30例恶性肿瘤患者化疗期间的护理体会

论文编号:HL238  论文字数:22802,页数:31

摘 要
 目的：本课题旨在通过对恶性肿瘤放疗患者的心理状况其心理干预的研究，调查恶性肿瘤放疗患者的心理状况，应对方式、人格特征及其相关性；探讨心理干预对恶性肿瘤放疗患者心理状况、应对方式的影响。以期进一步完善恶性肿瘤放疗患者的护理内容和措施，为恶性肿瘤放疗患者的心理干预提供理论基础和参考依据。
 方法：对77例恶性肿瘤放疗患者放疗前和42例健康对照进行心理学问卷调查(SCL-90、SAS、SDS、TCSQ、EPQ)，然后将恶性肿瘤放疗患者随机分为干预组(n=38)和非干预组(n=39)。其中干预组在放疗过程中给予心理干预治疗，对照组只给予标准护理。放疗结束后再进行心理学问卷调查。
 结果：1．恶性肿瘤组SCL-90总分、总均分、阳性项目数、阳性症状均分及各因子分均显著高于健康对照组(P<0.05或P<0.01)，主要表现在躯体化、抑郁，焦虑和精神病性。2．恶性肿瘤组SAS、SDS得分及情绪异常率均明显高于健康对照组(P<0.05或P<0.01)：恶性肿瘤组SAS得分与SCL-90总分、总均分、阳性项目数、阳性症状均分及各园子分呈正相关(P<O.05或P<0.001)，SDS得分与SCL90总分、总均分、阳性项目数、阳性症状均分及各因子分呈显著正相关(P<0.005或P<0.001)。3．恶性肿瘤组积极应对得分与健康对照组无显著差异(P>0.05)，而消极应对得分明显高于健康对照组(P<0.005)。恶性肿瘤组积极应对得分与SCL-90总分、总均分、阳性项目数、阳性症状均分及各因子分、SAS、SDS呈负相关(P<0.5或P<0.01)；恶性肿瘤组消极应对得分与SCL-90总分、总均分、阳性项目数、阳性症状均分及各因子分、SAS、SDS呈正相关(P<0.05或P<0.01)。4．恶性肿瘤组EPQ的神经质(N)和掩饰性(L)分显著高于健康对照组(P均<0.05)，而外倾性(E)和精神质(P)分无显著差异(均P>0．05)。5．恶性肿瘤干预组患者放疗后SCL-90总分、总均分、阳性项目数、阳性症状均分、各因子分及SAS、SDS均明显低于放疗前和非干预组(P<O.05或P<0.01或P<0.001)，而非干预组患者放疗后SCL-90总分、总均分、阳性项目数、阳性症状均分、抑郁、焦虑因子分以及SAS、SDS均显著高于放疗前(P<0.05或P<0．01或P<0.001)。进一步分析发现，恶性肿瘤干预组患者放疗后焦虑及抑郁罹患率及严重程度均明显低于放疗前和非干预组(均P<0.05)。6．恶性肿瘤干预组患者放疗后消极应对得分明显低于放疗前和非干预组(P(0.05或P<0.001)、积极应对得分明显高于放疗前和非干预组(P<O.001)。
 结论：恶性肿瘤放疗患者具有神经质、情绪不稳的人格特征，细胞免疫功能低下，存在严重的躯体症状，焦虑抑郁情绪异常，心理问题较多，心理状况较差，而且多采取消极应对方式，放疗后进一步加重。相关分析提示，情绪与躯体症状、应对方式与躯体症状、情绪与免疫功能、应对方式与免疫功能、躯体症状与免疫功能之间均有密切的联系。经心理干预后，恶性肿瘤放疗患者采取消极应对方式减少，积极应对方式增多，焦虑抑郁程度均明显减轻，负性情绪反应降低，心理问题减少，心理状况改善，细胞免疫功能改善，促进了患者生活质量的提高和疾病的康复。

