认知行为疗法对乳腺癌改良根治术患者围手术期心理应激反应和免疫功能的影响
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摘要
目的:探讨认知行为疗法对乳腺癌改良根治术患者围手术期心理应激反应和免疫功能的影响。方法:选取我院2014年6月-2017年3月118例女性乳腺癌改良根治术患者作为研究对象,根据不同的干预方式分为认知组(59例)和常规组(59例),常规组患者给予常规干预,认知组患者在其基础上给予认知行为疗法干预,观察干预前后两组患者焦虑、抑郁等心理情绪的变化;比较干预前后两组患者免疫指标及干预后满意度的情况。结果:干预后,认知组患者CD3、CD4、CD4/CD8比值及NK细胞活性均高于常规组患者,CD8低于常规组患者,差异均具有统计学意义(t=3.777,8.148,5.312,3.900,-6.466;P<0.001)。干预后,两组患者SAS、SDS评分均有所降低,认知组患者SAS、SDS评分低于常规组患者,差异均具有统计学意义(t=-7.394,-6.837;P<0.001)。认知组患者总满意度(96.61%)高于常规组患者(77.97%),差异具有统计学意义(χ~2=9.241,P<0.01)。结论:认知行为疗法可有效降低乳腺癌患者改良根治术围手术期心理应激反应所产生的焦虑、抑郁等负面情绪及增强机体免疫功能,提高患者的护理满意度。
Objective:To investigate the effects of cognitive behavior therapy on psychological stress response and immune function in patients undergoing modified radical mastectomy.Methods:From June 2014 to March 2017,a total of 118 female radical mastectomy patients with breast cancer were selected as the subjects,according to different intervention methods,they were divided into cognitive group(59 cases)and routine group(59 cases),the patients in the routine group received routine intervention,and the cognitive group received cognitive behavioral therapy intervention on the basis of it,we observed the psychological and emotional changes of anxiety and depression in the two groups before and after the intervention and compared the immune indexes,prognosis and satisfaction of the two groups before and after the intervention.Results:After the intervention,the CD3,CD4,CD4,/CD8 ratio and NK cell activity in the cognitive group were higher than those in the conventional group,CD8 was lower than that in the conventional group,and the differences were statistically significant(t=3.777,8.148,5.312,3.900,-6.466;P<0.001).After the intervention,the scores of SAS and SDS were decreased in the two groups,and the scores of SAS and SDS in the cognitive group were lower than those in the routine group,the differences were statistically significant(t=-7.394,-6.837;P<0.001).The total satisfaction of the patients in the cognitive group(96.61%)was higher than that in the routine group(77.97%),and the difference was statistically significant(χ~2=9.241,P<0.01).Conclusion:Cognitive behavioral therapy can effectively reduce the psychological stress response during the perioperative period of modified radical mastectomy in patients with breast cancer,anxiety,depression and other negative emotions and enhance immune function,improve satisfaction of patients.
Objective:To investigate the effects of cognitive behavior therapy on psychological stress response and immune function in patients undergoing modified radical mastectomy.Methods:From June 2014 to March 2017,a total of 118 female radical mastectomy patients with breast cancer were selected as the subjects,according to different intervention methods,they were divided into cognitive group(59 cases)and routine group(59 cases),the patients in the routine group received routine intervention,and the cognitive group received cognitive behavioral therapy intervention on the basis of it,we observed the psychological and emotional changes of anxiety and depression in the two groups before and after the intervention and compared the immune indexes,prognosis and satisfaction of the two groups before and after the intervention.Results:After the intervention,the CD3,CD4,CD4,/CD8 ratio and NK cell activity in the cognitive group were higher than those in the conventional group,CD8 was lower than that in the conventional group,and the differences were statistically significant(t=3.777,8.148,5.312,3.900,-6.466;P<0.001).After the intervention,the scores of SAS and SDS were decreased in the two groups,and the scores of SAS and SDS in the cognitive group were lower than those in the routine group,the differences were statistically significant(t=-7.394,-6.837;P<0.001).The total satisfaction of the patients in the cognitive group(96.61%)was higher than that in the routine group(77.97%),and the difference was statistically significant(χ~2=9.241,P<0.01).Conclusion:Cognitive behavioral therapy can effectively reduce the psychological stress response during the perioperative period of modified radical mastectomy in patients with breast cancer,anxiety,depression and other negative emotions and enhance immune function,improve satisfaction of patients.
