知情与否对肺癌患者围术期身心症状的影响

The Influence of Knowing Disease on Physical and Mental Symptoms of Patients with Lung Cancer in the Perioperative Period

目的观察知情与否对肺癌患者围术期身心症状的影响。方法收集2003年5月至2005年10月在我院手术的肺癌患者96例,分为知情组和不知情组,对照组选择健康人群。全部患者在手术前后接受SCL-90量表、疼痛评估表(verbal rating scale,VRS)、PSQI问卷、Barthel指数、Karnofsky问卷和遵医嘱依从性评分表测评。结果术前1周SCL-90的评分,对照组的躯体化、强迫、人际关系、抑郁、焦虑、敌对、恐怖、偏执和精神病性等评分及总分均明显低于知情组与不知情组,同时知情组的强迫、抑郁、焦虑、恐怖、偏执和精神病性等评分及总分均明显高于不知情组(P<0.01或0.05)。术后半个月内SCL-90评分比较中,3组间的大部分症状因子评分及SCL-90总分无显著差异(P均>0.05);知情、不知情组术后的VRS评分、Barthel指数、Karnofsky评分无显著差异(P均>0.05),但知情组的PSQI和遵医嘱依从性评分均明显高于不知情组(P<0.01或0.05)。结论肺癌患者手术前知晓病情后经常出现各类精神心理问题,但多属正常应激反应,且患者的遵医嘱依从性高,护理上应合理干预。

Objective To explore the influence of knowing disease on physical and mental symptoms of patients with lung cancer in the perioperative period. Methods Ninety-six cases of lung cancer patients,who underwent operation in our hospital from May 2003 to October 2005,were divided into 2 groups： knowing and not knowing disease groups. The control group was chosen from healthy person. All patients received evaluation by SCL-90 scale,verbal rating scale（VRS） ,PSQI, Barthel index, Karnofsky questionnaire and compliance scale before and after the operation. Results In the SCL-90 evaluation of the 3 groups a week before the operation, the bodily trend, force, human relation, blues, anxiety, hostility, fear, crankiness and psychopathy symptom index points and the total point of the control group was obviously lower than both the knowing and not knowing groups. And the force, blues, anxiety, fear, crankiness and psychopathy symptom index points and the total point of knowing group were obviously higher than those of the not knowing group（ P 〈0.01 or P 〈0.05）. In the SCL-90 evaluation among the 3 groups 15 days after the operation, most symptom index points and the total point had obvious differences （ P 〉 0. 05 ）. Between knowing and not knowing groups, VRS evaluation, Bartbel index and karnofsky evaluation were without obvious difference after the operation（ P 〉0.05）. However,the PSQI and compliance points of the knowing group were obviously higher than those of the not knowing group （ P 〈0.01, P 〈0.05）. Conclusion Patients with lung cancer experienced various kinds of mental problems after knowing their disease. However, most of the symptoms were normal stress responses. The patients had higher compliance after knowing their disease. Appropriate nursing interventions are needed for patients.