【作者】 赵勇；

【导师】 刘桂英；

【作者基本信息】 吉林大学 ， 护理学， 2007， 硕士

【摘要】 目的:通过对围手术期乳腺癌患者建立一个特定的心理干预模式,并依此模式进行具有个性化、综合性的心理干预,评估此心理干预方法对围手术期乳腺癌患者情绪及免疫状态的效应。方法:将入选的60例围手术期乳腺癌患者随机分成两组,30例对照组患者只给予围手术期常规护理,30例实验组患者除此之外从术前一天到术后12天跟踪给予个性化、综合性心理干预,将两组患者进行对比观察。两组患者均于术前1天及术后12天填写焦虑、抑郁（SAS、SDS）量表并测量外周血中T淋巴细胞亚群各项指标。结果:两组患者的年龄、职业、文化程度和经济收入等一般临床资料差异无显著意义,两组患者具有可比性。两组患者焦虑、抑郁状况横向比较结果为:手术前两组焦虑、抑郁评分比较无显著差异性,经干预后实验组焦虑、抑郁评分平均值降低,与对照组相比具有显著差异性（t=2.619,P=0.011<0.05;t=3.169,P=0.025<0.05）;纵向比较结果为:实验组干预后焦虑、抑郁评分平均值低于干预前,经统计学分析具有显著性（t=4.228,P=0.0002 <0.005;t=6.776,P=0.0001<0.005）.两组患者T淋巴细胞亚群横向比较结果为:手术前两组T淋巴细胞亚群各项指标比较无显著差异性,心理干预后实验组CD₃、CD₄、CD₄/CD₈比值,平均值均高于对照组,其中CD₃、CD₄具有显著差异(t=3.032,P=0.025<0.05;t=5.267,P=0.014<0.05。CD₈值的平均值低于对照组,但CD₈、CD₄/CD₈比值无显著性差异（t=1.42,P=0.156>0.05;t=1.36,p=0.095>0.05）;纵向比较结果为:实验组干预后CD₃、CD₄、CD₄/CD₈比值,均高于干预前,CD₃、CD₄有显著性差异（t=2.228,P=0.033<0.05;t=2.344,P=0.026<0.05）,CD₈值低于干预前,CD₈、CD₄/CD₈比值无显著差异（t=0.614,P=0.54>0.05;t=1.41,p=0.092 >0.05）。结论:依照本研究的心理干预模式,对围手术期乳腺癌患者进行具有针对性、综合性心理干预,对改善患者情绪有显著效果,对免疫调节状况有正性作用。更多还原

【Abstract】 Background:With the conversion of medical model from biological medicine to biological-social-psychological model, influence of psychosocial factors on health attracts people’s more and more attention. Many evidences indicate that there are complicated relationships among the psyche, neuron and immunity. Psychosocial factors affect the immune system through neuroendocrine system, and also immune factors released by immune cells can induce changes of mind or behavior. A study shows that as a kind of chronic stressor, the diagnosis and treatment of cancer can decrease clients’immune function, thus to influence the progress of disease and metastasis of cancer.Breast cancer is one of the most horrible diseases for women, not only for the deprivation of lives, but also the treatment may destroy the integrity of female secondary sex organ. Therefore, the women will confront two losses, one is loss of body part and living competence, the other is loss of female sex characteristic, both of which will bring great mental impact, and occasionally the latter is more serious than the former. Sexual life limitation and marriage crisis make the clients feel discriminated, low self-esteem, lonely, and consequently upset, anxious and frightened. Therefore, the psychological damage of patients with breast cancer is more severe than other patients. Former studies indicate that most of the psychological pains of patients with breast cancer come from the perioperative period. In fact, more emotional impact and indefinite diagnosis deepen patients’pains. From different perspectives, most patients may endure huge psychological changes under serious stresses in perioperative period.From the aspect of“biology-psychology-society”, psychological intervention can remove the negative influence of stress and promote the progress of recovery. The impression and adaptation of psychological stress can be affected by the manners, and thus the immune activities are affected indirectly. Many psychological behavior interventions have been applied in the clinical therapy at the present, and some impression achieved, such as emotion improvement, management competence increases, sexual function mediation and lifetime prolongation.As psychology used more and more widely in clinical nursing areas, psychological nursing becomes an important means of treating disease with its special function other than medicine and surgery. Razavi considers that intervention after definite diagnose and therapy beginning is the prior intervention, the effect of which is superior to the latter. Therefore, nursing staffs should take advantage of the frequency of contacting with the clients and as the same gender to help the client correct bad behaviors, utilize the social supportive system, build up good cognitive techniques and full of hope for the present and future treatment.Objective: In order to evaluate the function of pertinent and generalized psychological interventions on perioperative breast cancer clients according to specific intervention patterns. Randomized contrast trial was performed in this study, systemic psychological intervention was given to the experimental group besides ordinary nursing care. Through comparing the result of anxiety, depression score and T lymph cell subgroup, we discuss a psychological intervention which can improve patients’emotion and immune status that is suitable for the clinic and orientation for the psychological nursing.Material and method: A prospective randomized contrast study was adopted in this study. We divided 60 clients into two groups, experimental group （30） and control group （30）. Control group only was given common nursing care and the experimental group was given specific pertinent and generalized psychological interventions according to intervention pattern from the first day before surgery to the twelfth day postoperatively additionally; and measured the scores of SAS, SDS and number of T lymph cells subgroup respectively. Compare the above two groups of values.Result: 1. There is no magnificent difference between the clinical data of age, career, education degree and economic income of two groups and there are compatibility between them.2. There is no obvious difference between anxiety and depression before surgery, but the score of them decreased after surgery and there is magnificent difference between them (=2.619,P=0.011<0.05;t=3.169,P=0.025<0.05=he score of anxiety and depression after intervention in experimental group is lower than before and has magnificent difference （t=4.228, P=0.0002<0.005; t=6.776, P=0.0001<0.005）.3. The result of transversal compare between T lymph cell subgroup is: no obvious difference between two T lymph cell subgroup before operation, and after operation, the average value of CD₃, CD₄, CD₄/CD₈ in experimental group after intervention is higher than the control group and has magnificent difference （t=3.032, P=0.025<0.05; t=5.267, P=0.014<0.05; t=4.375, P=0.020<0.05）。The value of CD₈ is lower than the control group and has obvious difference （t=3.016, P=0.027<0.05）; The longitudinal comparing result is : The value of CD₃, CD₄, CD₄/CD₈ after intervention of experimental group is higher than before and has obvious difference （t=2.228, P=0.033< 0.05; t=2.344, P=0.026<0.05; t=5.643, P=0.0032<0.005）, value of CD₈ is lower than before and has magnificent difference （t=2.174, P=0.038<0.05）.Conclusion: In this study, we make a specific psychological intervention pattern and give pertinent and generalized intervention for the clients with breast cancer, following results were concluded:1. This specific psychological intervention pattern has psychological instructions on perioperative clients with breast cancer;2. For the optimal pertinent and generalized interventions, perioperative period is the optimal time.3. Effective psychological interventions can improve the emotional status of clients with breast cancer in perioperative period.4. Effective psychological interventions can modulate the immune status of clients with breast cancer to the optimum in perioperative period.更多还原