摘要
目的:探讨心理干预对改善消化道恶性肿瘤术后患者心理状态及生活质量的作用。方法:于2000-02/2004-12选择江门市新会区会城医院外科病房收治的消化道恶性肿瘤术后住院患者58例。年龄>18岁,符合消化道恶性肿瘤诊断标准,排除术中、术后并发症及其他严重躯体疾病。随机分成观察组(30例)及对照组(28例)。观察组患者术后即开始接受心理治疗。干预方法:①进行健康教育:正确认知、面对消化道恶性肿瘤疾病。②明星座谈:讨论交流经验,针对个人的具体情况拟订康复计划。③行为疗法:指导患者放松全身肌肉,以消除焦虑、抑郁等不良情绪。诱导患者进入催眠状态。④心理疏导治疗:理解疏导病患,随时解除其消极,悲观,紧张,抑郁,焦虑的情绪。采用症状自评量表(包括90项内容,有躯体化,强迫,人际关系,恐怖,抑郁,焦虑,敌对,偏执,精神病性9大症状因子,得分越高,心理问题越重)反映患者的精神卫生症状,采用专用于测量消化系统疾病患者的胃肠生活质量量表(包括生理功能状态,症状学,社会活动和日常生活能力、精神状态等5个方面36项调查项目,采用4级记分每项为0至4分,总分144分)测定患者生活质量,各项得分越高说明生活质量越高,正常人群总分为125.8分。结果:58份问卷均完整合格进入结果分析。①消化道恶性肿瘤患者术后症状自评量表的躯体化,强迫,抑郁,焦虑,恐怖,偏执和精神病性因子评分明显高于正常人常模数据(t=2.176-3.351,P<0.05)。②消化道恶性肿瘤患者观察组的躯体化、强迫、人际关系、焦虑、恐惧、抑郁、偏执等症状因子评分明显低于对照组(t=2.260-2.775,P<0.05)。③消化道恶性肿瘤患者观察组的生活质量总分明显高于对照组犤(104.96±11.28),(90.35±12.51),t=4.667,P<0.05犦。自觉症状,躯体生理功能状态,心理情绪状态评分也均明显高于对照组,(t=4.124-4.985,P<0.05)。结论:消化道恶性肿瘤术后患者存在明显的心理障碍,表现在躯体化,强迫,抑郁,焦虑,恐怖,偏执和精神病性症状显著。心理干预可改善患者术后的生活质量。
AIM： To investigate the role of psychological interventions in improving the quality of life and mental health status in postoperative patients with digestive malignant tumour. METHODS： Fifty-eight postoperative inpatients with digestive malignant tumour over 18 years old, who were hospitalized in the Department of General Surgery, Xinhui District Huicheng Hospital of Jiangmen city from February 2000 to December 2004, were involved in this study. All the patients were in accordance with the diagnostic criteria of digestive malignant tumour, and those with complications and other severe somatic diseases during and after operation were excluded. The patients were randomly divided into observational group （n=30） and control group （n=28）. The patients in the observational group received psychotherapy immediately postoperation： ① Health education： right cognition and attitude to diseases of digestive malignant tumour; ② Discussion with famous stars： discussing and communicating experience, rehabilitative program was designed according to the individual specific conditions; ③ Behavioral therapy： The patients were guided to relax the muscle of whole body so as to eliminate the bad emotions of anxiety and depression, and they were induced to sleep; ④ Psychological persuasion： The patients were understood and persuaded, and their negative, pessimistic, nervous, depressive and anxious emotions were eliminated at any time. Their mental health symptoms were assessed with the symptom checklist-90 （consisted of 90 items, including 9 symptom factors of somatization, obsession- compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism; The higher the socres, the severer theirmental problems）. Their quality of life was evaluated with the gastroenterological quality of life scale, which was specially for patients with diseases of digestive system, including 5 aspects of physiological function, semiology, social activities and abilities of daily life, mental status, consisted of 36 items; The 4-grade scoring （0 to 4 points） was used, the total score was 144 points）; The higher the scores, the better their quality of life; The total score of normal people was 125.8 points. RESULTS： All the 58 questionnaires were completed and qualified, and they were involved in the analysis of results. ① The scores of somatization, obsession-compulsion, depression, anxiety, phobic anxiety, paranoid ideation and psychoticism in symptom checklist-90 were obviously higher in the postoperative patients with digestive malignant tumour than in the normal people （t=2.176 to 3.351, P 〈 0.05）. ② Among the patients with digestive malignant tumour, the scores of somatization, obsession- compulsion, interpersonal sensitivity, anxiety, phobic anxiety, depression and paranoid ideation were obviously lower in the observational group than in the control group （t=2.260 to 2.775, P 〈 0.05）. ③ Among the patients with digestive malignant tumour, the total score of quality of life was obviously higher in the observational group than in the control group （104.96±11.28, 90.35±12.51, t=4.667, P 〈 0.05）; The scores of self- consciousness, somatic physiological function and psychological emotion were also obviously higher in the observational group than in the control group （t=4.124 to 4.985, P 〈 0.05）. CONCLUSION： The postoperative patients with digestive malignant tumour have obvious psychological obstacles, manifested by the significant symptoms of somatization, obsession-compulsion, depression, anxiety, phobic anxiety, paranoid ideation and psychotieism. Psychological interventions can improve the postoperative quality of life in the patients.
出处
《中国临床康复》
CSCD
北大核心
2005年第24期42-44,共3页
Chinese Journal of Clinical Rehabilitation
