前列腺汽化电切手术患者使用支持性心理治疗对心理状态及生活质量影响

Effects of supportive psychotherapy on mental state and quality of life in patients undergoing electrovaporization of prostate

目的:研究支持性心理治疗对前列腺汽化电切手术(TVP)患者术后心理状态及生活质量影响情况。方法:回顾性分析我院162例行择期TVP手术治疗患者临床资料,其中82例予以围术期支持性心理治疗,纳入观察组;80例给予常规干预措施,纳入对照组。记录两组入院时及术前恐惧情绪[恐惧视觉模拟评分法(FAVS)]、心理应激[皮质醇(Cor)、促肾上腺皮质激素(ACTH)]水平、术后疼痛、膀胱痉挛发生情况,并比较两组入院时、术后1d、出院时焦虑、抑郁情绪[焦虑自评量表(SAS)、自评抑郁量表(SDS)]和生活质量[世界卫生组织生活质量量表(WHOQOL)]差异。结果:观察组入院时FAVS评分低于术前(t=13.208,P=0.000),且低于对照组(t=-11.176,P=0.000)。观察组术前血清Cor、ACTH水平较入院时降低(t=3.396,7.299;P<0.05),且低于对照组(t=-4.309,-6.963;P<0.05)。观察组术后疼痛、膀胱痉挛发生率均低于对照组(χ~2=6.453,4.661;P<0.05)。两组SAS、SDS评分变化情况均为入院时>术后1d>出院时(t=8.958,11.526,16.736,11.717,13.613,22.977,4.683,5.709,8.762,8.182,9.369,13.117;P<0.05),且观察组术后1d、出院时SAS、SDS评分低于对照组(t=-3.514,-3.565,-8.771,-6.048;P<0.05)。两组WHOQOL评分变化情况均为入院时<术后1d<出院时(t=-4.443,-5.570,-9.052,-2.078,-3.492,-5.437;P<0.05),且观察组术后1d、出院时WHOQOL评分高于对照组(t=2.171,4.073;P<0.05)。结论:支持性心理治疗应用于TVP围术期中效果显著,可纠正患者负性情绪,减轻术前心理应激反应,并改善患者生活质量,于降低术后并发症发生风险也有利。

Objective:To study the effects of mental state and quality of life of patients with supportive psychological quality transurethral electrovaporization of prostate(TVP).Methods:The clinical data of 162 patients undergoing elective TVP surgery in our hospital were retrospectively analyzed.Among them,82 patients were given perioperative supportive psychotherapy and were included in observation group,and 80 patients were given routine intervention and included in control group.The fears[fear visual analogue scale(FAVS)],psychological stress[cortisol(Cor),adrenocorticotropic hormone(ACTH)]levels and occurrence of postoperative pain and bladder spasm were compared between the two groups at admission and before operation.The anxiety and depression[self-ratinganxiety scale(SAS),self-rating depression scale(SDS)]and quality of life[World Health Organization Quality of Life Scale(WHOQOL)]were compared between the two groups at admission,at 1 d after operation and at discharge.Results:The FAVS score of the observation group at admission was lower than that before operation(t=13.208,P<0.01),and was lower than that of the control group(t=-11.176,P<0.01).The levels of serum Cor and ATCH before operation in the observation group were lower than those when they were admitted to hospital(t=3.396,7.299;P<0.05),and were lower than those of the control group(t=-4.309,-6.963;P<0.05),the incidence of postoperative pain and bladder spasm in the observation group was lower than that in the control group(χ~2=6.453,4.661;P<0.05).The changes of SAS and SDS score in both groups were Admission>1 d after operation >leave hospital(t=8.958,11.526,16.736,11.717,13.613,22.977,4.683,5.709,8.762,8.182,9.369,13.117;P<0.05),and the scores of SAS and SDS in the observation group when 1 d after operation and leave hospital were lower than those in the control group(t=-3.514,-3.565,-8.771,-6.048;P<0.05).The change of WHOQOL score in both groups were admission<1 d after operation<leave hospital(t=-4.443,-5.570,-9.052,-2.078,-3.492,-5.437;P<0.05),and the scores of WHOQOL in the observation group when 1 d after operation and leave hospital were higher than those in the control group(t=2.171,4.073;P<0.05).Conclusion:Supportive psychotherapy has significant effects in the perioperative period of TVP.And it can correct negative emotions,reduce preoperative psychological stress response,and improve quality of life.And it is also beneficial to reduce the risk of postoperative complications.