the English databases Cochrane, Embase, Ovid, CINAHL, Pub Med, Web of Science, Chinese databases CNKI, CBM disc, VIP, Sino Med, Wang Fang were retrieved by computer. The randomized controlled trials on psychological intervention in malignant tumor patients published at home and abroad up to April 2015 were retrieved. According to the literature quality standard provided by Cochrane handbook, we screened the literatures and analyzed the literatures that met the established inclusion criteria quantitatively. The original data of various literatures were extracted from the unified literature information table, and the data were analyzed by Revman 5.0 software. Results: After various screening, 41 articles were included in this study. Meta-analysis (12 Chinese articles, 29 English articles). Psychological intervention can effectively improve the quality of life of patients with malignant tumors (average increase of 5.31 percentage points, MD = 5.31, 95% CI (2.99, 7.63), Z = 4.49, P 0.00001), reduce the anxiety level of patients with malignant tumors (average decrease of 10.75 percentage points, MD = - 10.75, 95% CI (- 15.59, - 5.90), Z = 4.35). Depression was lowered by 9.85 percentage points (MD = - 9.85, 95% CI (- 11.35, - 8.35), Z =12.86, P 0.00001), and overall emotional distress was lowered by 10.07 percentage points, MD = - 20.13 (2 T points), 95% CI (- 25.35, - 14.91), Z =7.75, P 0.00001) in patients with malignant tumors. The effect of short-term psychological intervention was better than short-term psychological intervention (short-term: MD = - 0.63,95CI (- 3.72,2.47), Z = 0.40, P = 0.69; long-term: MD = 7.93,95CI (3.75,12.12), Z = 3.71, P = 0.0002); short-term psychological intervention was better than long-term psychological intervention (short-term: MD = - 13.98, 95% CI (- 23.73, - 4). Long-term: MD = - 6.01, 95 CI% (- 9.07, - 2.95), Z = 3.85, P = 0.0001), short-term psychological intervention is better than long-term psychological intervention (short-term: MD = - 13.10, 95% CI (- 16.99, - 9.22), Z = 6.61, P 0.00001; long-term: MD = - 7.86, 95 CI% (- 9.30, - 6.42), Z = 10.72, P Psychological intervention is better than long-term psychological intervention (short-term: MD = - 29.32, 95% CI (- 38.76, - 19.88), Z = 6.09, P 0.00001; long-term: MD = - 12.37, 95 CI% (- 16.24, 8.5), Z = 6.27, P 0.00001). In addition, in-patient psychological intervention can improve the quality of life of patients with malignant tumors. To be better than outpatient psychological intervention (inpatient: MD = 8.78, 95 CI% (4.74, 12.82), Z = 4.26, P.0.001, outpatient: MD = 3.11, 95 CI% (0.62, 5.60), Z = 2.45, P = 0.01), inpatient psychological intervention for reducing overall emotional distress of malignant tumor patients is better than outpatient psychological intervention (inpatient: MD = - 22.09, 95 CI% (- 26.99, - 17.2), Z = 2.36, P = 0.02; MD = - 16.23, 95 CI% (- 29.70, 2.76), Z = 2.36, P = 0.02); group psychotherapy is superior to individual psychotherapy in improving the quality of life of patients with malignant tumors (group: MD = 8.41, 95 CI% (6.62, 10.20), Z = 9.21, PO.0000; individual: MD = 4.64, 95 CI% (2.03, 7.25), Z = 3.48, P = 0.0005); and individual psychotherapy is superior to individual psychotherapy in alleviating malignant tumors. The overall effect of emotional distress in cancer patients was better than that of group therapy (group: MD = - I6.32, 95 CI% (- 18.77, - 4.81), 2 = 3.31, PO.00001; individual: MD = - 23.62, 95 CI% (- 29.59, 17.64), Z = 7.75, P 0.0001). Conclusion: Combined with Chinese and English literature, psychological intervention can effectively improve the quality of life of cancer patients and reduce their emotional distress. The results of this meta-analysis show that short-term psychological intervention is more effective than long-term psychological intervention in alleviating patients'emotional distress and improving their quality of life. The meta-analysis suggested that the effect of psychological intervention (quality of life and emotional distress) on inpatients was better than that of outpatients; group therapy was better than one-to-one individual therapy in improving the quality of life of patients, and one-to-one individual therapy was better than group therapy in alleviating emotional distress. To sum up, we suggest that patients receive short-term one-to-one personal psychological intervention (acute phase) with long-term outpatient group psychological intervention (chronic phase), so as to improve their quality of life and reduce the level of emotional distress has a more obvious effect, while saving medical costs, timely and efficient distribution of medical care. Resources, resulting in higher medical value.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R273
，

本文編號(hào)：2217997