病友互助模式对肝癌介入手术患者不良情绪、主观幸福感及生活质量的影响

目的 研究病友互助模式对肝癌介入手术患者不良情绪、主观幸福感及生活质量的影响.方法 将2017年3月至2018年3月的肝癌介入手术患者(96例)作为对照组,2018年4月至2019年4月的肝癌介入手术患者(104例)作为观察组.两组患者均采用腹腔镜肝癌根治术,术后化疗方案一致.对照组采用常规护理模式干预,观察组在对照组的基础上,给予病友互助模式干预,持续干预2个月.观察记录观察组和对照组不良情绪、主观幸福感、生活质量以及术后不良反应发生情况.患者出院后进行为期1年的随访,记录患者预后情况.结果 干预后,观察组患者的焦虑自评量表(SAS)评分明显低于对照组(P﹤0.01).干预后,观察组患者幸福感指数量表(IWB)评分明显高于对照组,差异有统计学意义(P﹤0.01).干预后,观察组患者躯体功能、心理功能、症状/副作用、社会功能评分及生活质量指数(LQI)均明显高于对照组,差异均有统计学意义(P﹤0.01).观察组患者不良反应总发生率低于对照组,差异有统计学意义(P﹤0.05).观察组患者1年生存率高于对照组,差异有统计学意义(P﹤0.05).结论 病友互助模式可明显改善肝癌介入手术患者不良情绪,提高患者主观幸福感,提高生活质量,减少术后不良反应,改善患者预后.     

多样性心理干预对宫颈癌患者心理状态、希望水平、睡眠质量及生活质量的影响

目的探讨多样性心理干预对宫颈癌患者心理状态、希望水平、睡眠质量和生活质量的影响。方法根据干预方式的不同将150例宫颈癌患者分为对照组(给予常规临床干预)和观察组(给予多样性心理干预)各75例。比较两组患者干预前后的焦虑自评量表(SAS)、抑郁自评量表(SDS)、Herth希望水平量表(HHI)、匹兹堡睡眠质量指数(PSQI)、Spitzer生活质量指数(SQLI)评分。结果干预后,观察组患者的SAS、SDS评分均明显低于对照组患者,差异均有统计学意义(P﹤0.01)。干预后,观察组患者的HHI中行动态度、积极态度、亲密关系的评分及总分均明显高于对照组,差异均有统计学意义(P﹤0.01)。干预后,两组患者的PSQI评分均低于本组干预前,SQLI评分均高于本组干预前,差异均有统计学意义(P﹤0.05);干预后,观察组患者的PSQI评分明显低于对照组,SQLI评分明显高于对照组,差异均有统计学意义(P﹤0.01)。结论多样性心理干预能够促进宫颈癌患者的心理健康,提高其希望水平,改善其睡眠和生活质量。     

腹腔镜手术与开腹手术治疗宫颈癌的疗效及对患者负性情绪、生活质量的影响

目的 比较腹腔镜手术与开腹手术治疗宫颈癌的疗效及对患者负性情绪、生活质量的影响.方法 依据手术方式的不同将100例宫颈癌患者分为观察组(n=61,接受腹腔镜宫颈癌根治术治疗)和对照组(n=39,接受传统开腹手术治疗).比较两组一般手术指标、负性情绪[焦虑自评量表(SAS)、抑郁自评量表(SDS)]、生活质量[癌症治疗功能评价系统宫颈癌特异模块(FACT-CX)]和预后情况(生存率、复发率).结果 观察组患者手术时间明显长于对照组(P﹤0.01),术中出血量明显少于对照组(P﹤0.01),术后排气时间和术后住院时间均明显短于对照组(P﹤0.01),淋巴结清扫数明显多于对照组(P﹤0.01).手术后,两组患者SAS、SDS评分均明显低于本组手术前(P﹤0.01),且观察组患者SAS、SDS评分均明显低于对照组患者(P﹤0.01).手术后,观察组患者FACT-CX评分高于本组手术前(P﹤0.05),对照组患者FACT-CX评分低于本组手术前(P﹤0.05),且观察组患者FACT-CX评分高于对照组(P﹤0.05).随访第1、2、3年,两组患者生存率和复发率均无明显差异(P﹥0.05).结论 与传统开腹手术相比,腹腔镜宫颈癌根治术可减少术中出血量,缩短术后排气时间及术后住院时间,增加淋巴结清扫数目,明显改善患者的负性情绪,提高生活质量.     

