宣泄和认知疗法对肺癌患者心理状况的影响(英文)

Influence of catharsis and cognitive therapy on the psychology of patients with lung cancer

背景:负性情绪可直接引起患者体液或细胞免疫功能下降导致肺癌发病,因此在肺癌的防治过程中心理治疗很有必要。目的:观察宣泄和认知疗法对肺癌患者心理状况和近期临床疗效的影响,探讨心理干预的重要性设计:非随机化同期对照,1∶1配对观察。单位:中国医科大学第二附属医院干诊科和解放军沈阳军区总医院干诊科病房。对象:以中国医科大学第二附属医院和解放军沈阳军区总医院1999-02/2002-12收治的肺癌患者124例为观察对象,患者根据自愿原则分别进入治疗组和对照组,治疗结束后统计资料时按相同年龄、性别、UICC-TUM分期和细胞病理分型1∶1配对,配成42对。方法:全部患者均选择同一化疗(足叶乙甙和卡铂)及放疗方案,治疗组在此基础上给予情绪宣泄和认知疗法:治疗开始阶段进行宣泄,每5d1次,需1～3次;然后进行每周一两次的癌症知识认知教育,共计6周。治疗前后应用精神卫生症状自评量表(分为9大症状因子,5级评分:0分为从无,l分为轻度,2分为中度,3分为相当重,4分为严重)评估患者的心理状况;按WHO肺癌评估标准(病灶完全消失4周以上为完全缓解;病灶面积减少50%以上,并持续4周为部分缓解)进行疗效评估。主要观察指标:两组患者治疗前后精神卫生症状自评量表评分及疗效。结果:共配成42对,84例进入结果分析。①精神卫生症状自评量表得分:治疗后两组各项评分均明显低于治疗前(P<0.05),但治疗后治疗组的躯体化、人际关系、抑郁、焦虑和精神病性等项评分均低于对照组(1.64±0.41,1.76±0.34;1.31±0.30,1.67±0.35;1.40±0.29,1.58±0.41;1.23±0.27,1.40±0.39;1.19±0.27,1.24±0.34;t=2.013～2.257,P均<0.05)。②疗效:治疗组总缓解率高于对照组,但无统计学意义(68%,52%,χ2=2.381,P>0.05)。结论:宣泄和认知疗法治疗对肺癌患者的近期临床疗效不明显,但可减轻患者的抑郁、焦虑等负性情绪,对改善其精神心理状态、提高机体免疫调节功能是有帮助的。

BACKGROUND： The negative emotion can directly attenuate the humoral and cell mediated immunity, which contrihuting to the onset of lung cancer, therefore psychological therapy is crucial for the prevention of lung cancer. OBJECTIVE： To investigate the effect of catharsis and cognitive therapy on the psychology of patients with lung cancer, as well as the short-term clinical therapeutie effect, so as to exploring the importance of psychological intervention DESIGN： Non-randomized same period control, 1：1 matched observation SETTING： Cadres Therapeutic Ward of Affiliated Second Hospital of China Medical University and Cadres Therapeutic Ward of General Hospital of Shenyang Military Area Command of Chinese PLA. PARTICIPANTS： Totally 124 patients with lung cancer, received treatment at Cadres Therapeutic Ward of Affiliated Second Hospital in China Medical University and General Hospital of Shenyang Military Area Command of Chinese PLA from Fehruary 1999 to December 2002, volunteered into this study, were randomly divided into treatment group and control group, all data was paired hy 1：1 according to age, gender, UICC-TUM stage and pathological type, totally 42 pair data were ohtained. METHODS： All participant received the same chemotherapy and radiotherapy （etoposide earhoplatin）, the patients in treatment group were given additional emotional catharsis and cognitive therapy at the beginning of treatment once every five days for 1-3 times; And then patients were informed of related eancer knowledge once or twice a week for totally 6 weeks. Before treatment, SCL-90 （including 9 symptomatic factors that divide into five grades： 0 score meant never, 1 score was gentle, 2 scores were medium, 3 scores were quite severe and 4 scores were severer） used to evaluate the psychology of patients; moreover the therapeutic effect was assessed according to WHO standards for lung cancer （focus disappeared for more than 4 weeks is believed of complete relieve; Focus area reduced hy above 50% and maintained for 4 weeks is helieved of part relieve） MAIN OUTCOME MEASURES： Scores for SCL-90 and therapeutic effect of two groups before and after treatment RESULTS： Totally 42 pairs （84 cases） were remained in the final result analysis. ① Seores for SCL-90： The score for each item was obviously reduced after treatment in two groups （P 〈 0.05）, hut the scores for somatzation, individual sensitivity, depression anxiety and psychosis in treatment group were found lower than corresponding control group after treatment （1.64±0.41, 1.76±0.34; 1.31±0.30, 1.67±0.35; 1.40±0.29, 1.58±0.41; 1.23±0.27, 1.40±0.39; 1.19±0.27, 1.24±0.34; t=2.013-2.257, P 〈 0.05）.② Therapeutic effect： The total relieve rate in treatment group was higher than control group, trot difference was of no statistical significance （68%, 52%, ）（χ^2=2.381, P 〉 0.05）. CONCLUSION： Although the therapeutic effect of catharsis and cognitive therapy is s unohvious short-term in patients with lung cancer, but it can attenuate the negative emotion, such as depression and anxiety, which can improve their psychology and immune-regulating function.