阶段性康复联合治疗性沟通对胆囊癌术后心理功能的影响

doi:10.3760/cma.j.cn441417-20241106-10034

摘要/Abstract

摘要：

目的　分析阶段性康复联合治疗性沟通对胆囊癌术后心理功能的影响。方法　选取2021年12月至2023年12月河南省肿瘤医院收治的胆囊癌术后患者86例，按随机数字表法分为观察组（43例）和对照组（43例）。对照组男24例，女19例；年龄（56.71±8.45）岁，采用阶段性康复。观察组男27例，女16例；年龄（57.23±8.36）岁，在对照组基础上联合治疗性沟通。对比两组围手术期情况（排气、下床活动、住院）、心理状态［焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分］、心理弹性量表（CD-RISC）、并发症、健康调查简表-36（SF-36）评分。采用独立样本t检验和χ2检验进行统计分析。结果　观察组排气时间、初次下床活动时间、住院时间均较对照组短［（24.16±1.84）h比（36.29±2.13）h、（3.25±0.92）h比（6.02±1.09）h］、（7.56±1.27）d比（11.13±1.85）d］，差异均有统计学意义（t=28.260，12.735，10.432；均P<0.05）；观察组SAS评分、SDS评分均较对照组低［（49.63±3.15）分比（55.37±4.09）分，（52.14±4.26）分比（58.31±5.03）分］，差异均有统计学意义（t=7.291，6.138，均 P<0.05）；观察组CD-RISC量表的韧性、自强、乐观评分均较对照组高［（24.53±2.08）分比（16.85±1.42）分、（22.68±1.56）分比（17.27±1.34）分、（11.24±0.76）分比（7.73±0.54）分］，差异均有统计学意义（t=19.997，17.251，24.688；均P<0.05）；观察组并发症发生率较对照组低［6.98%（3/43）比23.26%（10/43），差异有统计学意义（χ2=4.441，P=0.035）；观察组SF-36量表的生理职能、躯体疼痛、总体健康评分均较对照组高［（69.52±5.63）分比（60.27±5.18）分、（72.34±6.19）分比（62.35±5.86）分、（71.64±6.12）分比（62.73±5.79）分］，差异均有统计学意义（t=7.929，7.685，6.935；均P<0.05）。结论　阶段性康复联合治疗性沟通应用于胆囊癌术后患者中，可改善心理状态，加快术后康复，降低并发症发生率，提高生活质量。

关键词: 胆囊癌, , , 阶段性康复, , , 治疗性沟通

Abstract:

Objective　To retrospectively analyze the effect of stage-based rehabilitation combined with therapeutic communication on postoperative psychological function in patients with gallbladder cancer. Methods　Eighty-six patients with gallbladder cancer treated at Henan Cancer Hospital from December 2021 to December 2023 were selected for the randomized controlled trial, and were divided into an observation group and a control group by the random number table method, with 43 cases in each group. In the control group, there were 24 males and 19 females; they were (56.71±8.45) years old; they did stage-based rehabilitation. In the observation group, there were 27 males and 16 females; they were (57.23±8.36) years old; they did stage-based rehabilitation and therapeutic communication. The perioperative conditions (exhaustion, off-bed activities, and hospitalization), psychological status [scores of Self-assessment Scale for Anxiety (SAS) and Self-assessment Scale for Depression (SDS)], scores of Psychological Resilience Inventory Connor-Davidson Resilience Scale (CD-RISC), complications, and scores of Short Form-36 of the Health Survey (SF-36) were compared between the two groups. Independent sample t test and χ² test were used for the statistical analysis. Results　The time to exhaustion, time to first off-bed activity, and hospitalization time in the observation group were shorter than those in the control group [(24.16±1.84) h vs. (36.29±2.13) h, (3.25±0.92) h vs. (6.02±1.09) h, and (7.56±1.27) d vs. (11.13±1.85) d], with statistical differences (t=28.260, 12.735, and 10.432; all P<0.05). The score of SAS and SDS in the observation group were lower than those in the control group (49.63±3.15 vs. 55.37±4.09 and 52.14±4.26 vs. 58.31±5.03], with statistical differences (t=7.291 and 6.138; both P<0.05). The score of resilience, self-improvement, and optimism in the observation group were higher than those in the control group (24.53±2.08 vs. 16.85±1.42, 22.68±1.56 vs. 17.27±1.34, and 11.24±0.76 vs. 7.73±0.54], with statistical differences (t=19.997, 17.251, and 24.688; all P<0.05). The incidence rate of complications in the observation group was lower than that in the control group [6.98% (3/43) vs. 23.26% (10/43); χ²=4.441, P=0.035]. The score of physiological function, somatic pain, and general health in the observation group were higher than those in the control group (69.52±5.63 vs. 60.27±5.18, 72.34±6.19 vs. 62.35±5.86, and 71.64±6.12 vs. 62.73±5.79], with statistical differences (t=7.929, 7.685, and 6.935, all P<0.05). Conclusion　Stage-based rehabilitation combined with therapeutic communication for patients with gallbladder cancer can improve their psychological state, accelerate their postoperative rehabilitation, reduce complications, and improve their quality of life.