Snyder希望理论干预对结直肠癌术后结肠造口患者负性情绪、希望水平的影响

目的 探讨Snyder希望理论干预对结直肠癌术后结肠造口患者负性情绪、希望水平的影响。方法 根据干预模式的不同将114例结直肠癌术后结肠造口患者分为对照组（n=56）和观察组（n=58）,对照组患者给予常规自主干预,观察组患者给予Snyder希望理论干预。比较两组患者的负性情绪[焦虑自评量表（SAS）、抑郁自评量表（SDS）、自我感受负担量表（SPBS）]、希望水平[Herth希望量表（HHI）]、自护能力[自我护理能力测定量表（ESCA）]和护理满意度。结果 干预后,两组患者SAS、SDS、SPBS评分均低于本组干预前,且观察组患者SAS、SDS、SPBS评分均低于对照组,差异均有统计学意义（P﹤0.05）。干预后,两组患者HHI、ESCA量表各维度评分均高于本组干预前,且观察组患者HHI、ESCA量表各维度评分均高于对照组,差异均有统计学意义（P﹤0.05）。干预后,对照组患者满意度评分为（72.82±1.83）分,明显低于观察组患者的（93.56±1.56）分,差异有统计学意义（P﹤0.01）。结论 Snyder希望理论干预可明显改善结直肠癌术后结肠造口患者的负性情绪,提高患者的...     

以Peplau人际关系理论为基础的干预模式对肺癌化疗患者心理状态、主观幸福感及生活质量的影响

目的 探讨以Peplau人际关系理论为基础的干预模式对肺癌化疗患者心理状态、主观幸福感及生活质量的影响.方法 将136例肺癌患者根据不同干预方案分为对照组(n=71)和观察组(n=65),对照组患者给予常规干预,观察组患者给予常规干预+以Peplau人际关系理论为基础的干预模式.比较两组患者干预前后的心理状态、主观幸福感及生活质量改善情况.结果 观察组患者下床活动时间、肛门排气时间、肠鸣音恢复时间、住院时间均明显短于对照组(P﹤0.01).干预后,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显低于本组干预前(P﹤0.01);且观察组患者SAS、SDS评分均明显低于对照组(P﹤0.01).干预后,两组患者主观幸福感各维度评分均明显高于本组干预前(P﹤0.01);且观察组患者主观幸福感各维度评分均明显高于对照组(P﹤0.01).干预后,两组患者生活质量(QOL)量表各维度评分均明显高于本组干预前(P﹤0.01);且观察组患者QOL量表各维度评分均明显高于对照组(P﹤0.01).对照组患者不良反应总发生率为63.38％(45/71),高于观察组的46.15％(30/65)(P﹤0.05).结论 对肺癌化疗患者实施以Peplau人际关系理论为基础的干预模式,可改善患者心理状态,提高主观幸福感及生活质量,临床应用前景广阔.     

基于期待效应的干预模式对膀胱癌术后患者心理应激及负性情绪的影响

目的 探讨基于期待效应的干预模式对膀胱癌术后患者心理应激及负性情绪的影响.方法 随机数字表法将86例膀胱癌患者分为对照组和干预组,每组43例,对照组患者术后给予常规护理干预,干预组患者在此基础上实施基于期待效应的护理干预.比较两组患者干预前后负性情绪、主观幸福感、家庭功能和生活质量.结果 干预前,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)、总体幸福感量表、家庭功能评定量表和欧洲癌症研究与治疗组织生命质量测定量表(EORTC QLQ-C30)评分比较,差异均无统计学意义(P﹥0.05).干预后,两组患者SAS、SDS评分均低于本组干预前,总体幸福感量表、家庭功能评定量表评分均高于本组干预前,EORTC QLQ-C30量表各维度评分均优于本组干预前,且干预组患者SAS、SDS评分均低于对照组患者,总体幸福感量表、家庭功能评定量表评分均高于对照组,EORTC QLQ-C30量表各维度评分均优于对照组,差异均有统计学意义(P﹤0.05).结论 基于期待效应的干预模式可明显降低膀胱癌患者术后的焦虑和抑郁情绪,提高主观幸福感和家庭功能,改善生活质量.     

