【摘要】： 目的:通過(guò)對(duì)比不同處理組的量表評(píng)分包括焦慮自評(píng)量表(SAS)、抑郁自評(píng)量表(SDS)和直腸癌生存質(zhì)量調(diào)查量表(QOL)及實(shí)驗(yàn)室指標(biāo)包括T細(xì)胞亞群的CD3、CD4、CD8、CD4/CD8和自然殺傷細(xì)胞(NK Cell)數(shù)目及白細(xì)胞計(jì)數(shù)(WBC),觀察心理干預(yù)對(duì)直腸癌腸造口患者的效果,探討心理干預(yù)對(duì)直腸癌腸造口患者情緒、免疫功能及生活質(zhì)量的意義,對(duì)促進(jìn)直腸癌腸造口患者康復(fù)和提高生活質(zhì)量具有實(shí)踐意義。 方法:從山西省腫瘤醫(yī)院肛腸科2008年5月至9月的現(xiàn)任住院病人中根據(jù)入組標(biāo)準(zhǔn)選取直腸癌術(shù)后腸造口患者共62例,以隨機(jī)分組(隨機(jī)數(shù)字表)的方法劃分為干預(yù)組和對(duì)照組,干預(yù)組患者32例,對(duì)照組患者30例。對(duì)干預(yù)組施行常規(guī)治療加心理干預(yù)三個(gè)月,在此期間對(duì)照組行常規(guī)治療。干預(yù)前、后對(duì)比兩組患者的量表評(píng)分和實(shí)驗(yàn)室指標(biāo)及進(jìn)行前—后測(cè)差值比較。 結(jié)果:(1)干預(yù)組和對(duì)照組患者干預(yù)前對(duì)比,在年齡、性別、職業(yè)、婚姻狀況、經(jīng)濟(jì)狀況、既往病史、造口時(shí)間、受教育程度方面均無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),在量表評(píng)分和實(shí)驗(yàn)室指標(biāo)方面亦無(wú)統(tǒng)計(jì)學(xué)差異(P0.05),可視為兩組患者具有均衡性。兩組患者SDS評(píng)分和SAS評(píng)分均高于國(guó)內(nèi)常模,提示直腸癌腸造口患者存在焦慮、抑郁情緒。(2)干預(yù)組經(jīng)心理干預(yù),在量表評(píng)分和實(shí)驗(yàn)室指標(biāo)方面與對(duì)照組均存在統(tǒng)計(jì)學(xué)差異。其SDS評(píng)分顯著低于對(duì)照組(P0.01);其SAS評(píng)分顯著低于對(duì)照組(P0.05);同時(shí),干預(yù)組QOL總分顯著高于對(duì)照組(P0.01),且心理因子評(píng)分和社會(huì)因子評(píng)分分別顯著高于對(duì)照組(P0.05),提示心理干預(yù)可幫助改善腸造口患者的情緒狀態(tài)和生活質(zhì)量。CD3數(shù)量顯著高于對(duì)照組(P0.01); CD4數(shù)目顯著高于對(duì)照組(P0.05); CD8數(shù)目顯著高于對(duì)照組(P0.05); NK Cell數(shù)量顯著高于對(duì)照組(P0.01); WBC計(jì)數(shù)顯著高于對(duì)照組(P0.05),提示心理干預(yù)有助于提高腸造口患者的免疫功能。(3)經(jīng)心理干預(yù),干預(yù)組前測(cè)—后測(cè)差值與對(duì)照組前測(cè)—后測(cè)差值存在顯著性差異。在量表評(píng)分方面,干預(yù)組SDS差值與對(duì)照組相比具有顯著性差異(P0.01),干預(yù)組SAS差值與對(duì)照組存在顯著性差異(P0.05),提示是心理干預(yù)的效力使干預(yù)組患者自身焦慮、抑郁情緒降低,促進(jìn)了情緒的改善。在實(shí)驗(yàn)室指標(biāo)方面,干預(yù)組和對(duì)照組在CD3差值和CD8差值上有顯著性差異(P0.01),且對(duì)照組差值顯著高于干預(yù)組;兩組患者在NK Cell差值上也存在顯著性差異(P0.05),對(duì)照組差值顯著高于干預(yù)組。以上結(jié)果提示,心理干預(yù)有效保護(hù)了干預(yù)組的免疫功能,而未經(jīng)心理干預(yù)的對(duì)照組則更多地受到化療副反應(yīng)的影響,出現(xiàn)免疫功能的下降。(4)對(duì)具有顯著性意義的差值進(jìn)行多元逐步回歸分析,SDS差值、SAS差值、CD3差值、CD8差值、NK Cell差值的主要相關(guān)因素為心理干預(yù)。 結(jié)論:直腸癌腸造口患者明顯存在焦慮、抑郁情緒,免疫功能低下,長(zhǎng)期處于這樣的狀態(tài)下,導(dǎo)致生活質(zhì)量差,容易影響疾病的預(yù)后和轉(zhuǎn)歸。心理干預(yù)可有效改善直腸癌腸造口患者的焦慮、抑郁情緒,積極、健康的心理狀況有助于糾正低下的免疫功能,進(jìn)而提高患者生活質(zhì)量,幫助和促進(jìn)直腸癌腸造口患者康復(fù)乃至延長(zhǎng)生存期。
[Abstract]:Objective: To observe the effect of psychological intervention on rectal cancer intestinal construction by comparing the scores of self-rating anxiety scale (SAS), self-rating depression scale (SDS), rectal cancer quality of life inventory (QOL) and laboratory indexes including CD3, CD4, CD8, CD4 / CD8, natural killer cell (NK cell) and white blood cell count (WBC) in different treatment groups. To explore the effect of psychological intervention on emotion, immune function and quality of life of patients with rectal cancer undergoing enterostomy, and to promote the rehabilitation and improve the quality of life of patients with rectal cancer undergoing enterostomy.
