【作者】 黄杰；

【导师】 娄凤兰； 曹枫林；

【作者基本信息】 山东大学 ， 护理学， 2010， 硕士

【摘要】 背景恶性肿瘤最有效的治疗方法是手术切除,但多数患者发现时已属晚期,失去手术机会。随着医学技术的发展,氩氦刀冷冻消融治疗为肿瘤患者提供了一种安全、有效的治疗方法。但该治疗在国内只有十几年,用于临床的时间远不如外科手术和血管内介入治疗,大样本和长期随访病例报道较少,而且护理心理研究方面尚无文献报道。基于此,本课题旨在研究氩氦刀冷冻消融治疗患者焦虑、抑郁情绪及相关因素,为临床心理护理提供科学的理论依据和干预措施。目的探讨氩氦刀冷冻消融术患者的焦虑、抑郁情绪及相关因素。方法抽取2009年6月至2010年2月就诊于山东省立医院的氩氦刀冷冻消融术患者101例作为观察组,抽取普通患者104例作为对照组,采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估被试的焦虑和抑郁水平,同时应用一般资料问卷、特制应对方式问卷(TCSQ)、社会支持评定量表(SSRS)、艾森克人格问卷(EPQ)及功能失调性态度问卷(DAS)进行相关因素分析。将调查数据整理后输入SPSS11.5进行统计分析,研究对象的一般资料及焦虑、抑郁水平采用描述性统计分析,观察组与国内常模及对照组比较采用独立样本t检验及χ2检验,观察组焦虑、抑郁与一般状况的单因素分析采用t检验及F检验,采用多元线性回归分析一般状况、应对方式、社会支持、人格及功能失调性态度对焦虑、抑郁情绪的影响。结果1.氩氦刀冷冻消融术患者焦虑、抑郁评分显著高于国内正常人常模,差异具有统计学意义(均P<0.01)。氩氦刀冷冻消融术患者焦虑发生率为49.50%,抑郁发生率为51.49%。氩氦刀冷冻消融术患者SAS评分、SAS≥50分百分比、轻度、中度及重度焦虑百分比均显著高于普通患者,差异具有统计学意义(均P<0.01)；SDS评分、SDS≥50分百分比、轻度、中度及重度抑郁百分比均显著高于普通患者,差异具有统计学意义(均P<0.01)。焦虑评分与抑郁评分呈显著正相关(r=0.55,P<0.01)。2.氩氦刀冷冻消融术患者焦虑、抑郁情绪与一般状况的单因素分析发现,女性焦虑、抑郁水平显著高于男性,差异具有统计学意义(P<0.01)；多元线性回归分析发现只有性别一项是氩氦刀冷冻消融术患者焦虑、抑郁水平的预测变量。3.氩氦刀冷冻消融术患者焦虑组积极应对评分显著低于非焦虑组,抑郁组积极应对评分显著低于非抑郁组,差异具有统计学意义(均P<0.01)；焦虑组消极应对评分显著高于非焦虑组,抑郁组消极应对评分显著高于非抑郁组,差异具有统计学意义(均P<0.01)。氩氦刀冷冻消融术患者焦虑、抑郁水平与积极应对方式呈显著负相关(r=-0.29,-0.38,均P<O.01),与消极应对呈显著正相关(r=0.269,0.42,均P<0.01)。4.氩氦刀冷冻消融术患者焦虑组社会支持总分、客观支持分和主观支持分均显著低于非焦虑组(P<0.01、P<0.05、P<0.05)；抑郁组社会支持总分、主观支持分和客观支持分显著低于非抑郁组(P<0.01、P<0.01、P<0.05)。焦虑与社会支持总分呈显著负相关(P<0.01),与客观支持分和主观支持分呈显著负相关(均P<0.05),抑郁与社会支持总分和主观支持分呈显著负相关(均P<0.01),与客观支持分呈显著负相关(P<0.05),焦虑、抑郁与对支持的利用度呈显著负相关(均P<0.05)。5.氩氦刀冷冻消融术患者焦虑组精神质和神经质评分显著高于非焦虑组(P<0.01,P<0.05),内外向评分显著低于非焦虑组(P<0.01)；抑郁组精神质评分和神经质评分显著高于非抑郁组(均P<0.01),内外向评分显著低于非抑郁组(P<0.01)；焦虑、抑郁水平与神经质呈显著正相关(均P<0.01),与精神质、内外向和掩饰度均无显著相关(P>0.05)。6.氩氦刀冷冻消融术患者焦虑组的完美化、寻求赞许、依赖性和认知哲学评分显著高于非焦虑组(均P<0.01)。氩氦刀冷冻消融术患者抑郁组完美化、寻求赞许、依赖性和认知哲学评分显著高于非抑郁组(均P<0.01),抑郁组强制性显著高于非抑郁组(P<0.05)。氩氦刀冷冻消融术患者焦虑水平与功能失调性态度总分、完美化、寻求赞许、依赖性和认知哲学呈显著正相关(r=0.23～0.36,均P<0.01),与脆弱性和强制性呈显著正相关(r=0.12～0.15,均P<0.05)。氩氦刀冷冻消融术患者抑郁水平与功能失调性态度总分、脆弱性、完美化、强制性、寻求赞许、依赖性和认知哲学呈显著正相关(r=0.24～0.38,均P<0.01)。7.以氩氦刀冷冻消融术患者焦虑评分和抑郁评分为因变量,以特质应对方式、社会支持水平、人格及功能失调性态度为自变量,进行多元线性回归分析,结果显示氩氦刀冷冻消融术患者焦虑水平与社会支持利用度、神经质和认知哲学之间有显著意义,而抑郁水平与社会支持利用度、内外向、精神质、神经质和认知哲学之间有显著意义。结论1.氩氦刀冷冻消融术患者存在一定程度的焦虑和抑郁情绪,其焦虑、抑郁水平均显著高于国内正常人常模和普通对照组患者。2.氩氦刀冷冻消融术患者女性焦虑、抑郁水平显著高于男性,性别是焦虑、抑郁情绪具有预测变量。3.氩氦刀冷冻消融术患者焦虑、抑郁情绪与特质应对方式、社会支持、人格及功能失调性态度均存在一定程度相关。其中社会支持利用度、内外向、精神质、神经质和认知哲学是焦虑、抑郁情绪的预测变量。更多还原

