短期结构式心理教育干预联合逍遥散对肝癌围手术期患者中重度抑郁情绪的影响

Effect of short-term structural psychological education intervention combined with Xiaoyaosan on moderate and severe depression in patients with hepatocellular carcinoma during perioperative period

目的探讨短期结构式心理教育干预联合逍遥散对肝癌围手术期患者中重度抑郁情绪以及趋化因子CCL2、炎症因子IL-6的影响。方法选择2016年10月至2018年2月首次接受肝切除术的肝癌患者,术前采用一般资料问卷、医院焦虑抑郁量表(HADS-D)、9条目患者健康问卷(PHQ-9)进行评定,将评分为中重度抑郁情绪的83例肝癌患者通过SPSS软件随机分为对照组(n=42)和观察组(n=41),对照组给予常规护理联合逍遥散进行干预,观察组在对照组的基础上给予短期结构式心理教育干预,采用重复测量方差分析术前、术后5 d、术后30 d两组患者的HADS-D、PHQ-9评分以及IL-6、CCL2水平。结果两组患者HADS-D、PHQ-9评分的时间效应、组间效应、交互效应差异均有统计学意义(P<0.05)。术后30 d,观察组HADS-D、PHQ-9评分显著低于对照组(P<0.001),CCL2、IL-6水平亦显著低于对照组(P<0.05)。结论短期结构式心理教育干预联合逍遥散能有效缓解肝癌围手术期患者的中重度抑郁情绪,可能通过下调CCL2、IL-6水平发挥抗抑郁作用。

Objective To explore the effects of short-term structured psychological education intervention combined with Xiaoyaosan on moderate and severe depression,chemokines CCL2 and inflammatory factors IL-6 in patients with hepatocellular carcinoma during perioperative period. Methods 83 patients included with hepatocellular carcinoma accepted liver resection for the first time from October2016 to February 2018. General information questionnaire,Hospital Anxiety and Depression Scale(HADS-D),and Patient Health Questionnaire-9 item(PHQ-9)were used to conduct the survey at baseline.Patients with moderate and severe depression were randomly divided into control group(n=42) and observation group(n=41) by SPSS software. The control group was treated with usual care combined with Xiaoyaosan,and the observation group was treated with short-term structural psychological education intervention on this basis. Repeated measures anova was used to compare the HADS-D,PHQ-9 scores and the level of CCL2,IL6 of the two groups at baseline,on day 5 post-surgery and 30 days after surgery. Results The time effect,intergroup effect and interaction effect of the HADS and PHQ-9 scores of the two groups were statistically significant(P<0.05). The HADS-D and PHQ-9 scores were significantly reduced at 30 d after surgery in the observation group compared with the control group(P<0.001),while the levels of CCL2,IL-6 were significantly lower in the observation group than control group at 30 d after surgery(P<0.05). Conclusions Short-term structural psychological education intervention combined with Xiaoyaosan can effectively alleviate the moderate and severe depression in patients with hepatocellular carcinoma during perioperative period,and down-regulate the levels of CCL2 and IL-6 to promote the postoperative recovery of patients with hepatocellular carcinoma.