肝癌病人术前焦虑对神经内分泌激素水平的影响及干预研究

Study on influence of preoperative anxiety of liver cancer patients on their neuroendocrine hormones and its intervention

[目的]探讨原发性肝癌病人术前焦虑对神经内分泌激素的影响及护理干预效果评价。[方法]采用焦虑自评量表(SAS)对所有肝癌住院病人进行评估,筛选出焦虑病人(A组)128例,在非焦虑病人中选择与焦虑组病人相匹配126例作为对照组(B组),应用随机分组序列号法将A组、B组分别分为心理+药物干预(A1组、B1组)、心理干预(A2组、B2组)、药物干预(A3组、B3组)、未干预(A0组、B0组)4个亚组,比较A组、B组术前及各亚组术后第1天、第4天、第7天、第14天、第30天SAS分值及促肾上腺皮质激素(ACTH)、皮质醇水平。[结果]焦虑组术前ACTH、皮质醇水平明显高于非焦虑组(P<0.001),术后各组均有所升高,焦虑组升高幅度大于非焦虑组(P<0.001);焦虑组各亚组中,A1组、A2组在术后第1天、第4天、第7天、第14天、第30天神经内分泌激素水平低于A3组、A0组(P<0.05或P<0.01));非焦虑组各亚组神经内分泌激素水平差异无统计学意义(P>0.05)。各组神经内分泌激素波动与SAS评分变化同步。[结论]肝癌病人术前焦虑可成为一种应激源引起病人的应激反应,并与手术存在协同增加病人的应激水平,使病人的神经内分泌激素水平升高幅度更大,心理+药物干预及心理干预可降低病人的应激反应,促进术后神经内分泌激素的恢复。

Objective： To probe into the influence of preoperative anxiety of liver cancer patients on their neuroendocrine hormones, and to evaluate the nursing intervention effect on it. Methods：Patients with liver cancer were as- sessed with self- rating anxiety scale （SAS）. And 128 cases were selected as anxiety group （group A）. Another 126 non - anxiety patients were matched as control group （group B）. Then,all group A and B cases were divided into four subgroups including psychological and drug intervention group （group A1, group El）, psychological intervention group （group A2, group B2）, drug intervention group （group A3, group B3）, and non - intervention group （group A0, group B0） based on random number table. Then the scores of SAS,blood ACTH and cortisol levels of preoperative group A,B patients, and subgroups cases before operation and on 1,4,7,14,30 days after opera- tion were compared. Results：Both blood ACTH and cortisol levels of anxiety group were significantly higher than that of non- anxiety group cases before operation （P^0. 001）. Both ACTH and eortisol levels of all groups of cases have increased after operation. And blood ACTH and cortisol levels of anxie- ty groups cases increased more than that of non,- anxiety groups cases after operation （P^0. 001）. Among all subgroups of anxiety group, both blood ACTH and cortisol levels of psychological and drug intervention group （group A1）, and psychological intervention group （group A2） were lower than that of drug intervention （group A3） and non - intervention group （group A0） cases on 1, 4, 7, 14, 30 days after operation（P^0. 05 or P~ 0.01）. However, there was no statistical significant difference among sub- groups of non- anxiety group（P^0.05）. The fluctuations of neuroendocrine hormones in each group cases were synchronous with their SAS scores. Con- clusion：Preoperative anxiety of liver cancer patients can cause their stress re- action. At the same time, the anxiety caused stress reaction could strengthen surgery itself caused stress reaction as synergies to enhance their stress lev- els. Therefore, neuroendocrine hormones levels of patients increase even more high. Psychological and drug intervention and psychological intervention can decrease stress reaction for patients. It could promote the postoperative re- covery of neuroendocrine hormones for patients.