基于“形神一体”的中医综合方案对围手术期肝癌患者睡眠质量、负性情绪以及生活质量的影响

Influence of Integrated Plan of Traditional Chinese Medicine Based on "Integration of Form and Spirit"on Sleep Quality,Negative Emotions and Quality of Life for Liver Cancer Patients during Perioperative Period

目的:观察中医综合方案对围手术期肝癌患者睡眠质量、负性情绪以及生活质量的影响。方法:选择2017年6月〜2019年6月在西南医科大学附属医院行肝切除术的120例原发性肝癌患者为研究对象,随机分为观察组、五行组、空白对照组各40例,空白对照组患者进行肝切除术围手术期的常规临床路径执行,五行组在对照组的基础上加入基于五行理论的五行音乐疗法和情志相胜法,观察组在五行组的基础上加入八段锦功法和耳穴压豆。比较3组患者干预前后的匹斯堡睡眠指数(PSQI)、症状自评量表(SCL-90)中的躯体化、抑郁和焦虑3方面指标以及SF-36生活质量量表。结果:在SCL-90中的躯体化、抑郁和焦虑比较以及PSQI评分方面,干预前3组差异均无统计学意义(P>0.05)。干预后,观察组和五行组各指标均优于干预前;而对照组仅抑郁一项与干预前有差异,其余躯体化、焦虑以及PSQI评分3项指标与干预前差异无统计学意义(P>0.05)。而组间比较,观察组在躯体化、抑郁、焦虑和PSQI评分均优于五行组和对照组,差异有统计学意义(P<0.05)。而在SF-36方面,干预前3组在所有指标的组间比较,差异均无统计学意义(P>0.05)。干预后,除对照组的躯体疼痛一项以外,三组所有指标均高于干预前,差异有统计学意义(P<0.05)。而组间比较,观察组在躯体疼痛、精神健康、活力、生理职能、总体健康优于其余两组,差异有统计学意义(P<0.05);在生理功能和情感职能两项仅优于对照组,与五行组差异无统计学意义;在社会功能一项,三组间差异无统计学意义(P>0.05)。结论:基于“形神一体”的中医综合方案对围手术期肝癌患者,能提高其睡眠质量,缓解焦虑、抑郁、躯体化等情况,提高生活质量,值得今后进一步多中心、大量本的研究、改进以及推广。

Objective: To explore influence of integrated plan of TCM based on "integration of form and spirit" on sleep quality, negative emotions and quality of life for liver cancer patients during perioperative period.Methods: A total of 120 patients with primary liver cancer who underwent hepatectomy at the Affiliated Hospital of Southwest Medical University from June 2017 to June 2019 were selected as the research subjects, and were randomly divided into observation group, five-element group and blank controlled group, 40 cases each.Patients in the blank controlled group performed the routine clinical path of the perioperative period of liver resection.The five elements group added five elements music therapy based on the five elements theory and the empathy method on the basis of the controlled group, and the observation group added Baduanjin exercises based on the five elements group, and adding ear points pressed beans.The three groups of patients were compared before and after the intervention of the Pittsburgh Sleep Index(PSQI),the symptom self-assessment scale(SCL-90) somatization, depression and anxiety and the SF-36 quality of life scale.Results: There was no statistically significant difference among the three groups before intervention in the comparison of somatization, depression and anxiety and PSQI score in SCL-90(P > 0.05).After the intervention, the observation group and the five elements group were better than before the intervention, while the controlled group had only one depression and no difference before the intervention, and the other three indicators of somatization, anxiety and PSQI score were not statistically different from before the intervention(P > 0.05).In comparison among the groups, the observation group was better than the five elements group and the controlled group in somatization, depression, anxiety and PSQI scores(P < 0.05).In terms of SF-36,there was no statistically significant difference between the three groups before intervention in all groups(P > 0.05).After the intervention, except for the physical pain of the controlled group, all indicators of the three groups were higher than before the intervention, and the difference was statistically significant(P < 0.05).Compared with the other groups, the observation group was better than the other two groups in "somatic pain","mental health","vigor","physiological function",and "overall health"(P < 0.05)."Function" and "Emotional function" were only superior to the controlled group, and there was no statistically significant difference from the five elements group.In "social function",there was no statistically significant difference among the three groups(P > 0.05).Conclusion: Based on the "integration of form and spirit",the integrated Chinese medicine program can improve the quality of sleep of patients with liver cancer during perioperative period, relieve negative emotions such as anxiety, depression, and somatization, and improve the quality of life.It is worthy of further multi-center, large number of research, improvement and promotion in the future.