心理康复治疗对脑卒中后抑郁症的疗效观察

目的探讨心理康复治疗对脑卒中后抑郁症的治疗效果。方法将50例脑卒中后抑郁患者随机分为治疗组与对照组各25例。对照组采用药物治疗,治疗组采用针对性的心理康复治疗,疗程8周。应用汉密尔顿抑郁量表对两组患者进行治疗前和治疗后评分,确定临床疗效。结果两组在治疗前HAMD评分无显著差异（P〉0.05）;两组在第8周后HAMD评分均较治疗前降低（P〈0.01）;治疗组在第8周后HAMD评分显著低于对照组（P〈0.01）,临床疗效显著优于对照组（P〈0.05）。结论针对性的心理康复治疗能明显缓解脑卒中后抑郁症患者的抑郁症状,提高患者生存质量。     

康复俱乐部人文关怀模式在肿瘤患者中的实践

目的探讨对肿瘤患者实施人文关怀的方法,促进肿瘤患者更好地康复。方法依托癌症康复俱乐部,成立由医生、护士、心理咨询师、康复志愿者等组成的多学科团队,对300例肿瘤患者进行人文关怀,包括心理痛苦筛查、沙盘游戏、鼓圈音乐工作坊、家庭工作坊、冥想疗法工作坊、科普讲座等,比较活动前及活动6个月后患者焦虑、抑郁、心理痛苦程度及患者的康复满意度。结果活动后肿瘤患者焦虑、抑郁及心理痛苦程度显著低于活动前(均P0.05),患者对康复满意度评价得分3.06±0.75。结论康复俱乐部人文关怀活动可改善肿瘤患者负性心理状况。     

肿瘤化疗患者心理韧性及其影响因素的研究

目的了解肿瘤化疗患者心理韧性状况并分析其影响因素,以期为肿瘤化疗患者的心理健康维护提供参考。方法选取2014年2~7月就诊于某三甲医院的200例肿瘤化疗患者,采用心理韧性量表、一般自我效能感量表、社会支持量表对患者进行问卷调查。结果肿瘤化疗患者心理韧性得分为(53.88±13.26)分;不同年龄、职业、婚姻状况、文化程度、家庭月收入、医疗费用支付形式及居住方式的患者心理韧性得分比较,差异有统计学意义(P0.05,P0.01)。文化程度、一般自我效能和社会支持对肿瘤化疗患者的心理韧性预测作用为40.90%。结论肿瘤化疗患者的心理韧性普遍较低,文化程度、一般自我效能感、社会支持是影响心理韧性的重要因素。护士需加强对肿瘤患者的心理行为干预,使患者保持良好的心理状态,使之积极配合治疗,以提高治疗效果。     

肿瘤患者在调强放射治疗中心理护理及探讨

目的:解除肿瘤患者对调强放射治疗的焦虑恐惧心理,增强病人对放射治疗的心理承受力,帮助病人度过放疗期,顺利完成治疗计划.方法:对我院2010年10月-2011年6月34例调强放射治疗患者,进行治疗前及治疗中心理护理,了解病人的心理需求,进行针对性心理沟通.结果:34例患者中4例出现Ⅰ -Ⅱ骨髓抑制;9例发生放射性口腔炎;9例发生Ⅰ度皮炎,1例发生Ⅱ度皮炎,经过治疗与护理恢复正常,无一例患者目焦虑、恐惧心理放弃治疗.结论:全面了解放疗患者的疾病心理反应,合理运用医学心理知识,结合熟练的临床技术,再进行更规范,更系统的护理措施,使患者增强对疾病治疗的勇气和信心,提高患者的生活质量和对放疗的耐受力,顺利完成治疗计划.     

乳癌术后腹直肌横行皮瓣乳房再造术护理

传统乳腺肿瘤术后乳房残缺,使女性特征缺失,造成严重的心理负担,影响其社会交往乃至家庭生活。乳房再造可以矫正乳腺癌术后乳房及胸壁的缺损和畸形,从而对患者形体及心理进行双重治疗。有资料显示,乳房再造术后患者的生活质量明显高于乳腺肿瘤切除加放疗或单纯乳房切除的患者,追求乳腺癌根治术后乳房再造的患者日渐增多。     

乳腺癌病人心理康复俱乐部模式在乳腺癌病人心理护理中的价值初探

目的 探讨乳腺癌病人治疗后回归社会前心理问题及心理护理的模式与方法。方法回顾分析我院自2003年10月建立乳腺癌病人俱乐部以来．260例乳癌患者进行心理辅助治疗和医患病患间互相进行心理帮助的经验。通过《抑制自评量表（SDS）与焦虑自评量表（SAS）》评定护理效果。结果心理护理干预前后,患者的SDS、SAS评分有显著差异（P〈0．05）．护理干预后病人存在的不良心理问题较前明显减轻,解除了患者回归社会的心理障碍。结论乳腺癌病人的总体心理状况较差,应采取有效的心理护理：“乳康会”模式可以改变患者不良心理状态和行为,从而使病人以良好的心态接受治疗并回归社会。     

