医护一体化护理对食管癌患者焦虑抑郁负面情绪及免疫功能的影响

Effect of all-in-one nursing intervention on patients with anxiety and depression of esophageal carcinoma negative emotion and immune function

目的：探讨医护一体化护理对食管癌患者焦虑和抑郁负面情绪及免疫功能的影响。方法将符合条件的102例食管癌患者按随机数字表法分为医护一体化护理组52例和常规护理组50例。采用焦虑自评量表（SAS）和抑郁自评量表（SDS）评价2组患者手术前后的焦虑和抑郁不良情绪的分值，同时分别检测2组患者手术前后应激和免疫指标。结果2组患者术前焦虑、抑郁、应激反应及免疫指标比较差异无统计学意义，P>0．05。医护一体化护理组患者术后SAS、SDS评分明显低于常规护理组[（34.6±6.7）分比（44.8±7.5）分、（33.7±6.9）分比（40.6±7.3）分]，t=7.234、4.902，P<0.05，差异有统计学意义；常规护理组患者术后第8天的空腹血糖、C反应蛋白和血浆皮质醇水平明显高于医护一体化护理组[（6.98±1.12）mmol/L比（6.09±0.85）mmol/L、（18.11±5.93）mg/L比（9.24±3.22）mg/L、（293.98±69.09） nmol/L比（221.97±67.94）nmol/L ]，t=4.532、9.336、5.307，P<0．05，差异有统计学意义。术后第8天时，医护一体化护理组和常规护理组患者IgA、IgM均较术后第1天明显回升[（2.41±0.46）g/L比（1.89±0.56）g/L、（2.51±0.58）g/L比（1.35±0.67）g/L和（2.36±0.53）g/L比（1.82±0.46）g/L、（2.34±0.62）g/L比（1.37±0.64） g/L ]，t=5.174、9.439、5.549、7.850，P＜0.05，差异有统计学意义。医护一体化护理组患者血淋巴细胞总数和细胞因子（CD3、CD4、CD8、CD4/CD8）明显高于常规护理组[（2.87±0.65）×109/L比（1.98±0.58）×109/L、0.62±0.10比0.57±0.07、0.41±0.08比0.35±0.08、0.24±0.04比0.26±0.05、2.06±0.44比1.65±0.46]，t=7.286、2.915、3.787、2.225、4.601，P＜0.05，差异有统计学意义。结论医护一体化护理干预可以改善食管癌患者焦虑和抑郁负面情绪，降低应激反应，增强患者的免疫功能，利于患者康复。

Objective To investigate the effect of all-in-one nursing intervention on esophageal carcinoma patients with bad emotion and immune function. Methods From the October, 2012 to the October, 2013, 102 patients with radical operation of esophageal carcinoma were divided into all-in-one nursing intervention group (research group, 52cases) and routine nursing group (control group, 50 cases) according to the random number table method.Two groups of patients were evaluated before and after operation of anxiety and depression emotion scores, with the Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) .At the same time, two groups of patients were detected the stress and immune index before and after the operation. Results Before operation, two groups of patients with anxiety, depression, stress reaction and immune index were not significantly different (P>0.05).After operation, the study group patients with anxiety and depression scores were significantly lower than those in the control group [(34.6+6.7) points vs. (44.8+7.5) points, (33.7+6.9) points vs. (40.6+7.3) points], the difference was statistically significant (t values were 7.234, 4.902, P<0.05). Eighth days after operation, patients in the control group FBG, CRP and Cor levels were significantly higher in the study group [(6.98±1.12)mmol/L vs.(6.09±0.85)mmol/L,(18.11±5.93) mg/L vs.(9.24±3.22)mg/L,(293.98±69.09)nmol/L vs.(221.97±67.94)nmol/L],the difference was statistically significant (t values were 4.532, 9.336, 5.307, P<0.05). Eighth days after operation, two groups of patients with IgA, IgM were higher than first days after operation [(2.41±0.46)g/L vs.(1.89±0.56)g/L,(2.51±0.58) g/L vs.(1.35±0.67)g/L and (2.36±0.53)g/L vs.(1.82±0.46)g/L, (2.34±0.62)g/L vs. (1.37±0.64) g/L], the difference was statistically significant (t values were 5.174, 9.439, 5.549, 7.850, P<0.05).The total number of patients blood lymphocytes (LYM) and cytokines (CD3, CD4, CD8, CD4/CD8) were significantly higher than the control group [(2.87±0.65)×109/L vs.(1.98±0.58)×109/L, 0.62±0.10 vs. 0.57±0.07, 0.41±0.08 vs. 0.35 ±0.08, 0.24 ±0.04 vs. 0.26 ±0.05, 2.06 ±0.44 vs. 1.65 ±0.46], the difference was statistically significant (t values were 7.286, 2.915, 6.942, 2.225, 4.601, P<0.05). Conclusion All-in-one nursing intervention can significantly improve the anxiety and depression in patients with esophageal cancer in bad mood, enhance the immune function of patients, conducive to the rehabilitation of patients.