引文
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[11]刘梅,滕敬华.围手术期护理干预对乳腺癌改良根治术患者情绪及疼痛影响[J].现代中西医结合杂志,2017,26(2):223-225
[12]王秋萍,章新琼,朱宇,等.认知行为疗法对乳腺癌患者抑郁和生活质量的影响系统评价和Meta分析[J].护理学报,2015,21(24):1-6
[13]何力,杨帆.乳腺癌改良根治术后乳房重建对患者应激反应、社会支持及生命质量的影响[J].解放军医药杂志,2016,28(12):69-72
[14]李建梅,孙静宜,赵月,等.替吉奥联合多西他赛治疗转移性乳腺癌的疗效及对血清HER2、VEGF及CA72-4水平的影响[J].空军医学杂志,2017,33(1):33-35
[15]Deledda G,Poli S,Giansante M,et al.P06Psychological wellbeing,acceptance and psychological flexibility,in breast cancer patients undergoing mastectomy or lumpectomy[J].Annals of Oncology,2015,26(6):191-193
[16]郭亚君.个性化心理干预对围手术期直肠癌患者心理状态及细胞免疫功能的影响[J].中华现代护理杂志,2015,21(22):2680-2683
[2]胡晓锋,何丹枫,卢树昌,等.右美托咪定对乳腺癌根治手术患者围术期应激反应激素及术后细胞免疫的影响[J].实用癌症杂志,2015,30(5):669-672
[3]路威,卢兆桐.食管癌患者围手术期心理健康状况的研究进展[J].中国健康心理学杂志,2015,23(3):464-468
[4]Kulhari S,Bharti N,Bala I,et al.Efficacy of pectoral nerve block versus thoracic paravertebral block for postoperative analgesia after radical mastectomy:A randomized controlled trial[J].British Journal of Anaesthesia,2016,117(3):382-384
[5]彭亮,谢敬聃,胡毅,等.认知行为心理治疗对肺癌患者情绪及免疫状态的影响[J].现代肿瘤医学,2015,23(20):2953-2956
[6]孙风丽,张培莉,单希征,等.认知行为疗法对前庭性偏头痛患者焦虑抑郁情绪的影响[J].中国健康心理学杂志,2016,24(8):1216-1219
[7]Santis W F,Hoffman M A,Dewolf W C.Early catheter removal in 100consecutive patients undergoing radical retropubicprostatectomy[J].Bju International,2015,85(9):1067-1068
[8]简国文,徐军,宋晓刚,等.乳腺癌改良根治术患者围手术期、化疗期的焦虑抑郁情绪、应对方式和生命质量的观察[J].国际精神病学杂志,2016,43(6):1046-1048
[9]曾龙武,唐漫漫,唐晓鸿,等.认知行为干预对肠癌化疗病人照顾者照顾负担的影响[J].中国健康心理学杂志,2017,25(1):43-47
[10]顾学群.整体护理模式对乳腺癌患者围术期应激反应及生活质量的影响[J].中华现代护理杂志,2016,22(18):2580-2584
[11]刘梅,滕敬华.围手术期护理干预对乳腺癌改良根治术患者情绪及疼痛影响[J].现代中西医结合杂志,2017,26(2):223-225
[12]王秋萍,章新琼,朱宇,等.认知行为疗法对乳腺癌患者抑郁和生活质量的影响系统评价和Meta分析[J].护理学报,2015,21(24):1-6
[13]何力,杨帆.乳腺癌改良根治术后乳房重建对患者应激反应、社会支持及生命质量的影响[J].解放军医药杂志,2016,28(12):69-72
[14]李建梅,孙静宜,赵月,等.替吉奥联合多西他赛治疗转移性乳腺癌的疗效及对血清HER2、VEGF及CA72-4水平的影响[J].空军医学杂志,2017,33(1):33-35
[15]Deledda G,Poli S,Giansante M,et al.P06Psychological wellbeing,acceptance and psychological flexibility,in breast cancer patients undergoing mastectomy or lumpectomy[J].Annals of Oncology,2015,26(6):191-193
[16]郭亚君.个性化心理干预对围手术期直肠癌患者心理状态及细胞免疫功能的影响[J].中华现代护理杂志,2015,21(22):2680-2683