关键词：肿瘤；放疗；心理健康；情绪；应对方式；人格；心理干预；护理
论文类型：应用研究

 Title: The study of the nursing methods of the psychological on malignant tumor patients
ABSTRACT
 Objectives:(1)To study psychological condition，coping style，personality feature and immune function of the tumor patients treated by radiotherapy；(2)To explore the relationships between psychological status and immune function；(3)To assess the effect of psychological intervention on the patients’psychological condition，coping style and immune function．The aim is accomplish the nursing measures for the tumor patients during radiotherapy and provide theoretical information for the psychologicalintervention．
 Methods:A total of 77 patients with cancer before radiotherapy and 42 healthy controls were administered with psychological rating scales(SCL-90，SAS，SDS，TCSQ，EPQ)，and test the immune function(CD3+，CD4+，CDS+cells percentage，CD4+／CD8+ratio and NK cell)．Then the 77 tumor patients were randomly divided into intervention group(n=38)and non-intervention group(n=39)，the former rcccived psychological intervention during radiotherapy,while the latter only received standard nursing．They were tested the psychological rating scales and the immune function after radiotherapy,as well.
 Results:1．The tumor patients group had significantly higher level than the healthy controls on SCI-90 total scores，total equipartition,positive items，positive item equipartition and all factors scores(P<0．05 or P<0．01)，distincfly in somatization,depression，anxiety and psycho-disposition．2．The patient showed apparently higher scores than controls in SAS，SDS and abnormal feeling ratio(P<0．05 or P<O．01)；the SAS scores of patient were positively related with the SCL-90 total scores，total equipartition，positive items，positive item equipartition and all factors scores(P<o．05 or P<0．01)，while the SDS SCOres were obviously positively with those of SCL-90(P<0.05 orP<0.01)．3．There was no significant difference between tumor patients and healthy groups in positive coping style scores(P<0.05)，while the tumor patients group had obviously higher negative coping style scores than controls(P<0.005)．There were negative correlations between positive coping style and psychological status(P<0.05 or P<0.01)。but positive correlations between negative coping style and psychological status(P<0．05 or P<0．01)in patients．4．The cancer patients group  had significantly higher scors than control group in EPQ Neuroticism(N)and Lie(L)(P<0.05)，while no significant difference in Extraversion(E)and Psychotieism(P)(P<0.05)．5．The intervention group after radiotherapy had significantly decreased scores in SCL-90 total scores，total equipartition，positive items，positive item equipartition，all factors scores and SAS，SDS compared to that before radiotherapy and the non-intervention group(P<O.05 orP<0.01)，while the non-intervention group after radio therapy had obviously high SCOres in those of SCL-90 and SAS，SDS compared to that before radiotherapy(P<O．05 or P<0．01)．In further study we found that the intervention group patients after radiotberapy had a obviously lower level in depression，anxiety and attack rate than that before radiotherapy and non-intervention group(P<O．05，respectively)．6．The intervention group after radiotherapy had obviously lower score in negative coping style than that of non-intervention group and before radiotherapy respectively(P<0.05 or P<O.001)，while scores of positive coping style were higher than those(P<0.001)．
 Conclusions:The malignant tumor patients eated by radiotherapy have the personality feature of psychoticism，emotional instability,low cell immune function and serious somatic symptom．They also have anxious and depressed emotion,and most of them are negative coping style，which aggravate after radiotherapy．Related analysis showed that there is dependability among emotion，somatic symptom，coping style and immune function．The psychological intervention has positive effect on emotional disorder and immune function in tumor patients treated with radiotherapy．

Keywords tumor；radiotherapy；psychological health；emotion；coping style；personality；immune function；psychological intervention；nursing
Type of thesis：Application research

 目  录
摘 要 IV
ABSTRACT VI
1 绪论 1
1.1背景及意义 1
1.2目的和目标 2
1.3关键词及定义 2
1.4 文献回顾 3
2 研究设计 6
2.1研究设计 6
2.2研究对象 6
2.3研究工具 6
2.4研究步骤 7
2.5统计分析 8
3.结果 9
3.1两组患者一般资料比较 9
3.2恶性肿瘤组与健康对照组的心理状况、应对方式、人格特征检测结果比较 9
3.3心理干预对恶性肿瘤放疗患者心理状况、应对方式的影响 10
4.讨论 13
4.1恶性肿瘤放疗患者的心理健康状况及情绪研究 13
4.2恶性肿瘤放疗患者的应对方式特点 15
5.推论与建议 17
5.1结论 17
5.2建议 17
参考文献 18
附录 21