Key words: Gallbladder cancer, Stage-based rehabilitation, Therapeutic communication

刘新颖董蓓. 阶段性康复联合治疗性沟通对胆囊癌术后心理功能的影响 [J]. 国际医药卫生导报, 2025, 31(10): 1748-1752.

Liu Xinying, Dong Bei.

Effect of stage-based rehabilitation combined with therapeutic communication on psychological function after gallbladder cancer surgery [J]. International Medicine and Health Guidance News, 2025, 31(10): 1748-1752.

参考文献

[1]吴向嵩,杨自逸,龚伟.基于循证医学模式对胆囊癌术后复发转化治疗后行R0切除1例报告并文献复习[J].中国实用外科杂志,2021,41(3):306-309,319. DOI:10.19538/j.cjps.issn1005-2208.2021.03.14.

[2]孙振,葛鹏磊,高志强,等.进展期胆囊癌患者术后应用替吉奥联合吉西他滨的临床疗效[J].中华肝胆外科杂志,2018,24(1):29-33. DOI:10.3760/cma.j.issn.1007-8118. 2018.01.007.

[3]郭国校.开腹与腹腔镜胆囊癌根治术治疗早期胆囊癌的疗效比较[J].临床医学,2020,40(9):48-49. DOI:10.19528/j.issn.1003-3548.2020.09.019.

[4]张铃福,侯纯升,徐智,等.腹腔镜胆囊切除术中或术后意外胆囊癌腹腔镜手术治疗:单中心10年回顾性分析[J].中华外科杂志,2019,57(4):277-281. DOI:10.3760/cma.j.issn.0529-5815.2019.04.007.

[5]张星月,崔大鹏,张鹏娟,等.阶段性康复结合心理干预对胆囊癌患者预后及CYFRA21-1、sICAM-1的影响[J].河北医药,2021,43(7):1004-1008. DOI:10.3969/j.issn.1002- 7386. 2021.07.009.

[6]辛云辉,胡婵媛,肖翠蓉,等.阶段性康复视频操在乳腺癌术后功能锻炼中的应用[J].中国康复医学杂志,2018,33(4):469-471. DOI:10.3969/j.issn.1001-1242.2018.04.020.

[7]魏国青,闫海红,尤晶,等.治疗性沟通系统干预模式结合阶段性康复对心脏瓣膜置换患者术后疗效及生命质量的影响[J].中国实用护理杂志,2021,37(18):1373-1377. DOI:10.3760/cma.j.cn211501-20200608-02677.

[8]典凤丽,王雪梅,夏俊杰.阶段性康复联合治疗性沟通对胆囊癌患者术后心理状态及生活质量的影响[J].中华现代护理杂志,2021,27(11):1511-1514. DOI:10.3760/cma.j.cn115682-20200619-03972.

[9]中华医学会外科学分会胆道外科学组.胆囊癌诊断和治疗指南(2015版)[J].中华消化外科杂志,2015,14(11):881-890. DOI:10.3760/cma.j.issn.1673-9752. 2015.11.001.

[10]段泉泉,胜利.焦虑及抑郁自评量表的临床效度[J].中国心理卫生杂志,2012,26(9):676-679. DOI:10.3969/j.issn. 1000-6729.2012.09.007.

[11]王汝展,刘兰芬,葛红敏,等. ZUNG氏抑郁自评量表(SDS)作为外科住院患者抑郁障碍常规筛查工具的可行性研究[J].精神医学杂志,2009,22(4):251-253. DOI:10.3969/j.issn.1009-7201.2009.04.004.

[12]梁宝勇,程诚.心理健康素质测评系统·中国成年人心理弹性量表的编制[J].心理与行为研究,2012,10(4):269-277.

[13]张磊,黄久仪,范凤美,等.美国简明健康测量量表与中国老年人生活质量调查表的对比研究[J].中国行为医学科学,2001,10(6):601-602. DOI:10.3760/cma.j.issn.1674-6554. 2001.06.042.

[14]胡明泰,唐庆贺,马文聪,等.胆囊癌根治性手术后教科书式结局影响因素分析及预测模型构建[J].中华肝胆外科杂志,2022,28(5):337-341. DOI:10.3760/cma.j.cn113884- 20220404-00143.

