调控睡眠行为对老年肠癌患者术后机体免疫功能的良性影响

Good influence of adjustment of sleep behavior on the postoperative immunological function of organ in elderly patients with bowel cancer

目的:探讨调控睡眠行为对老年肠癌术后患者机体免疫功能的影响,寻求改善老年癌患者术后的心理情绪及提高躯体抗病能力。方法:选择2002-03/2004-12铁岭市中心医院普外科肠癌患者72例,随机分为实验组与对照组各36例。对照组给予常规手术治疗,不予特殊指导。实验组在此基础上采用积极的睡眠调控干预:①主观情绪放松训练。②客观环境支持。③社会支持。④改善躯体症状。两组患者实验前后分别进行抑郁自评量表、焦虑自评量表进行心理情绪评定(两个量表各包括20个条目,每个条目按症状出现频度分4个等级,记分方式1～4分,分数愈高,表示症状出现的频度愈多。20个条目中各个条目相加既得到总分。标准分≥50分设定为抑郁和焦虑患者)。睡眠检测采用睡眠效率值测量,免疫指标采用血清免疫球蛋白和外周血淋巴细胞亚群指标测定。结果:72例患者均进入结果分析。①经4周观察,实验组睡眠效率值Ⅰ级睡眠率(睡眠率70%～80%,睡眠尚可)由19.44%提高到55.56%(P<0.05)。②抑郁自评量表和焦虑自评量表评分:实验组治疗后各项评分明显降低,实验组治疗后抑郁自评量表明显低于对照组犤(35.76±8.25),(38.21±12.12)分,P<0.01犦。实验组治疗后焦虑自评量表低于对照组犤(34.81±9.03),(40.93±11.86)分,P<0.01犦。③实验组4周后患者IgG,IgM,CD3,CD4,CD8等免疫参数均高于实验前,也明显高于对照组(t=2.58～6.19,P<0.01)。结论:调控睡眠行为可提高老年肠癌患者术后睡眠效率,提升患者的心理情绪,形成良性的心理环境,进而促进患者术后免疫调节功能的改善。

AIM：To investigate the influence of the adjustment of sleep behavior on the postoperative immunological function of organ in elderly patients with bowel cancer, so as to find out the effective ways for ameliorating the postoperative emotion, improving ability of body against disease in elderly patients with carcinoma. METHODS： Seventy-two patients with bowel cancer, who were treated in the Department of General Surgery,Tieling Central Hospital between March 2002 and December 2004, were randomly divided into study group （n=36） and control group （n=36）. All the patients were given routine operation, no special instruction was given to the patients in the control groups, besides, interventions of active sleep adjustment were given to those in the study group： ① relaxing training of subjective emotion; ②support of objective environment;③ social support;④ amelioration of somatic symptoms. Before and after treatment, the emotions of patients in both groups were assessed with self-rating depressive scale （SDS） and self-rating anxiety scale （SAS）, there were 20 items in each scale respectively,each item was scored hy 4 grades according to the frequency of the symptom,marked by 1-4 points, the higher the score, the more frequently the symptom occurred; the add up of scores of the 20 items was taken as the total score, standard score ≥50 points was taken as depression and anxiety）;The value of sleep effectiveness was measured,serum immunoglobulin and indexes of peripheral lymphocyte subgroup were determined. RESULTS： All the 72 patients were involved in the analysis of results. ① After 4-week observation, the value of grade I sleep effectiveness （sleep rate 70%-80% in the study group was increased from 19.44% to 55.56% （P 〈 0.05）. ② Scores of SDS and SAS： The factor scores after treatment in the study group were obviously decreased, the total scores of SDS after treatment in the study group was obviously lower than that in the control group [（35.76±8.25）,（38.21±12.12） points, P 〈 0.01], the score of SAS after treatment was lower in the study group than in the control group [（34.81± 9.03）, （40.93±11.86） points, P 〈 0.01]. ③ The immunological indexes of IgG, IgM, CD3, CD4, CD8 after 4 weeks in the study group were all higher than those before treatment, also ohviously higher than those in the control group （t= 2.58-6.19, P 〈 0.01）. CONCLUSION：Adjustment of sleep behavior can ameliorate the postoperative sleep disorder in elderly patients with bowel cancer, promote the elevation of emotion, so as to form good psychological environment, and then accelerate the improvement of their postoperative immunological regulating function.