Abstract:

Objective　To analyze the effects of relaxation therapy on pain stress response and adverse mood in patients with primary liver cancer complicated with portal hypertension after jugular intrahepatic portal shunt (TIPS). Methods　A total of 92 patients with primary liver cancer complicated with portal hypertension after TIPS at First Hospital, Henan University of Science and Technology from June 2020 to June 2022 were selected for the randomized controlled trial, and were divided into a control group and an experimental group by the random number table method, with 46 cases in each group. In the control group, there were 25 males and 21 females; there were 8 cases of stage A, 20 cases of stage B, and 18 of stage C; they were 40- 76 (55.16±5.80) years old. In the experimental group, there were 27 males and 19 females; there were 10 cases of stage A, 21 cases of stage B, and 15 cases of stage C; they were 42-75 (54.61±5.63) years old. Both groups were given routine intervention after the operation. The control group did postoperative music relaxation training; in addition, the experimental group did abdominal breathing training after the surgery. The degrees of postoperative pain, the levels of stress response, and the negative emotions were compared between the two groups. t test was applied. Results　After the intervention, the scores of Visual Analogue Scale (VAS) and Brief Pain Assessment Scale (BPI) and level of neuropeptide Y (NPY) in the experimental group were significantly lower than those in the control group [(2.53±0.55) vs. (3.61±0.89), (10.35±1.90) vs. (13.26±2.24), and (135.58±15.21) ng/L vs. (159.15±19.08) ng/L], while the level of calcitonin gene-related peptide (CGRP) in the experimental group was higher than that in the control group [(34.13±5.48) ng/L vs. (29.73±4.86) ng/L], with statistical differences (t=7.00, 6.72, 6.55, and 4.07; all P<0.05). After the intervention, the levels of prostaglandin E2 (PGE2), 5-hydroxytryptamine (5-HT), substance P (SP), and cortisol (Cor) in the experimental group were lower than those in the control group [(95.38±9.27) μg/L vs. (106.12±12.37) μg/L, (242.16±30.79) mmol/L vs. (282.13±36.67) mmol/L, (40.13±5.91) pg/L vs. (46.89±6.75) pg/L, and (532.12±50.79) nmol/L vs. (603.60±57.21) nmol/L], with statistical differences (t=4.71, 5.66, 5.04, and 6.43; all P<0.05). After the intervention, the scores of Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in the experimental group were lower than those in the control group [(13.02±2.08) vs. (15.13±2.26) and (9.83±1.37) vs. (12.95±2.08)], while the level of dopamine (DA) in the experimental group was higher than that in the control group [(75.59±7.25)ng/L vs. (67.39±6.78)ng/L], with statistical differences (t=4.66, 8.50, and 5.60; all P<0.05). Conclusion　Relaxation therapy for patients with primary liver cancer complicated with portal hypertension after TIPS can relieve their pain, reduce their stress response level, and improve their bad mood.

Key words:

Primary liver cancer, Portal hypertension, Abdominal breathing training, Intrahepatic portal shunt of jugular vein

摘要：

目的　分析应用松弛疗法对原发性肝癌伴门静脉高压经颈静脉肝内门体静脉分流术（TIPS）患者疼痛应激反应及不良情绪的影响。方法　选取2020年6月至2022年6月期间就诊于河南科技大学第一附属医院的92例原发性肝癌伴门静脉高压TIPS患者进行随机对照试验，应用随机数字表法分为两组。两组术后均给予常规干预。对照组46例，其中男性25例，女性21例，年龄40～76（55.16±5.80）岁，术后给予音乐放松训练；癌症分期：A期8例、B期20例、C期18例。试验组46例，其中男性27例，女性19例，年龄42～75（54.61±5.63）岁，术后在对照组基础上增加腹式呼吸训练；癌症分期：A期10例、B期21例、C期15例。对比两组患者术后疼痛程度、应激反应水平、不良情绪。统计学方法采用t检验。结果　干预后，试验组疼痛视觉模拟量表（VAS）评分、简明疼痛评估量表（BPI）评分分值、神经肽Y（NPY）均低于对照组［（2.53±0.55）分比（3.61±0.89）分、（10.35±1.90）分比（13.26±2.24）分、（135.58±15.21）ng/L比（159.15±19.08）ng/L］，降钙素基因相关肽（CGRP）水平高于对照组［（34.13±5.48）ng/L比（29.73±4.86）ng/L］，差异均有统计学意义（t=7.00、6.72、6.55、4.07，均P<0.05）。干预后，试验组前列腺素E2（PGE2）、5羟色胺（5-HT）、P物质（SP）、皮质醇水平均低于对照组［（95.38±9.27）μg/L比（106.12±12.37）μg/L、（242.16±30.79）mmol/L比（282.13±36.67）mmol/L、（40.13±5.91）pg/L比（46.89±6.75）pg/L、（532.12±50.79）nmol/L比（603.60±57.21）nmol/L］，差异均有统计学意义（t=4.71、5.66、5.04、6.43，均P<0.05）。干预后，试验组汉密尔顿抑郁量表（HAMD）评分、汉密尔顿焦虑量表（HAMA）评分均低于对照组［（13.02±2.08）分比（15.13±2.26）分、（9.83±1.37）分比（12.95±2.08）分］，多巴胺（DA）水平高于对照组［（75.59±7.25）ng/L比（67.39±6.78）ng/L］，差异均有统计学意义（t=4.66、8.50、5.60，均P<0.05）。结论　松弛疗法能够减轻原发性肝癌伴门静脉高压TIPS患者疼痛程度，降低应激反应水平，改善不良情绪。

关键词:

原发性肝癌, 门静脉高压, 腹式呼吸训练, 经颈静脉肝内门体静脉分流术