脑出血患者的不良心理及护理对策

目的观察并分析脑出血患者不良心理情绪,总结护理对策。方法对59例脑出血患者采取定时与患者沟通,观察不同病情阶段患者的不同心理情绪状态,针对性给予心理护理干预,并从营造住院环境,取得家属配合方面入手,配合心理护理干预。结果患者治疗前后SAS及SDS自评量表评比较,差异有统计学意义(P0.05)。结论对脑出血患者给予针对性护理及心理疏导,可明显缓解患者各种不良心理刺激,提高患者治疗信心,促进病情康复。     

1例家族性脑血管网状细胞瘤病人的心理护理及康复训练

血管网状细胞瘤多发生于成人,大部分位于小脑和延髓背侧,可向第四脑室发展[1].遗传性血管网状细胞瘤属染色体异常疾病,家族中可有多人患病 .手术是最主要的治疗方法,全切除肿瘤可以获得治愈[1].但因肿瘤供血极丰富 ,手术难度及风险性极大,特别是巨大血管网状细胞瘤,因此病人心理负担极重.我科于20 00年5月4日收治1例,在病人4个月的住院时间内,我们实施了针对性的心理护理和康复训练 ,使其痊愈出院.     

ICU患者的心理分析与护理干预

目的 分析ICU患者的心理反应与特点,并探讨有效而实用的心理干预.方法 根据患者的心理特点进行有针对性的个性化护理.结果 通过心理护理,患者能积极配合治疗和护理.结论 切实有效的心理护理可大大降低ICU患者的负性心理反应,使其配合治疗和护理,促进早日康复.     

恶性肿瘤患者临床化疗的护理

恶性肿瘤是临床上常见的疾病之一,往往给患者造成生理及心理上的严重创伤,严重威胁着人们的身心健康乃至生命.化疗是目前治疗恶性肿瘤的一种有效手段,但由于化疗药物的细胞毒性作用,常伴有不同程度的毒副作用及组织脏器的损伤,而且肿瘤患者普遍存在不同程度的恐惧、焦虑心理,对患者的生存质量和治疗效果都造成不良影响.     

The effect of trimodal prehabilitation on the physical and psychological health of patients undergoing colorectal surgery: a randomised clinical trial

Prehabilitation aims to increase the endurance capacity of patients who are awaiting major surgery. However, there are no studies investigating the implementation of this demanding and expensive intervention in low-income countries. This study aimed to assess the impact of a 4-week trimodal prehabilitation program on the physical and psychological health of patients waiting for colorectal surgery compared with a control group managed according to enhanced recovery after surgery principles supplemented by nutritional care. This study was a single-centre, randomised controlled trial. The primary outcome measures for the physical aspects were 6-minute walking distance (6MWD) and incentive spirometry, whereas the psychological elements were measured using the 36-item short form survey questionnaire and the hospital anxiety and depression score. In total, data from 149 patients were analysed (77 in the prehabilitation group and 72 in the control group). At the time of surgery, patients in the prehabilitation group had improved 6MWD and incentive spirometry compared with the control group (median (IQR [range]) percentage improvement 131% (112–173 [68–376]) vs. 107% (99–120 [63–163]); p < 0.001 and 113% (100–125 [75–200]) vs. 100% (100–112 [86–167]); p < 0.001 respectively). Patients in the prehabilitation group also had reduced anxiety scores compared with the control group (mean (SD) anxiety score (4 (3) vs. 5 (3) respectively; p = 0.032). However, these effects did not translate into improvements in postoperative mortality and morbidity, or a reduction in duration of hospital stay. Trimodal (physical, emotional and nutritional) prehabilitation is able to improve functional status as well as some parameters of emotional and physical well-being of patients waiting for colorectal surgery.     