共情护理对乳腺癌患者根治手术后希望水平和主观幸福感的影响

目的探讨共情护理对乳腺癌患者根治手术后希望水平和主观幸福感的影响。方法选取2013年8月至2015年8月间秦皇岛市抚宁区人民医院收治的50例乳腺癌根治手术患者,按入组时间顺序,分为观察组和对照组,每组25例。观察组患者在术后常规护理基础上联合共情护理,对照组患者术后采用常规护理。于护理前后分别采用中文版Herth希望量表(herth hope index,HHI)、纽芬兰纪念大学幸福度量表(memorial university of newfoundland scale of happiness,MUNSH)评估和比较两组患者的希望水平及主观幸福感。结果护理后,观察组患者HHI总评分和MUNSH总评分分别为(42.3±3.1)分和(16.8±3.4)分,对照组分别为(33.5±5.2)分和(9.3±2.2)分。观察组患者HHI总评分和MUNSH总评分均显著高于对照组,差异有统计学意义(P<0.05)。结论对乳腺癌患者根治术后实施共情护理,可显著提高其希望水平和主观幸福感。     

叙事疗法对肺癌患者疼痛应激、心理弹性和生活质量的影响

目的 探讨叙事疗法对肺癌患者疼痛应激、心理弹性和生活质量的影响.方法 依据干预方法将120例肺癌患者分为观察组(n=65)和对照组(n=55),对照组患者给予常规宣教心理疏导,观察组患者在此基础上给予五步式叙事疗法干预.干预前后,比较两组患者的疼痛应激因子[血清P物质、去甲肾上腺素(NE)、皮质醇、前列腺素E2(PGE2)]水平、情绪状态[焦虑自评量表(SAS)、抑郁自评量表(SDS)和正负性情绪量表(PANAS)]、心理弹性[心理弹性量表(CD-RISC)]、生活质量[简明健康状况调查问卷(SF-36)].结果 干预后,两组患者P物质、NE、皮质醇、PGE2水平均明显低于本组干预前(P﹤0.01),且观察组患者P物质、NE、皮质醇、PGE2水平均明显低于对照组(P﹤0.01).干预后,两组患者PA分量表评分均明显高于本组干预前(P﹤0.01),SAS、SDS和NA分量表评分均明显低于本组干预前(P﹤0.01),且观察组患者PA分量表评分明显高于对照组(P﹤0.01),SAS、SDS和NA分量表评分均明显低于对照组(P﹤0.01).干预后,两组患者SF-36量表各维度评分、CD-RISC量表各维度评分及总分均明显高于本组干预前(P﹤0.01),且观察组患者SF-36量表各维度评分、CD-RISC量表各维度评分及总分均明显高于对照组(P﹤0.01).结论 叙事疗法可有效降低肺癌患者的疼痛应激水平,减轻焦虑、抑郁等负性情绪,增强心理弹性,提高生活质量.     

基于同伴支持的PDCA循环管理对宫颈癌术后康复进程及负性情绪的影响

目的 探究基于同伴支持的PDCA循环管理对宫颈癌术后康复进程及负性情绪的改善作用.方法将96例宫颈癌患者随机分为观察组和对照组,每组48例.对照组患者采用常规的PDCA循环管理,观察组患者在对照组的基础上予以同伴支持.观察并比较两组患者自护能力、负性情绪、生活质量、性功能以及护理满意度.结果 干预后,两组患者自护能力量表(ESCA)中健康知识、自我概念、自护技能、责任感评分及总分均明显高于本组干预前(P﹤0.01),且观察组均明显高于对照组(P﹤0.01).干预后,两组患者焦虑自评量表(SAS)、抑郁自评量表(SDS)评分均明显低于本组干预前(P﹤0.01),且观察组均明显低于对照组(P﹤0.01).干预后,两组患者简明健康状况调查问卷(SF-36)中角色功能、认知功能、躯体功能、社会功能及情绪功能评分均明显高于本组干预前(P﹤0.01),且观察组均明显高于对照组(P﹤0.01).观察组患者术后性交疼痛、阴道干涩发生率均低于对照组,护理满意度高于对照组,差异均有统计学意义(P﹤0.05).结论 基于同伴支持的PDCA循环用于宫颈癌患者术后康复进程中效果较理想,显著提高患者自护能力,有效缓解患者负性情绪,改善患者生活质量以及性功能障碍等,同时有利于提高护理满意度,值得在临床实践中推广使用.     

