认知行为疗法对局部进展期肾细胞癌患者术后焦虑抑郁情绪、生活质量和并发症的影响研究

Effects of Behavioral Cognitive Intervention on Postoperative Anxiety,Depression,Quality of Life and Complications in Patients with Locally Advanced Renal Cell Carcinoma

目的探讨认知行为疗法(cognitive behavioral therapy,CBT)对局部进展期肾细胞癌(renal cell carcinoma,RCC)患者术后焦虑、抑郁情绪,生活质量及并发症的影响。方法将100例局部进展期RCC患者随机分为对照组(常规护理,n=51)和干预组(常规护理+CBT,n=49),分别在入院后第1天、出院前1天和出院后3个月使用焦虑自评量表(self-rating axiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)评定两组患者的焦虑、抑郁情绪;使用健康调查简表(medical outcomes study 36item short form health survey,SF-36)评估两组患者的生活质量,在出院前1天统计两组患者并发症发生率、护理满意度和遵医行为依从率。结果两组患者一般情况及入院后第1天时的SDS、SAS、SF-36评分差异无统计学意义(P>0.05),干预组患者在出院前1天和出院后3个月时的SDS、SAS评分显著低于对照组(P均<0.05),且干预组患者在出院后3个月时的SDS和SAS评分显著低于出院前1天(P均<0.05)。干预组患者在出院后3个月时SF-36中8个方面的评分均显著高于对照组(P均<0.05),干预组患者除了生理机能评分比入院后第1天降低(P<0.05)之外,一般健康状况、社会功能、情绪角色和精神健康4个方面的评分均较入院后第1天显著提高(P均<0.05),但是生理职能、躯体疼痛和精力3个方面的评分与入院后第1天相比,差异无统计学意义(P>0.05)。干预组患者的术后并发症发生率显著低于对照组(P<0.05),干预组患者对护理服务质量的评价和遵医行为依从率均显著高于对照组(P均<0.05)。结论给予CBT能够明显减少局部进展期RCC患者术后的焦虑、抑郁情绪,提高护理满意度、遵医行为依从性和患者术后的生活质量,减少术后并发症的发生率。

Objective To investigate the effects of cognitive behavioral therapy(CBT)on postoperative anxiety,depression,quality of life and complications in patients with locally advanced renal cell carcinoma(RCC).Methods A total of 100 patients with locally advanced RCC were randomly divided into control group(routine nursing,n=51)and intervention group(routine nursing+CBT,n=49).Anxiety and depression were assessed by self-rating anxiety scale(SAS)and self-rating depression scale(SDS)on the first day after admission,1 day before discharge and 3 months after discharge respectively;the quality of life of patients in both groups was assessed by the medical outcomes study 36-item short form health survey(SF-36);the complication rate,nursing satisfaction and compliance rate of medical behavior of the two groups were calculated 1 day before discharge.Results There was no significant difference between the two groups in general conditions and SDS,SAS and SF-36 scores on the first day after admission(P>0.05),SDS and SAS scores of patients in the intervention group were significantly lower than those in the control group at 1 day before discharge and 3 months after discharge(all P<0.05).In addition,SDS and SAS scores of patients in the intervention group at 3 months after discharge were significantly lower than those at 1 day before discharge(all P<0.05).The scores of 8 aspects of SF-36 scale in the intervention group were significantly higher than those in the control group 3 months after discharge(all P<0.05).In addition to the decrease of physiological function score(P<0.05),the scores of general health,social function,role-emotional and mental health in the intervention group were significantly higher than those first day after admission(all P<0.05),how-ever,the scores of role-physical,somatic pain and vitality showed no statistical difference compared with those first day after admission(P>0.05).The incidence of complications in the intervention group was significantly lower than that in the control group(P<0.05),and the evaluation of nursing service quality and compliance rate of medical behavior in the intervention group were significantly better than those in the control group(all P<0.05).Conclusion Assessment of anxiety,depression in patients with locally advanced RCC and administration of CBT can be significantly reduced nursing satisfaction,compliance with medical behavior and postoperative quality of life in patients can be improved,and the incidence of complications can be reduced.