Psychological factors,prehabilitation and surgical outcomes: evidence and future directions

The pre-operative optimisation of comorbidities is increasingly recognised as an important element of the pre-operative pathway. These efforts have primarily focused on physical comorbidities such as anaemia and the optimisation of exercise and nutrition. However, there is a growing recognition of the importance of psychological morbidity. Increasingly, evidence suggests that psychological factors have an impact on surgical outcomes in both the short and long term. Pre-operative anxiety, depression and low self-efficacy are consistently associated with worse physiological surgical outcomes and postoperative quality of life. This has led to the emergence of psychological prehabilitation and the trimodal approach to prehabilitation, incorporating psychological intervention as well as exercise and nutritional optimisation. However, there is currently insufficient evidence to be sure that pre-operative psychological interventions are of benefit, or which interventions are most effective, because their impact has been mixed. There is an urgent need for high quality, contemporaneous prospective trials with baseline psychological evaluation, well-described interventions and agreement on the most appropriate psychological, quality of life and physiological outcomes measures.     

Prehabilitation for general surgery: a systematic review of randomized controlled trials

Background

Prehabilitation seeks to optimize patient health before surgery to improve outcomes. Randomized controlled trials (RCTs) have been conducted on prehabilitation, however an updated synthesis of this evidence is required across General Surgery to inform potential Supplementary discipline-level protocols. Accordingly, this systematic review of RCTs aimed to evaluate the use of prehabilitation interventions across the discipline of General Surgery.

Methods

This study was registered with PROSPERO (CRD42023403289), and adhered to PRISMA 2020 and SWiM guidelines. PubMed/MEDLINE and Ovid Embase were searched to 4 March 2023 for RCTs evaluating prehabilitation interventions within the discipline of General Surgery. After data extraction, risk of bias was assessed using the Cochrane RoB 2 tool. Quantitative and qualitative data were synthesized and analysed. However, meta-analysis was precluded due to heterogeneity across included studies.

Results

From 929 records, 36 RCTs of mostly low risk of bias were included. 17 (47.2%) were from Europe, and 14 (38.9%) North America. 30 (83.3%) investigated cancer populations. 31 (86.1%) investigated physical interventions, finding no significant difference in 16 (51.6%) and significant improvement in 14 (45.2%). Nine (25%) investigated psychological interventions: six (66.7%) found significant improvement, three (33.3%) found no significant difference. Five (13.9%) investigated nutritional interventions, finding no significant difference in three (60%), and significant improvement in two (40%).

Conclusions

Prehabilitation interventions showed mixed levels of effectiveness, and there is insufficient RCT evidence to suggest system-level delivery across General Surgery within standardized protocols. However, given potential benefits and non-inferiority to standard care, they should be considered on a case-by-case basis.     

The Impact of Total Body Prehabilitation on Post-Operative Outcomes After Major Abdominal Surgery: A Systematic Review

Background

Despite advances in perioperative care, post-operative clinical and functional outcomes after major abdominal surgery can be suboptimal. Prehabilitation programmes attempt to optimise a patient’s preoperative condition to improve outcomes. Total body prehabilitation includes structured exercise, nutritional optimisation, psychological support and cessation of negative health behaviours. This systematic review aims to report on the current literature regarding the impact of total body prehabilitation prior to major abdominal surgery.

Methods

Relevant studies published between January 2000 and July 2017 were identified using MEDLINE, EMBASE, AMED, CINAHL, PsychINFO, PubMed, and the Cochrane Database. All studies published in a peer-reviewed journal, assessing post-operative clinical and functional outcomes, following a prehabilitation programme prior to major abdominal surgery were included. Studies with less than ten patients, or a prehabilitation programme lasting less than 7 days were excluded.

Results

Sixteen studies were included, incorporating 2591 patients, with 1255 undergoing a prehabilitation programme. The studies were very heterogeneous, with multiple surgical sub-specialties, prehabilitation techniques, and outcomes assessed. Post-operative complication rate was reduced in six gastrointestinal studies utilising either preoperative exercise, nutritional supplementation in malnourished patients or smoking cessation. Improved functional outcomes were observed following a multimodal prehabilitation programme. Compliance was variably measured across the studies (range 16–100%).

Conclusions

There is substantial heterogeneity in the prehabilitation programmes used prior to major abdominal surgery. A multimodal approach is likely to have better impact on functional outcomes compared to single modality; however, there is insufficient data either to identify the optimum programme, or to recommend routine clinical implementation.

     

Neoadjuvant treatment: A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma

Patients affected by pancreatic ductal adenocarcinoma (PDAC) frequently present with advanced disease at the time of diagnosis, limiting an upfront surgical approach. Neoadjuvant treatment (NAT) has become the standard of care to downstage non-metastatic locally advanced PDAC. However, this treatment increases the risk of a nutritional status decline, which in turn, may impact therapeutic tolerance, postoperative outcomes, or even prevent the possibility of surgery. Literature on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications, length of hospital stay, and readmission rate, while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still missing. Particularly, appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical trauma. In this regard, NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program, aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival outcomes. Given these perspectives, this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.     

Multi-modal prehabilitation: addressing the why,when, what,how, who and where next?

