认知行为疗法对乳腺癌改良根治术患者围手术期心理应激反应和免疫功能的影响

Effects of cognitive behavior therapy on psychological stress response and immune function in patients undergoing modified radical mastectomy

目的:探讨认知行为疗法对乳腺癌改良根治术患者围手术期心理应激反应和免疫功能的影响。方法:选取我院2014年6月-2017年3月118例女性乳腺癌改良根治术患者作为研究对象,根据不同的干预方式分为认知组(59例)和常规组(59例),常规组患者给予常规干预,认知组患者在其基础上给予认知行为疗法干预,观察干预前后两组患者焦虑、抑郁等心理情绪的变化;比较干预前后两组患者免疫指标及干预后满意度的情况。结果:干预后,认知组患者CD3、CD4、CD4/CD8比值及NK细胞活性均高于常规组患者,CD8低于常规组患者,差异均具有统计学意义(t=3.777,8.148,5.312,3.900,-6.466;P<0.001)。干预后,两组患者SAS、SDS评分均有所降低,认知组患者SAS、SDS评分低于常规组患者,差异均具有统计学意义(t=-7.394,-6.837;P<0.001)。认知组患者总满意度(96.61%)高于常规组患者(77.97%),差异具有统计学意义(χ~2=9.241,P<0.01)。结论:认知行为疗法可有效降低乳腺癌患者改良根治术围手术期心理应激反应所产生的焦虑、抑郁等负面情绪及增强机体免疫功能,提高患者的护理满意度。

Objective:To investigate the effects of cognitive behavior therapy on psychological stress response and immune function in patients undergoing modified radical mastectomy.Methods:From June 2014 to March 2017,a total of 118 female radical mastectomy patients with breast cancer were selected as the subjects,according to different intervention methods,they were divided into cognitive group(59 cases)and routine group(59 cases),the patients in the routine group received routine intervention,and the cognitive group received cognitive behavioral therapy intervention on the basis of it,we observed the psychological and emotional changes of anxiety and depression in the two groups before and after the intervention and compared the immune indexes,prognosis and satisfaction of the two groups before and after the intervention.Results:After the intervention,the CD3,CD4,CD4,/CD8 ratio and NK cell activity in the cognitive group were higher than those in the conventional group,CD8 was lower than that in the conventional group,and the differences were statistically significant(t=3.777,8.148,5.312,3.900,-6.466;P<0.001).After the intervention,the scores of SAS and SDS were decreased in the two groups,and the scores of SAS and SDS in the cognitive group were lower than those in the routine group,the differences were statistically significant(t=-7.394,-6.837;P<0.001).The total satisfaction of the patients in the cognitive group(96.61%)was higher than that in the routine group(77.97%),and the difference was statistically significant(χ~2=9.241,P<0.01).Conclusion:Cognitive behavioral therapy can effectively reduce the psychological stress response during the perioperative period of modified radical mastectomy in patients with breast cancer,anxiety,depression and other negative emotions and enhance immune function,improve satisfaction of patients.