改良健康教育方法在肺癌介入手术术后康复、并发症预防中的应用效果分析

目的 研究改良健康教育方法在肺癌介入手术术后康复、并发症预防中的应用效果.方法 将110例接受肺癌介入手术治疗的患者按随机数字表法随机分为对照组和观察组,每组55例.对照组采用常规护理辅以传统健康教育干预,观察组在对照组基础上应用改良健康教育方法干预,两组均干预1个月.比较两组患者术后康复情况;干预前后采用抑郁自评量表(SDS)、焦虑自评量表(SAS)、自我管理效能量表(SUPPH)比较两组患者负性情绪和自我管理效能水平;干预前后比较两组患者肺功能变化;比较两组患者术后并发症发生情况.结果 观察组患者吸氧时间、首次下床时间、拔管时间和住院时间均明显短于对照组,差异均有统计学意义(P﹤0.01).干预后,两组患者SDS、SAS评分均降低(P﹤0.05),且观察组患者SDS、SAS评分均明显低于对照组(P﹤0.01).干预后,两组患者SUPPH各维度评分及总分均升高(P﹤0.05),且观察组患者SUPPH各维度评分及总分均明显高于对照组(P﹤0.01).干预后,两组患者第1秒用力呼气容积(FEV1)、用力肺活量(FVC)均升高(P﹤0.05),且观察组患者FEV1、FVC均明显高于对照组(P﹤0.01).干预后,观察组患者并发症总发生率低于对照组,差异有统计学意义(P﹤0.05).结论 采用改良健康教育方法对行肺癌介入手术患者预后康复效果较好,可调节患者负性情绪,提高自我管理效能,有效改善患者肺功能,减少术后并发症发生.     

Former cancer patients as counselors of newly diagnosed cancer patients

This study tested the hypothesis that counseling of newly diagnosed cancer patients by former cancer patients will increase the use of coping strategies and reduce psychological stress beyond what can be accomplished by just counseling from professional staff. Thirty-two newly diagnosed patients in a gynecologic oncology service were subjects in this study. All subjects received supportive services from professionals assigned to the service. Control group patients received just the professional support program, while the experimental group patients received professional support plus additional counseling by former cancer patients that emphasized four coping strategies characteristic of patients who have adapted well to cancer. Results 6 and 12 weeks after entering the study showed no statistically significant differences in emotional status between experimental and control groups and only one significant difference in coping behaviors that was opposite to what was predicted. The findings do not support the hypothesis.     

胸腺瘤166例临床分析

目的 对166例胸腺瘤进行临床分析,以探讨不同分期胸腺瘤手术的特点及与预后的关系。方法 分析1985年2月－2000年2月收治的166例胸腺瘤患者。按Masaoka分期法进行分期,I期102例（61．4％）,Ⅱ期28例（16．9％）,Ⅲ期24例（14．5％）,Ⅳa期12例（7．2％）。对166例患者进行随访,分析不同分期胸腺瘤与生存率之间的关系。用寿命表法统计生存率。结果 手术后死亡1例（0．6％）,完整切除137例（82．5％）。随访所有患者,逐年失访30例。10年生存率为56．8％,其中I期为79．8％,Ⅱ期为51．6％,Ⅲ期为33．5％,Ⅳ期为0。结论 胸腺瘤诊断仍需依靠临床与病理结合判断,治疗原则应尽可能广泛切除肿瘤,以达到缓解症状、延长生存时间的目的。其预后与分期相关。     

Cardio-oncological management of patients

Session III of the Second International Colloquium on Cardio-Oncology focused on the diagnosis, management, and prevention of cardiovascular toxicity of cancer drugs. With a large menu of biomarkers and imaging modalities available to the cardio oncologist, there continues to be no consensus regarding the best use of each modality alone and in combination and whether we can actually prevent early and late cardiotoxicity using these tests to guide a preventive strategy. It has become increasingly clear that early diagnosis and intervention leads to less late cardiotoxicity and fewer cardiac-related events. This can be accomplished by taking a thorough history and performing a goal directed physical examination coupled with use of biomarkers and imaging studies. This session attempted to provide rationale for a current and integrated approach to these issues.     

