认知干预对胃癌患者术后抑郁、焦虑及失眠的疗效

目的探索认知干预对胃癌患者术后伴发抑郁、焦虑和失眠的疗效。方法使用17项汉密尔顿抑郁量表、汉密尔顿焦虑量表和阿瑟斯失眠量表对在院胃癌术后1周内患者进行情绪和睡眠状况的评估，符合纳入标准的患者随机进入认知干预组和临床管理组，接受为期8周，共6次认知干预或临床管理，在最后1次干预结束时和3个月后对患者的情绪和睡眠情况再次评估。结果①在干预后和随访期，认知行为干预组和临床管理组的抑郁、焦虑和失眠程度和发生比例和基线期相比均显著降低，差异有统计学意义（P〈0．05）；②干预后，认知行为干预组抑郁得分（7．37±2．72）低于临床管理组（9．40±3．09），差异有统计学意义（P=0．009），两组的焦虑（7．03±3．07，8．23±2．90）和睡眠得分（7．76±1．68，8．57±2．65）差异无统计学意义；两组抑郁、焦虑和失眠的疗效比较差异无统计意义；③随访期，认知行为干预组抑郁、焦虑得分和疗效与临床管理组比较，差异有统计学意义（P〈0．001），两组的睡眠得分（5．00±2．88，4．73±3．24）和疗效比较，差异无统计学意义。结论认知行为疗法和临床管理均可改善胃癌术后患者的抑郁、焦虑、失眠情况，认知行为疗法对胃癌患者术后抑郁、焦虑情绪改善效果好于临床管理，对睡眠的改善两者效果相当。

Cognitive Intervention on Depression,Anxiety and Insomnia in Patients with Gastric Cancer.

Objective To explore the effect of cognitive intervention on depression, anxiety and insomnia associated with gastric cancer patients after operation. Methods The mood and somnus condition of gastric cancer patients were assessed within one week after the operation. The patients who met the inclusion criteria were randomly into the cognitive intervention group and clinical management group, received an eight - week, a total of six times cognitive intervention or clinical management. The mood and somnus condition was re - evaluated after finishing the intervention and 3 months later. Results （1） Right after the intervention and the follow - up period, the depression, anxiety and insomnia degree decreased significantly compared to the baseline in both groups. （2） After the intervention, the depression scores of the cognitive behavior intervention group （7.37 ± 2.72） the depression scores of the cognitive behavior intervention group （7.37 ± 2.72） was lower than that of the clinical management group （9.40 ± 3.09） , and the difference was statistically significant （ P = 0. 009）. The scores of anxiety （7.03 ± 3.07,8.23 ± 2.90） and somnus （7.76± 1.68,8.57± 2.65 ） had no significant difference between the two groups. The affection was not statistically significant between the two groups in depression, anxiety and insomnia. （3）During the follow- up period, the difference was significantly different （P 〈0. 001 ） in depression, anxiety scores and curative affection be- tween the cognitive behavior intervention group and clinical management group. The somnus score （5 -＋ 2.88,4.73 ＋ 3.24） and curative effi- cacy showed no differences between the two groups. Conclusion Both the cognitive behavior therapy and clinical management can improve depression, anxiety and somnus in postoperative gastric cancer patients. The efficacy of reliving anxiety and depression in cognitive behavior therapy group was much better than clinical management group, and continually playing an important role after finishing the intervention.