安宁疗护中老年终末期患者心理状况特征分析与心理干预效果

Analysis of the Psychological Status of the Elderly under Hospice Care and the Effect of Psychological Intervention

目的分析安宁疗护中疾病终末期老年患者心理状态特征及其心理干预效果,为更好地改善终末期老年患者生命质量提供参考。方法:选择疾病终末期老年患者185例,按照是否是晚期肿瘤进行分组:肿瘤组(n=151)和非肿瘤组(n=34)。分别采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)和疼痛数字评分法(NRS)对每例患者进行焦虑、抑郁程度和疼痛程度进行评估,同时采用Barthel评估生活质量,对各组数据进行对比分析。接着对2组终末期患者在接受缓解症状及支持治疗的同时予以心理疏导,10 d后进行复评,对干预前后各数据进行对比分析。结果心理干预前后肿瘤组的HAMA及HAMD值均明显高于非肿瘤组(均P<0.05),提示肿瘤患者较非肿瘤患者焦虑和抑郁等心理问题更加突出。经过心理干预后,2组患者焦虑、抑郁和疼痛等心理状况均得到一定的改善。结论终末期患者均存在一定的焦虑和抑郁情绪,从而影响患者的生活质量,肿瘤患者焦虑和抑郁更为明显,生活质量更差。适当的心理疏导有助于改善终末期患者的心理状况,在安宁疗护中对肿瘤患者实施心理干预显得更加重要。

Objective To analyze the psychological status of the elderly patients under hospice care at the end-stage of diseases and the effect of psychological intervention so as to provided reference for better improvement of their quality of life.Methods 185 elderly patients at the end-stage with or with no tumor were selected and were divided into 2 groups：tumor group（n=151）and non-tumor group（n=34）;Hamilton anxiety scale（HAMA）and Hamilton depression scale（HAMD）were applied in evaluating the degree of anxiety and depression,NRS was used in pain assessment while Barthel in the assessment of quality of life;a comparative analysis was made to the data of the 2 groups;at the same time,psychological guidance was provided;10 days after,re-evaluations were performed and the data before and after intervention were comparatively analyzed.Results Before intervention,the scores of HAMA and HAMD of the patients in tumor group were much higher than those of the patients in non-tumor group（P〈0.05）,which indicated that the anxiety and depression of the patients in tumor group were more severe than those of the patients in non-tumor group;after intervention,the psychological status of the patients in both group had certain improvement.Conclusions There exists anxiety and depression of certain degree in patients at end-stage of diseases,which have negative impact on their quality of life,anxiety and depression in patients with tumor are more serious and the quality of life is even poorer;psychological intervention is of help in improving the psychological status of patients at end-stage of diseases,it is more helpful in the hospice care of patients with tumor.