Survival of patients with relapsing breast cancer: analysis of 302 patients

This retrospective study analyzes overall survival and relapse-free survival after mastectomy and survival after recurrence of 302 patients with metastatic breast cancer. In the whole group the median survival after mastectomy is 99 months: 5-year survival rate is 68.4% and 10-year survival rate is 38.5%. The median survival from relapse was 36 months: 5-year and 10-year survival rates were respectively 26.8 and 18.9%. Various subsets of patients divided according to several prognostic factors have been analyzed.     

Survival experience of black patients and white patients with bladder carcinoma

BACKGROUND: Blacks are less likely than whites to develop bladder carcinoma. However, once they are diagnosed, black patients experience poorer survival. The authors investigated which factors were related to survival differences in black patients and white patients with bladder carcinoma stratified by extent of disease. METHODS: A population-based cohort of black patients with bladder carcinoma and a random sample of frequency-matched white patients with bladder carcinoma, stratified by age and gender, were identified through cancer registry systems in Atlanta, New Orleans, and San Francisco/Oakland. Patients had no previous cancer history and were ages 20-79 years at the time they were diagnosed with bladder carcinoma in 1985-1987. Medical records were reviewed at initial diagnosis, and 77% of patients were interviewed. Tumor grade, T classification, and other variables, including age, socioeconomic position, symptom duration, smoking history, and comorbidities, were recorded. Survival of black patients and white patients by extent of disease was modeled using Cox regression analysis. RESULTS: A greater proportion of black patients had histologic types of tumors that were associated with poorer survival. Among those with pure urothelial carcinoma, black patients had greater extent of disease at the time of diagnosis. Within specific extent-of-disease categories, there was some evidence of poorer survival for black patients with T2 tumors and strong evidence of poorer survival among those with T3 tumors compared with white patients. Black patients with muscle-invasive carcinoma who died within 6 months of diagnosis tended to present with life-threatening symptoms. Black patients and white patients did not differ with respect to diagnostic tests performed or therapy given. CONCLUSIONS: Black patients with bladder carcinoma had poorer survival due to greater extent of disease at diagnosis and a higher proportion of more aggressive histologies compared with white patients. Within urothelial carcinomas, by extent of disease (clinical/pathologic stage) these black/white survival differences were limited to patients with muscle invasion (T2 and T3 tumors).     

Education of cancer patients

Increasing patients' information is currently evolving toward real education, mainly concerning chronic diseases. Cancer patients could also benefit from this evolution of medical care. Rationale for such education certainly includes theoretical endpoints (patient's autonomy) but also practical considerations that will improve treatment quality (compliance), tolerance and further rehabilitation. Many patients may benefit from this education during complex and long-term treatments. Furthermore, sequelae and handicaps will be either reduced or better tolerated. This education is provided by practitioners and other care-providers. That implies improved specific training and further need for written and video-taped documents. Such an evolution should further lead to proper evaluation and cost-benefit analyses in order to ensure real improvement of both treatment quality and patient's experience.     

Quality-of-life of cancer patients

During March and April 1986 a study of the quality-of-life of cancer patients was done in a medical school-affiliated community hospital in the Midwest, USA. The control group was that of a family practitioner. The experimental group was composed of only those suffering from oncological diseases and the control group of only those without cancer. Ninety-eight experimental patients were studied during 293 visits as were 112 controls during 137 visits. The study instrument was a linear analogue scale of 10 items. Patients were scored from 0 to 10 on each item and then the median, mean, span, and standard deviation were calculated. The means were compared. Overall the control group scored on average 6.67; the experimental group 6.06. This was statistically significant. Subgroups of each practice were then compared with each other, and subgroups of the oncological patients were compared with each other. In general, women in the experimental group did not differ significantly from women in the control group, while men related that they were doing more poorly than did men in the control group and women in the experimental arm. An analysis of exactly where men did worse is made. Lastly, an informed, experienced laywoman attempted to blindly predict, within one point, the scores some consecutive experimental patients would make on their test. She was unable to do this more than 20% of the time.