癌症患者预期性恶心和呕吐的不良情绪与应激

Negative Emotion and Stress Reaction of Cancer Patients with Anticipatory Nausea and Vomiting

目的：观察不良情绪与预期性恶心和呕吐（Anticipatory nausea and vomiting,ANV）发生之间的关系及预期性恶心和呕吐发生患者的交感神经兴奋性和肾上腺皮质激素的变化情况.方法：采用恶心、呕吐情况调查表及ZUNG氏焦虑自评量表（SAS）、抑郁自评量表（SDS）对87例经历过一或两个化疗周期的癌症患者进行调查,以皮肤电测试仪测量其皮肤电阻水平,以放射免疫法测其唾液中皮质醇含量.结果：预期性恶心和呕吐发生组患者（n=35）恶心问卷总分（0.3±0.2）及三因子躯体不适（0.3±0.2）、消化道反应（0.5±0.3）、情绪痛苦（0.2±0.2）均高于未发生预期性恶心和呕吐组（n=52）（0.1±0.1、0.1±0.1、0.1±0.1、0.1±0.1,P＜0.05或0.01）.发生组焦虑（38.0±8.7）、抑郁（38.3±10.8）、唾液皮质醇含量（6.8±2.9）的得分均高于未发生组（31.6±6.0,P＜0.01）、（33.1±7.3,P＜0.05）、（5.14±2.45,P＜0.05）.发生组皮肤电阻（0.60±0.37）低于未发生组（1.44±1.01,P＜0.01）.相关分析结果显示,发生组恶心问卷总分及其三因子分与焦虑正相关（r=0.49～0.62, P＜0.01）,与抑郁正相关（r=0.26～0.40, P＜0.05或0.01）.结论：发生期待性恶心和呕吐的癌症患者具有较重的应激反应,焦虑、抑郁是伴随期待性恶心和呕吐发生的重要因素.

Objective： To study the relationship between anxiety, depression and anticipatory nausea and vomiting （ANV） and the response of sympathetic nerve system and hypothalamic-pituitary-adrenal axis of cancer patients with ANV. Methods： 87 patients experienced of one or two cycles of chemotherapy participated the study. Before administration of the next chemotherapy, all the subjects received the tests of scales （ the nausea profile, The impatient, the second impatient toxicity respond standard of the anti-cancer medicine by WHO established , Self-rating Anxiety Scale, Self-rating Depression Scale）, electronic skin resistance were recorded, and their saliva cortisol was kept and tested on the first chemotherapy day. Results： There were significantly differences in Overall, Somatic, Skin resistance, Emotion, SAS, SDS, electronic skin resistance, saliva cortisol. Compared to the patients without ANV, the patients with ANN had significantly higher scores in overall （ 0. 3 ± 0. 2/0. 1 ± 0. 1 ）, somatic （ 0. 3 ± 0. 2/0. 1 ± 0. 1 ）, GI （0. 5 ± 0. 3/0. 1 ± 0. 1 ）, emotion（0. 2 ± 0. 2/0. 1 ± 0. 1 ）, SAS（38. 0 ± 8. 7/31.6 ± 6. 0）, SDS（ 38. 3 ± 10. 8/33.1 ± 7. 3）, saliva cortisol（6. 8 ±2.9/5.1 ±2.5） （P 〈0. 01 or P 〈0. 05）. The patients with ANV had significantly lower scores in Skin resistance （ 0. 60 ± 0. 37 ） compared to the patients without ANV （ 1.44 ± 1.01, P 〈 0. 01 ）. The total scores of the nause profile and 3 dimensions points of the patients with ANV were significantly positive correlated with SAS, SDS （ r = 0. 49 ± 0. 62, r = 0. 26 ± 0. 40, P 〈 0. 01 or P 〈 0. 05 ）. Conclusion： Percentages of patients experiencing ANV is 40. 2%. Anxiety and depression were important clinic symptoms of ANV. The patients with ANV manifested the significantly response of stress.