Just as there is growing interest in enhancing recovery after surgery, prehabilitation is becoming a recognised means of preparing the patient physically for their operation and/or subsequent treatment. Exercise training is an important stimulus for improving low cardiovascular fitness and preserving lean muscle mass, which are critical factors in how well the patient recovers from surgery. Despite the usual focus on exercise, it is important to recognise the contribution of nutritional optimisation and psychological wellbeing for both the adherence and the response to the physical training stimulus. This article reviews the importance of a multi-modal approach to prehabilitation in order to maximise its impact in the pre-surgical period, as well as critical future steps in its development and integration in the healthcare system.     

老年早期肺癌患者术前预康复感知的质性研究

目的 了解老年早期肺癌患者对术前预康复的感知,为制定术前预康复方案提供依据。方法 采用描述性质性研究方法,以目的抽样法选取术前接受过预康复健康教育的老年早期肺癌患者15例进行半结构式深入访谈,并以内容分析法归纳和提炼主题。结果 提炼出4个主题：术前预康复的意向（态度积极、愿意尝试接受、缺乏行为动机）、术前预康复的益处（利于适应手术、改善术后结局）、术前预康复障碍（环境设施障碍、安全问题、准备时间不足）、术前预康复需求（信息咨询需求、完善方案需求、联系支持需求）。结论 老年早期肺癌患者对术前预康复有积极接受的倾向,术前预康复有助于加速术后康复。医护人员应开展个性化教育促进患者实施术前预康复、构建适老化术前预康复方案、完善联系支持体系,以提高术前预康复的适宜性。     

Perioperative exercise training in elderly subjects

The association between physical fitness and outcome following major surgery is well described - less fit patients having a higher incidence of perioperative morbidity and mortality. This has led to the idea of physical training (exercise training) as a perioperative intervention with the aim of improving postoperative outcome. Studies have started to explore both preoperative training (prehabilitation) and postoperative training (rehabilitation). We have reviewed the current literature regarding the use of prehabilitation and rehabilitation in relation to major surgery in elderly patients. We have focussed particularly on randomised controlled trials, systematic reviews and meta-analyses. There is currently a paucity of high-quality clinical trials in this area, and the evidence base in elderly patients is particularly limited. The review indicated that prehabilitation can improve objectively measured fitness in the short time available prior to major surgery. Furthermore, for several general surgical procedures, prehabilitation using inspiratory muscle training may reduce the risk of some specific complications (e.g., pulmonary complications and predominately atelectasis), but it is unclear whether this translates into an improvement in overall surgical outcome. There is clear evidence that rehabilitation is of benefit to patients following cancer diagnoses, in terms of physical activity, fatigue and health-related quality of life. However, it is uncertain whether this improved physical function translates into increased survival and delayed disease recurrence. Prehabilitation using continuous or interval training has been shown to improve fitness but the impact on surgical outcomes remains ill defined. Taken together, these findings are encouraging and support the notion that pre- and postoperative exercise training may be of benefit to patients. There is an urgent need for adequately powered randomised control studies addressing appropriate clinical outcomes in this field.     

乳腺癌手术患者绘画训练主导的功能锻炼研究

目的探讨绘画训练主导的功能锻炼对乳腺癌术后患者负性情绪、患侧肢体功能和淋巴水肿的影响。方法将90例乳腺癌手术患者按随机数字表法分为对照组和干预组各45例。对照组实施乳腺癌常规护理,干预组在常规护理基础上进行绘画训练主导的功能锻炼。结果干预14d后,干预组肩关节前屈、后伸、外展、内收角度显著高于对照组,激惹、抑郁和焦虑得分显著低于对照组(P<0.05,P<0.01);两组淋巴水肿程度比较,差异无统计学意义(P>0.05)。结论绘画训练主导的功能锻炼能有效缓解乳腺癌术后患者的负性情绪,改善肩关节活动度,但对淋巴水肿的效果需延长时间进一步观察。     

Prehabilitation

As the geriatric population continues to grow, the number of elderly patients undergoing major surgeries has also increased. These patients have a higher incidence of postoperative complications, potentially resulting in long-term disability, prolonged hospitalization and poor quality of life. Recent research has identified several predictive factors for postoperative morbidity and mortality; these include premorbid functional dependence, malnutrition, anaemia, cognitive impairment and an increased number of comorbidities. A rising body of evidence shows that optimization of patients’ physiological, physical, nutritional and mental status in the preoperative setting may improve the overall surgical outcome. This is known as prehabilitation. This article focuses on the multi-modal approach for prehabilitation – which comprises of medical optimization, exercise therapy, nutritional supplementation, and psychological support.