癌痛的认知干预对晚期癌症病人生活质量的影响

The influence to the life quality of advanced cancer patients by the interference to the cognition of cancer pain

目的通过对接受宁养服务的病人中存在错误认识的病人与家属进行系统的干预,以提高疼痛的疗效,改善病人的生活质量。方法选择正在宁养院进行治疗的晚期重度疼痛病人,但NAS仍>3,且排除生理耐受或病情进展而致止痛效果不佳以及顽固的神经性疼痛者83例,其家属85例。按自行拟定的问卷调查表进行问答,并根据问答结果针对病人与家属所存在的不同的问题进行干预,消除错误的认识与行为;纪录干预前、后病人及其家属所存在的问题,以及包括疼痛在内的患者的生活质量评分,用药情况等。结果干预前所有的病人与家属都存在着不同的错误认识与行为,干预后都得到显著的改善。吗啡用量由(74.57±15.82)mg增至(102.64±20.35)mg,差异有统计学意义(P<0.001);NRS评分由(4.55±1.13)分降至(1.79±1.01)分,差异有统计学意义(P<0.001);除食欲外各项生活质量评分都明显升高。结论通过对接受宁养服务的病人中存在错误认识的病人与家属进行系统的干预,可以提高吗啡的用量,从而减轻疼痛,改善病人的生活质量。

Objective To improve the curative effect of cancer pain relief and the life quality of cancer patients by systematic interference with the patients who have wrong cognitions while receiving hospice care and their relatives with wrong cognitions. Methods Selecting 83 cases of the advanced cancer patients with severe pain who were receiving treatment in hospice but whose NAS were still above 3 ,excluding the patients whose pain-relieving effects were not good because of physiological tolerance, progress of illness or refractory neuropathic pain. Eighty five relatives of the patients were also selected for the proiect. The patients and their relatives were asked for some questions according to the sefl-made questionnaire, and different interference was done in accordance with different answers to the questions from patients and their relatives, to correct their wrong cognitions and behaviors. We recorded the problems existing in the patients and their relatives before and after the interference, the assessment scores of the patients＇life quality including pain, and the situation of patients＇drug administration. Results All patients and their relatives had various wrong cognitions and behaviors before the interference ;such situation changed remarkably after the interference. The dosage（mg） of morphine increased from 74.57 ±15.82 to 102.64 ±20.35 （ P 〈 0.001 ）, NRS assessment score decreased from 4. 55 ± 1.13 to 1.79 ± 1.01 （ P 〈 0. 001 ）. Except for the appetite, the scores of all other items for the assessment of life quality increased significantly. Conclusion The dosage of morphine can be increased to alleviate the patientspain and the patientslife quality can be improved by systematic interference with the patients who have wrong cognitions while receiving hospice care and their relatives with wrong cognitions.