30例惡性腫瘤患者化療期間的護理體會

論文編號:HL238  論文字數:22802,頁數:31

摘 要
 目的：本課題旨在通過對惡性腫瘤放療患者的心理狀況其心理干預的研究，調查惡性腫瘤放療患者的心理狀況，應對方式、人格特征及其相關性；探討心理干預對惡性腫瘤放療患者心理狀況、應對方式的影響。以期進一步完善惡性腫瘤放療患者的護理內容和措施，為惡性腫瘤放療患者的心理干預提供理論基礎和參考依據。
 方法：對77例惡性腫瘤放療患者放療前和42例健康對照進行心理學問卷調查(SCL-90、SAS、SDS、TCSQ、EPQ)，然后將惡性腫瘤放療患者隨機分為干預組(n=38)和非干預組(n=39)。其中干預組在放療過程中給予心理干預治療，對照組只給予標準護理。放療結束后再進行心理學問卷調查。
 結果：1．惡性腫瘤組SCL-90總分、總均分、陽性項目數、陽性癥狀均分及各因子分均顯著高于健康對照組(P<0.05或P<0.01)，主要表現在軀體化、抑郁，焦慮和精神病性。2．惡性腫瘤組SAS、SDS得分及情緒異常率均明顯高于健康對照組(P<0.05或P<0.01)：惡性腫瘤組SAS得分與SCL-90總分、總均分、陽性項目數、陽性癥狀均分及各園子分呈正相關(P<O.05或P<0.001)，SDS得分與SCL90總分、總均分、陽性項目數、陽性癥狀均分及各因子分呈顯著正相關(P<0.005或P<0.001)。3．惡性腫瘤組積極應對得分與健康對照組無顯著差異(P>0.05)，而消極應對得分明顯高于健康對照組(P<0.005)。惡性腫瘤組積極應對得分與SCL-90總分、總均分、陽性項目數、陽性癥狀均分及各因子分、SAS、SDS呈負相關(P<0.5或P<0.01)；惡性腫瘤組消極應對得分與SCL-90總分、總均分、陽性項目數、陽性癥狀均分及各因子分、SAS、SDS呈正相關(P<0.05或P<0.01)。4．惡性腫瘤組EPQ的神經質(N)和掩飾性(L)分顯著高于健康對照組(P均<0.05)，而外傾性(E)和精神質(P)分無顯著差異(均P>0．05)。5．惡性腫瘤干預組患者放療后SCL-90總分、總均分、陽性項目數、陽性癥狀均分、各因子分及SAS、SDS均明顯低于放療前和非干預組(P<O.05或P<0.01或P<0.001)，而非干預組患者放療后SCL-90總分、總均分、陽性項目數、陽性癥狀均分、抑郁、焦慮因子分以及SAS、SDS均顯著高于放療前(P<0.05或P<0．01或P<0.001)。進一步分析發現，惡性腫瘤干預組患者放療后焦慮及抑郁罹患率及嚴重程度均明顯低于放療前和非干預組(均P<0.05)。6．惡性腫瘤干預組患者放療后消極應對得分明顯低于放療前和非干預組(P(0.05或P<0.001)、積極應對得分明顯高于放療前和非干預組(P<O.001)。
 結論：惡性腫瘤放療患者具有神經質、情緒不穩的人格特征，細胞免疫功能低下，存在嚴重的軀體癥狀，焦慮抑郁情緒異常，心理問題較多，心理狀況較差，而且多采取消極應對方式，放療后進一步加重。相關分析提示，情緒與軀體癥狀、應對方式與軀體癥狀、情緒與免疫功能、應對方式與免疫功能、軀體癥狀與免疫功能之間均有密切的聯系。經心理干預后，惡性腫瘤放療患者采取消極應對方式減少，積極應對方式增多，焦慮抑郁程度均明顯減輕，負性情緒反應降低，心理問題減少，心理狀況改善，細胞免疫功能改善，促進了患者生活質量的提高和疾病的康復。

關鍵詞：腫瘤；放療；心理健康；情緒；應對方式；人格；心理干預；護理
論文類型：應用研究

 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  錄
摘 要 IV
ABSTRACT VI
1 緒論 1
1.1背景及意義 1
1.2目的和目標 2
1.3關鍵詞及定義 2
1.4 文獻回顧 3
2 研究設計 6
2.1研究設計 6
2.2研究對象 6
2.3研究工具 6
2.4研究步驟 7
2.5統計分析 8
3.結果 9
3.1兩組患者一般資料比較 9
3.2惡性腫瘤組與健康對照組的心理狀況、應對方式、人格特征檢測結果比較 9
3.3心理干預對惡性腫瘤放療患者心理狀況、應對方式的影響 10
4.討論 13
4.1惡性腫瘤放療患者的心理健康狀況及情緒研究 13
4.2惡性腫瘤放療患者的應對方式特點 15
5.推論與建議 17
5.1結論 17
5.2建議 17
參考文獻 18
附錄 21