认知行为干预对上消化道早癌行内镜下黏膜剥离术患者的效果研究

Effect of cognitive behavioral intervention in patients with endoscopic submucosal dissection for early upper gastrointestinal cancer

目的探讨基于人文关怀理念的认知行为干预对上消化道早癌患者疼痛、心理和康复效果的影响。方法选择196例上消化道早期癌症行内镜下黏膜剥离术(ESD)患者,随机分为对照组和观察组,每组98例。对照组给予上消化道早癌ESD知识宣教,观察组在此基础上给予基于人文关怀理念的认知行为干预。比较2组康复情况、疼痛视觉模拟评分法(VAS)评分、焦虑自评量表(SAS)评分、一般自我效能感量表(GSES)评分、术后并发症。结果观察组的术后肛门排气时间、术后首次排便时间和术后住院时间为(24.67±8.25)h、(43.90±10.27)h、(9.38±2.02)d,分别短于对照组的(27.83±9.40)h、(50.03±12.85)h、(10.26±2.37)d;手术24、48、72 h后观察组VAS评分为(2.63±0.67)、(1.84±0.52)、(1.33±0.38)分,分别低于对照组的(2.89±0.70)、(2.06±0.58)、(1.47±0.42)分;观察组干预后SAS评分为(38.73±7.40)分,低于对照组的(42.05±8.01)分;观察组干预后的GSES评分为(31.53±6.27)分,高于对照组的(29.28±5.96)分,差异均有统计学意义(P<0.05)。2组总并发症发生率比较,差异无统计学意义(P>0.05)。结论对上消化道早癌患者实施基于人文关怀理念的认知行为干预可减轻疼痛和焦虑情绪,促进患者快速康复。

Objective To investigate the effects of cognitive behavioral intervention based on humanistic care principles on pain,psychological state and recovery in patients with endoscopic submucosal dissection(ESD)for early upper gastrointestinal cancer.Methods A total of 196 patients with ESD for early upper gastrointestinal cancer were randomly divided into control group and observation group,with 98 cases in each group.The control group received standard education about ESD for early upper gastrointestinal cancer,while the observation group received additional cognitive behavioral intervention based on humanistic care principles.The recovery status,the score of Visual Analogue Scale(VAS)for pain,the score of the Self-rating Anxiety Scale(SAS),the score of the General Self-efficacy Scale(GSES),and postoperative complications were compared between the two groups.Results In the observation group,the time to first flatus after surgery,the time to first defecation,and the length of hospital stay were(24.67±8.25)hours,(43.90±10.27)hours and(9.38±2.02)days respectively,which separately were shorter than(27.83±9.40)hours,(50.03±12.85)hours and(10.26±2.37)days in the control group;the VAS scores at 24,48,and 72 hours after surgery in the observation group were(2.63±0.67),(1.84±0.52)and(1.33±0.38)points respectively,which were separately lower than(2.89±0.70),(2.06±0.58)and(1.47±0.42)points in the control group;the SAS score after intervention was(38.73±7.40)points in the observation group,which was lower than(42.05±8.01)points in the control group;the GSES score in the observation in the control group;all the between-group differences were statistically significant(P<0.05).There was no significant difference in the overall incidence rate of complications between the two groups(P>0.05).Conclusion Implementation of cognitive behavioral intervention based on humanistic care principles for patients with early upper gastrointestinal cancer can effectively alleviate pain and anxiety,and promote faster recovery in patients.