围术期认知行为干预对肺癌患者焦虑、抑郁情绪及疼痛、失眠、疲乏症状群的影响研究

目的探讨围术期认知行为干预对肺癌患者焦虑、抑郁情绪及疼痛、失眠、疲乏症状群的影响。方法将57例肺癌患者依对照匹配原则分为干预组(n=28)和对照组(n=29)。于入院后第1天(前测)、术后第3天(中测)、出院前1天(后测)对患者进行焦虑、抑郁、失眠、疼痛、疲乏症状及住院天数的评估,并给予干预组患者认知行为治疗,包括4次40min的面对面合理情绪会谈,以及4次30min的皮温生物反馈仪辅助的放松训练。结果术后第3天、出院前1天的各症状得分,以及住院天数,干预组均低于对照组,差异均具有统计学意义(P0.001)。术后第3天较入院后第1天,干预组焦虑、抑郁减轻,失眠、疼痛、疲乏加重,出院前1天所有症状较术后第3天均减轻,差异有统计学意义(P0.001);而对照组术后第3天较入院后第1天所有症状均加重,出院前1天所有症状较术后第3天缓解,差异有统计学意义(P0.001)。结论对围术期肺癌患者进行焦虑、抑郁情绪及疼痛、失眠、疲乏症状群的评估,并给予认知行为干预,可以有效缓解焦虑、抑郁情绪,失眠、减轻疼痛及疲乏症状,缩短住院时间。认知行为干预有望为肺癌患者症状群管理提供一种经济有效的辅助治疗方法。

Influence of peri-operative cognitive behavioral intervention on anxiety,depression pain,insomnia and fatigue symptoms in patients with lung cancer

Objective To assess initial efficacy of a peri-operative cognitive-behavioral (CB) intervention for anxiety,depression,pain,insomnia,and fatigue symptom cluster during treatment for lung cancer.Method 57 adults with lung cancer receiving surgery from Department of oilfield general hospital in Daqing were selected for the study.29 patients was assigned to the control group.28 patients in intervention group was given cognitive behavioral therapy,including four time face-to-face talks for 40 min,and 4 times of skin temperature biofeedback assisted relaxation training for 30 min.The anxiety,depression,insomnia,pain,fatigue symptoms and length of hospital stay were evaluated on first days (pre-test),third days after operation (1 days after surgery) and before discharge.Result The scores of each symptom and the length of hospital stay of the first day before discharge and third days after operation for patients in intervention group were much lower than that of the control group.There was significant difference between group(P＜0.001).Third days after operation,compared with first days after admission,the anxiety and depression of the intervention group decreased,and the insomnia,pain and fatigue worsened.All symptoms were relieved 1 days before discharge compared with that at third days after operation.There was significant difference (P＜0.001).Compared with first days after admission,all the symptoms were aggravated third days after operation for patients in control group.All symptoms were relieved at first before discharge compared with that of the third after operation.There was significnat difference (P＜ 0.001).Conclusion The lung cancer patients' anxiety,depression,insomnia,pain and fatigue symptoms,length of hospital stay can be effectively alleviate and shorten by assessing the anxiety,depression,pain,insomnia and fatigue symptoms and providing cognitive behavioral intervention during peri-operative period.Cognitive behavioral intervention is expected to provide an economic and effective adjunctive therapy for symptom management in patients with lung cancer.