[15]Tetsuya Mochizuki,Tomoyuki Abe,Hironobu Amano,et al.Efficacy of the gallbladder cancer predictive risk score based on pathological findings: a propensity score-matched analysis[J].Ann Surg Oncol.2018,25(6):1699-1708.DOI:10.1245/s10434-018-6444-3. Epub 2018 Apr 6.

[16]郑又侨,王钢,杨彦伟,等.腹腔镜与开腹胆囊癌根治术治疗早期胆囊癌的临床疗效比较[J].癌症进展,2023,21(23):2588-2590,2594. DOI:10.11877/j.issn.1672-1535.2023. 21.23.10.

[17]Zhang F, Xiang S, Cao Y, et al.Correction: EIF3D promotes gallbladder cancer development by stabilizing GRK2 kinase and activating PI3K-AKT signaling pathway. Cell Death Dis. 2021 Dec 20;13(1):19. DOI:10.1038/s41419-021-04465-2.

[18]潘德标,叶冠雄,徐胜前,等.腹腔镜根治术与开腹根治术治疗早期胆囊癌的临床疗效比较[J].肝胆胰外科杂志,2019,31(2):83-86. DOI:10.11952/j.issn.1007-1954. 2019.02.006.

[19]Hyeong Seok Kim,Jae Woo Park,Hongbeom Kim,et al.Optimal surgical treatment in patients with T1b gallbladder cancer: an international multicenter study[J].J Hepatobiliary Pancreat Sci,2018,25(12):533-543.DOI: 10.1002/jhbp.593.

[20]易毅,张劼,王雷.阶段性康复联合治疗性沟通系统干预模式应用于胆囊癌手术患者的效果观察[J].国际医药卫生导报,2022,28(18):2586-2590. DOI:10.3760/cma.j.issn.1007-1245.2022.18.016.

[21]赵圆圆,范静雯,崔胤,等.阶段性康复治疗联合针对性心理干预在腹腔镜肝癌根治术患者中的应用效果[J].癌症进展,2024,22(9):987-990. DOI:10.11877/j.issn.1672-1535. 2024.22.09.12.

[22]刘冬,王崇,王建明.阶段性康复训练联合心理指导对急性缺血性卒中预后影响[J].西南国防医药,2018,28(2):179-181. DOI:10.3969/j.issn.1004-0188.2018.02.029.

[23]杨艳,张清.治疗性沟通对缺血性脑卒中患者残疾接受度的干预效果[J].广东医学,2020,41(9):910-914. DOI:10.13820/j.cnki.gdyx.20200267.

[24]苑丹.基于人文关怀的治疗性沟通对宫外孕腹腔镜手术患者心理状态及预后的影响[J].医学临床研究,2018,35(2):409-411. DOI:10.3969/j.issn.1671-7171.2018.02.071.

[25]宛久会,马士辉,胡玲,等.穴位贴敷联合阶段性康复功能训练对股骨颈骨折术后患者功能康复、血清疼痛因子和骨代谢标志物的影响[J].现代生物医学进展,2023,23(1):177-181. DOI:10.13241/j.cnki.pmb.2023.01.035.

[26]赵欣,顾燕玲,史娟.微格教学法指导的阶段性康复训练对髋部骨折康复依从性及肢体功能恢复的影响[J].中国医药导报,2022,19(24):143-146,158. DOI:10.20047/j.issn1673-7210.2022.24.33.

[27]陆小香,徐迪,林强,等.早期阶段性康复干预对老年膝关节骨性关节炎患者全关节置换术后下肢疼痛及功能的影响[J].中国康复医学杂志,2019,34(3):273-279. DOI:10.3969/j.issn.1001-1242.2019.03.005.

[28]陈少平,卢慧婉,徐六妹,等.基于治疗性沟通模式联合马斯洛需求理论对妊娠合并HIV感染患者的影响[J].国际护理学杂志,2022,41(3):561-564. DOI:10.3760/cma.j.cn221370-20200428-00147.

[29]王海燕,朱亚珍,潘友让,等.治疗性沟通联合常规护理对阻塞性睡眠呼吸暂停综合征患者睡眠质量和心理状况的影响[J].中华全科医学,2023,21(12):2160-2164. DOI:10.16766/j.cnki.issn.1674-4152.003313.

[30]郭艳,夏洪芬,龚雪梅,等.消化内镜粘膜剥离术联合治疗性沟通系统在消化道粘膜下隆起性病变中的临床研究[J].川北医学院学报,2019,34(6):820-824. DOI:10.3969/j.issn.1005-3697.2019.06.43.