【作者】 王宇飞；

【导师】 李虹彦；

【作者基本信息】 吉林大学 ， 护理硕士（专业学位）， 2024， 硕士

【摘要】 背景:乳腺癌是全球女性最常见的恶性肿瘤之一,治疗方法多种多样。化疗作为提高乳腺癌患者总体生存率的重要手段已被广泛应用。然而,乳腺癌化疗患者常常报告认知损害的不良反应。近年来,主观认知损害(Subjective Cognitive Impairment,SCI)在乳腺癌化疗患者中较为多见,主要表现为患者主诉记忆力减退、注意力不集中和处理速度缓慢等症状,严重影响患者的日常生活质量。研究证实,心理干预可有效改善SCI症状,是改善乳腺癌化疗患者SCI的重要方法之一。回忆疗法(Reminiscence Therapy,RT)作为一种心理干预方法,在其他慢性疾病患者中显示出对心理状态及认知功能的积极影响。然而,关于回忆疗法在乳腺癌化疗患者中的效果,目前尚缺乏充分的研究报道。目的:本研究旨在探讨回忆疗法对乳腺癌化疗患者SCI症状的干预效果,验证RT改善乳腺癌化疗患者SCI症状的有效性及可行性。方法:本研究为类实验性研究,选取2023年7月～12月在长春市某三级甲等综合医院乳腺外科接受化疗的60例SCI患者为研究对象,采取历史对照的方法,分为对照组和干预组,每组各30例。对照组患者给予常规护理,干预组患者给予常规护理和回忆疗法。干预时间为6周。主要结局指标为SCI症状,测量工具为癌症治疗功能评估-认知功能量表(FACT-Cog)。次要结局指标为焦虑、抑郁,测量工具为医院焦虑抑郁量表(HADS)。比较两组患者在基线及干预6周后SCI症状、焦虑抑郁的结局指标差异。采用IBM SPSS Statistics 24.0统计软件对数据进行分析。结果:1.一般资料:基线时,两组患者在年龄、婚姻状况、职业、工作状态、付费方式、居住地、宗教信仰、受教育程度等方面差异均无统计学意义(P>0.05),具有可比性。2.主观认知损害:基线时,两组患者FACT-Cog总分及各维度差异无统计学意义(P>0.05)。干预组患者在干预6周后的FACT-Cog总分有所提高,与对照组相比差异具有统计学意义(P<0.05)。3.焦虑抑郁:基线时,两组患者HADS总分及各维度评分差异无统计学意义(P>0.05)。干预组6周后的HADS焦虑和抑郁维度评分与基线时比较显著降低,差异具有统计学意义(P<0.05)。对照组干预6周后的评分与基线时比较差异无统计学意义(P>0.05)。结论:回忆疗法可以缓解乳腺癌化疗患者的SCI症状,减轻焦虑、抑郁情绪,提升患者的心理健康水平。更多还原

【Abstract】 Background:Breast cancer is one of the most common malignant tumors among women worldwide,with a variety of treatment methods available.Chemotherapy is widely used as an important means to improve the overall survival rate of breast cancer patients.However,patients undergoing chemotherapy for breast cancer often report adverse cognitive impairments.In recent years,Subjective Cognitive Impairment(SCI)has become more common among breast cancer chemotherapy patients,with primary symptoms including complaints of memory decline,lack of concentration,and slow processing speeds,severely affecting patients’ quality of daily life.Research has confirmed that psychological interventions can effectively alleviate SCI symptoms,making them an important method for improving SCI in breast cancer chemotherapy patients.Reminiscence Therapy(RT),as a form of psychological intervention,has shown positive effects on psychological states and cognitive functions in other chronic disease patients.However,there is currently a lack of sufficient research on the effectiveness of reminiscence therapy in breast cancer chemotherapy patients.Objective:This study aims to explore the therapeutic effect of Reminiscence Therapy(RT)on subjective cognitive impairment symptoms in breast cancer patients undergoing chemotherapy,and to verify the effectiveness and feasibility of RT in improving the subjective cognitive function of breast cancer patients receiving chemotherapy.Method:This quasi-experimental study selected 60 SCI patients undergoing chemotherapy in the Breast Surgery Department of a tertiary comprehensive hospital in Changchun from July to December 2023.The patients were divided into a control group and an intervention group,with 30 patients in each group,using a historical control method.The control group received routine care,while the intervention group received routine care plus reminiscence therapy.The intervention lasted for six weeks.The primary outcome measure was SCI symptoms,assessed using the Functional Assessment of Cancer Therapy-Cognitive Function(FACT-Cog).The secondary outcome measures were anxiety and depression,assessed using the Hospital Anxiety and Depression Scale(HADS).The differences in SCI symptoms,anxiety,and depression outcomes between the two groups at baseline and after six weeks of intervention were compared.Data were analyzed using IBM SPSS Statistics 24.0.Result:1.General information: at baseline,the differences between the two groups in terms of age,marital status,occupation,work status,payment method,place of residence,religious beliefs,and education level were not statistically significant(P>0.05)and were comparable.2.Subjective cognitive impairment: at baseline,the difference in FACT-Cog total score and dimensions between the two groups was not statistically significant(P> 0.05).Patients in the intervention group had an improved FACT-Cog total score after 6 weeks of intervention,and the difference was statistically significant compared with the control group(P<0.05).3.Anxiety and Depression Symptoms: at baseline,the difference between the total HADS score and the dimension scores of the two groups was not statistically significant(P>0.05).The HADS anxiety and depression dimension scores in the intervention group were significantly lower after 6 weeks compared with those at baseline,and the difference was statistically significant(P<0.05).The difference between the scores of the control group after 6 weeks of intervention compared with those at baseline was not statistically significant(P>0.05).Conclusion:Reminiscence therapy in can alleviate SCI symptoms in breast cancer chemotherapy patients,reduce anxiety and depression,and enhance patients’ mental health.更多还原