正念训练对食管癌患者术后负性心理与睡眠及生活质量影响

Effect of mindfulness training on postoperative negative psychology,sleep and quality of life in patients with esophageal cancer

目的食管癌术后多数患者存在抑郁和焦虑等负性心理,影响患者睡眠、术后康复和生活质量,为改善这种情况,本研究探讨正念训练即将情绪和压力的管理,以及疾病的临床适应方法应用于食管癌术后护理,为食管癌术后护理提供指导。方法选取2017-02-01-2018-08-10南阳医学高等专科学校第一附属医院胸外科收治的83例手术治疗食管癌患者,根据入院顺序编号,单号为对照组42例,双号为观察组41例,两组患者均接受8d术后护理,观察组采用正念训练,对照组采用常规护理。采用焦虑自评量表(self-rating anxiety scale,SAS)和抑郁自评量表(self-rating depression scale,SDS)评估患者的负性心理情况,采用匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)量表评估患者睡眠质量,入院时及干预后比较两组患者的负性心理和睡眠质量得分。对两组患者院外随访3个月后,采用QLQ-C30生活质量量表评估患者的生活质量。结果术后护理8d后,观察组与对照组SAS评分分别为(50.50±6.72)和(57.30±7.15)分,差异有统计学意义,t=-4.463,P=0.012;SDS评分分别为(41.40±7.01)和(50.70±6.89)分,差异有统计学意义,t=-6.947,P=0.001;PSQI评分分别为(6.52±2.40)和(8.77±3.61)分,差异有统计学意义,t=-3.335,P=0.008。随访3个月,观察组生活质量评分中躯体功能(t=6.508,P=0.001)、角色功能(t=2.897,P=0.028)、认知功能(t=4.317,P=0.005)、情绪功能(t=6.868,P=0.001)和社会功能(t=4.773,P=0.005)评分差异均有统计学意义。结论情绪和压力的管理方法正念训练可减轻食管癌患者术后焦虑、抑郁状况,改善负性心理,提高睡眠质量,对改善术后长期生活质量有一定的帮助。

OBJECTIVE Most of the patients after esophagectomy have negative mentality,such as depression and anxiety,influencing their sleep,postoperative rehabilitation and quality of life.To improve this situation,this study explores the mindfulness training applied in nursing after esophagectomy,which is the emotion and stress management,and disease clinical adaptation method,providing guidance to nursing after esophagectomy.METHODS A total of 83 cases of patients with esophageal cancer receiving surgical treatment in the department of thoracic surgery of the first affiliated hospital of Nanyang Medical College were selected.According to the admission sequence,42 cases with odd number were in the control group and 41 cases with even number were in the observation group.Patients in both groups received postoperative care for 8 days.The observation group was treated with mindfulness training,while the control group was treated with routine nursing.The negative psychological status of the patients was assessed by self-rating anxiety scale(SAS)and self-rating depression scale(SDS),and the sleep quality of the patients was assessed by Pittsburgh sleep quality index(PSQI).The negative psychological and sleep quality scores of the two groups were compared on admission and after intervention.QLQ-C30 quality of life scale was used to evaluate the patients′quality of life after 3 months of follow-up.RESULTS After 8 days of postoperative care,SAS scores of the observation group and the control group were(50.50±6.72)and(57.30±7.15),respectively,with statistically significant difference(t=-4.463,P=0.012).The SDS scores were(41.40±7.01)and(50.70±6.89)respectively,and the differences were statistically significant(t=-6.947,P=0.001).The PSQI scores were(6.52±2.40)and(8.77±3.61),respectively,with statistically significant differences(t=-3.335,P=0.008).After a 3-month follow-up,the differences of body function(t=6.508,P=0.001),role function(t=2.897,P=0.028),cognitive function(t=4.317,P=0.005),emotional function(t=6.868,P=0.001)and social function(t=4.773,P=0.005)in QLQ-C30 quality of life scale of the observation group were statistically significant.CONCLUSION Mindfulness training can reduce postoperative anxiety and depression in patients with esophageal cancer,improve negative psychology,sleep quality,and long-term postoperative quality of life to some extent.