【Abstract】 Background The most effective treatment of malignant tumor is surgical resection,but many patients were incidentally detected in the late stage and standard nephrectomy can’t be performed. In recent years, several minimally invasive treatments have been developed,and cryoablation has been proved to be a safe, effective, minimally invasive therapy, although further studies are necessary to determine the long term efficacy of this procedure.so far,there isn’t any literature in the nursing psychology.Therefore, by studying mental health and related factors of patients treated with cryoablation, we can provide a scientific basis and interventions for clinical nursing.Objective To study the emotional problems and related factors of patients with Ar-He targeted cryoablation.Methords Convenience sampling was adopted to select 101 patients with Ar-He targeted cryoablation and 104 ordinary patients, who received treatment in Shandong Provincial Hospital between June 2009 and February 2010. Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to assess the patients’ anxiety and depression. The general information questionnaire, Trait Coping Style Questionnaire (TCSQ),Social Support Rating Scale (SSRS), Eysenck Personality Questionnaire (EPQ), and Dys-functional Attitudes Scales (DAS) were also administrated to the patients. All data obtained were statistically analyzed by software package SPSS11.5 for windows. Statistical methods such as descriptive statistics, independent samples t test, F test,x2 test, Pearson correlation and multiple linear regression analysis were used in this study.Results1. The scores of anxiety and depression of patients with Ar-He targeted cryoablation were significantly higher than norms (P<0.01). The incidence ratio of anxiety and depression were 49.50% and 51.49%. The scores of SAS and SDS of patients with Ar-He targeted cryoablation were significantly higher than ordinary patients, and so were the incidence ratio of anxiety and depression (P<0.01). There were significant correlation between anxiety and depression (r= 0.55,P<0.01).2. Single factor analysis of general information and anxiety and depression symptom showed that the anxiety and depression of female were significantly higher than males (P <0.01). Multiple linear regression analysis also showed that only the gender was the predictive variable of anxiety and depression.3. The score of positive coping of anxiety group was significantly lower than non-anxiety group, and the score of positive coping of depression group was also significantly lower than non-depression group (P<0.01). The score of negative coping of anxiety group was significantly higher than non-anxiety group, and the score of negative coping of depression group was also significantly higher than non-depression group(P<0.01).The positive coping style was significantly negatively correlated with anxiety and depression, while the negative coping style was significantly positively correlated with anxiety and depression (P <0.01)4. The scores of social support, subjective support and objective support of anxiety group were significantly lower than non-anxiety group, and so were the depression and non-depression group (P<0.01、P<0.05、P<0.05). Negative correlation was found between the anxiety and social support (P<0.01),and so were the anxiety and subjective support and objective support (P<0.05). Negative correlation was found between depression and social support and subjective support (P<0.01),and so was the depression and objective support(P<0.05).While the utilization of support and anxiety/depression were significantly correlated (P<0.05)5. The scores of psychoticim and neuroticism of anxiety group were significantly higher than non-anxiety anxiety (P<0.01, P<0.05),while the score of extroversion was significantly lower than non-anxiety group (P<0.01),and so were the depression and non-depression group. Significantly positive correlation were found between the anxiety and neuroticism (P<0.01),while no significantly correlation were found between anxiety and psychoticim, extroversion and lie (P>0.05),and the same results were found between depression and personality.6. The scores of perfectionism, seeking applause, dependence and cognition philosophy of anxiety group were significantly higher than non-anxiety group (P<0.01) The scores of perfectionism, seeking applause, dependence and cognition philosophy of depression group were significantly higher than non-depression group (P<0.01),and the score of compulsion of depression group was significantly higher than non-depression group (P< 0.05). The anxiety and depression were significantly correlated with the total score, fectionism, vulnerability, compulsion, seeking applause, dependence, self-determination attitude and cognition philosophy.7. Multiple linear regression analysis also showed that the utilization of support, psychoticim and cognition philosophy were the predictive variable of anxiety, while the utilization of support, extroversion, psychoticim, neuroticism and cognition philosophy were the predictive variable of depression.Conclusions1. Patients with Ar-He targeted cryoablation have a degree of anxiety and depression. The scores of anxiety and depression of patients with Ar-He targeted cryoablation were significantly higher than norms and control group.2. The anxiety and depression of female were significantly higher than males, and the gender was the predictive variable of anxiety and depression.3. The anxiety and depression of patients with Ar-He targeted cryoablation have a degree of correlation with coping style, social support, personality and Dys-functional Attitudes. The utilization of support, extroversion, psychoticim, neuroticism and cognition philosophy are the productive variables of anxiety and depression.更多还原