认知干预对妇科恶性肿瘤化疗患者心理健康的影响

Effect of cognitive intervention on the mental health of patients with gynecological malignant tumor undergoing chemiotherapy

目的:探讨认知干预前后妇科恶性肿瘤化疗患者心理状态的变化情况。方法:选择2002-01/2004-12在河南焦作煤业集团公司中央医院妇产科住院化疗的妇科恶性肿瘤患者125例,均知情同意。另抽取妇科一般住院患者30例为对照组。①将125例妇科化疗患者作为化疗组,根据调查问卷于化疗前1天让患者逐项填写近1周来的实际感觉,在规定的时间内完成。然后进行症状自评量表评分,心理健康各因子采用5级评分,无～严重分别评为1～5分。并采用自制调查问卷调查相关因素。化疗组化疗7d为1个疗程。在化疗的同时,同步实施认知干预,包括入院宣教、化疗前及化疗期间的知识宣教、帮助患者赢得社会支持、应用认知行为技术与认知心理疗法。于化疗第8天再次采用同一问卷进行调查,并对认知干预前后的调查资料进行统计分析,观察护理干预效果。②对照组采用相同调查问卷于住院后进行治疗的第1天进行心理测评后再进行症状自评量表评分。结果:155例观察对象全部进入结果分析,无脱落。①化疗组患者心理健康的影响因素:治疗方法与效果占93.6%,化疗药物毒副作用占90.4%,病情预后占56.4%(70/125)。②认知干预前化疗及对照组患者的各心理健康因子评分比较:两组患者的躯体化、强迫症状、人际敏感、忧郁、焦虑、敌对、恐惧、偏执、精神病性及饮食睡眠因子评分相比,差异均具有显著性意义(t=2.14～6.11,P<0.05～0.01)。③认知干预后化疗及对照组患者的各心理健康因子评分比较:化疗组的各心理健康因子评分均明显改善,其中两组躯体化、敌对、人际敏感、恐惧4项因子评分相近(P>0.05)。④认知干预前后化疗组患者心理健康各因子的自身对照比较:除精神病性及睡眠饮食外,干预后其余各因子评分均较干预前显著降低(t=2.74～6.26,P<0.01)。结论:多种因素可影响妇科恶性肿瘤化疗患者的心理健康。认知干预能有效地缓解化疗患者的不良情绪状态,使之产生积极的情绪体验,从而使心理健康水平得到提高。

AIM： To investigate the changes of mental status in patients with gynecological malignant tumor undergoing chemiotherapy before and after cognitive intervention. METHODS： 125 patients with gynecological malignant tumor undergoing chemiotherapy were selected from the Department of Obstetrics and Gynecology, First Branch Hospital of Central Hospital, Jiaozuo Coal Group Company from January 2002 to December 2004. Another 30 patients hospitalized for general gynecological diseases were recruited as controls. All the participants agreed to participate in the study. ① One day before chemiotherapy, 125 patients in the chemiotherapy group filled in the questionnaire about actual feeling within the past one week in a certain time. Then symptom checklist 90 was adopted： scores 1 to 5 presented from no symptoms to severe symptoms. And a self-designed questionnaire was used to evaluate related factors. Duration of chemiotherpay was 7 days as a course. Meanwhile, cognitive intervention was performed, including admission education, education before and during chemiotherapy, to help patients obtain the social support, cognitive＇psychotherapy and cognitive behavior therapy. The same questionnaire was carried out again at the 8^th day after chemiotherapy to analyze the collected data before and after cognitive intervrntion and observe the effect of nursing intervention. ② Patients in the control group received the same questionnaire to evaluate mental status at the 1st day after treatment followed by symptom checklist 90. RESULTS： All the 155 participants entered the final analysis. ①Factors related to mental health： Among all the influencing factors, therapy and effect accounted for 93.6%, side effects due to chemiotherapy accounted for 90.4%, and prognosis accounted for 56.4%（70/125）. ② Comparison of scores on mental factors between the chemiotherapy and control groups before cognitive intervention： There were significantly differences in somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psyehoticism, diet and sleeping between the two groups （t=2.14-6.11, P 〈 0.05-0.01）. ③ Comparison of scores on mental health factors between the two groups after cognitive intervention： In the chemiotherapy groups, all the scores were improved significantly, and there were no difference in somatizaiton, hostility, interpersonal sensitivity and phobic anxiety between the two groups（P 〉 0.05）. ④ Comparison of scores on mental health factors in the chemiotherpay group before and after cognitive intervention： Except psychoticism, diet and sleeping, scores on all the factors were decreased significantly after cognitive intervention（t=2.74-6.26, P 〈 0.01）. CONCLUSION： Multiple factors can influence the mental health of patients with gynecological malignant tumor undergoing ehemiotherapy, and cognitive intervention can make bad emotion turned into positive attitude so as to improve patients＇ mental status.