Methods: According to the admission criteria, 62 patients with rectal cancer undergoing enterostomy were selected from the current inpatients in Anorectal Department of Shanxi Cancer Hospital from May to September 2008. The patients were randomly divided into intervention group and control group, 32 patients in intervention group and 30 patients in control group. Three months after intervention, the control group received routine treatment. Before and after intervention, the scale scores, laboratory indexes and the difference between the two groups were compared.
Results: (1) There was no significant difference in age, sex, occupation, marital status, economic status, previous medical history, stoma time, education level between the intervention group and the control group before intervention (P The scores of SDS and SAS were significantly lower than those of the control group (P 0.01), and the scores of SAS were significantly lower than those of the control group (P 0.05). The total score of OL was significantly higher than that of the control group (P 0.01), and the scores of psychological factors and social factors were significantly higher than those of the control group (P 0.05), suggesting that psychological intervention can help improve the emotional state and quality of life of patients with enterostomy. The number of NK Cells in the intervention group was significantly higher than that in the control group (P 0.05), and the WBC count was significantly higher than that in the control group (P 0.05), suggesting that psychological intervention can improve the immune function of patients with enterostomy. The difference of SAS between intervention group and control group was significant (P 0.01), suggesting that the effect of psychological intervention could reduce the anxiety and depression of intervention group, and promote the improvement of emotion. The difference was significant (P 0.01), and the difference between the control group and the intervention group was significantly higher. The difference between the two groups was also significant (P 0.05). The difference between the control group and the intervention group was significantly higher. (4) Multivariate stepwise regression analysis was used to analyze the significant difference. The main related factors of SDS difference, SAS difference, CD3 difference, CD8 difference and NK Cell difference were psychological intervention.
Conclusion: Anxiety, depression and low immune function exist in rectal cancer patients with enterostomy, which lead to poor quality of life and prognosis of the disease. Psychological intervention can effectively improve the anxiety, depression, positive and healthy psychological status of rectal cancer patients with enterostomy. Immune function, and then improve the quality of life of patients, help and promote rectal cancer patients with enterostomy rehabilitation and even prolong survival.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2009
【分類號(hào)】：R735.37;R395.5

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