【作者】 苏茜；

【导师】 王维利； 李惠萍；

【作者基本信息】 安徽医科大学 ， 护理学， 2010， 硕士

【摘要】 【目的】获得消化系统肿瘤患者术前焦虑情绪、生命质量、应对方式、人格特质的流行病学资料,并分析其相关性;探讨消化系统肿瘤患者术前伴发焦虑情绪的主要影响因素;研究并评价对消化系统肿瘤术前伴发焦虑情绪患者实施治疗性沟通系统干预的效果。【方法】在四所三级甲等医院的相关科室中,连续收集拟行消化系统肿瘤切除术的患者451例,通过横断面调查,在入院当天调查患者一般资料,采用焦虑自评量表、癌症患者生命质量测定量表中文版核心量表及特质应对方式问卷进行测量。以患者一般资料、生命质量、应对方式、人格特质为自变量,以是否伴发焦虑为应变量,经多元线性回归分析患者术前焦虑可能的主要影响因素。筛选出术前伴发焦虑情绪的患者87例,随机分为干预组41例,对照组46例。对照组予以常规术前护理及临床一般沟通,干预组在此基础上予以系统的治疗性沟通。干预前(术前一天)采用焦虑自评量表与癌症患者生命质量测定量表中文版核心量表、特质应对方式问卷进行测量。【结果】横断面研究显示,消化系统肿瘤患者术前焦虑得分为44.33±8.644,高于国内常模(t=25.861,p<0.001),拟行消化系统肿瘤切除术451例患者中的145例(32.2%)患者伴发焦虑情绪;生命质量中的功能领域与总体生命质量与焦虑水平呈负相关,症状维度、单一维度与焦虑水平呈正相关,且除气促、便秘、腹泻、经济困难外生命质量各维度水平在焦虑组与非焦虑组中的分布有统计学差异(p<0.05)。特质应对方式测量结果显示积极应对得分为34.224±8.185,消极应对得分为30.446±8.329,积极应对水平与焦虑水平呈负相关(r=-0.449,p<0.001),消极应对水平与焦虑水平呈正相关(r=0.249,p<0.001),且积极应对方式水平在焦虑组与非焦虑组中的分布有统计学差异(t=8.598,p<0.001),消极应对方式水平在焦虑组与非焦虑组中的分布有统计学差异(t=-4.144,p<0.001)。人格特质与中国常模对照,精神质较高(t=8.821,p<0.001),内外向较低(t=-13.050,p<0.001),神经质较高(t=18.837,p<0.001),掩饰性较高(t=9.808,p<0.001)。且内外向与焦虑水平呈负相关(r=-0.231,p<0.001)、掩饰性与焦虑水平呈负相关(r=-0.108,p<0.05),神经质与焦虑水平呈正相关(r=0.434,p<0.001),内外向在焦虑组与非焦虑组中的分布有统计学差异(t=3.447,p<0.01),神经质在焦虑组与非焦虑组中的分布有统计学差异(t=-7.160,p<0.001)。经多元线性回归分析后,最终确定为消化系统肿瘤患者术前焦虑的影响因素有性别、受教育程度、主要陪护者、躯体功能、情绪功能、认知功能、疲倦、失眠、积极应对(p<0.05)。实验性研究显示,干预前,一般资料、焦虑、生命质量各领域、应对方式干预组与对照组的组间无统计学差异(p>0.05);干预组自身干预前、后比较焦虑有所缓解(p<0.001),生命质量量表中的情绪、社会、认知功能及总体生命质量有所提高(p<0.05),便秘、经济困难方面问题有所降低(p<0.05),积极应对方式有所增强(p<0.01),消极应对方式有所降低(p<0.001);对照组自身干预前、后比较社会功能有所降低(p<0.01),食欲丧失有所加重(p<0.05),积极应对方式有所减弱(p<0.05);干预后,在焦虑、情绪功能、角色功能、认知功能、社会功能、总体生命质量、食欲丧失、经济困难、积极应对、消极应对方面干预组与对照组组间存在显著性差异(p<0.05)。【结论】消化系统肿瘤患者术前焦虑情绪较国内常模高发,人格特质中精神质、神经质、掩饰性较国内常模高,内外向较低。且生命质量、应对方式、人格特质与焦虑存在一定程度的关联。患者性别、受教育程度、主要陪护者、躯体功能、情绪功能、认知功能、疲倦、失眠、积极应对对患者焦虑起一定的影响作用。此外,治疗性沟通系统能比较有效地缓解消化系统肿瘤患者术前焦虑,提高其生命质量,改善应对方式。更多还原

【Abstract】 【Objective】To obtain the anxiety epidemiological data of the digestive system tumor patients before operation,and understand fully the main influence factor, evaluate the effect of therapeutic communication system on the anxiety ,quality of life and trait coping styles of digestive system tumor patients before operation.【method】451 digestive system tumor patients before operation were recruited continuously in four A-grade hospitals in hefei.In cross section study, General Information has been surveyed,and Self-Rating Anxiety Scale(SAS), Chineseversion of European Organization for Research and Treatment quality of life Questionnaire (EORTC QLQ- C30) ,trait coping styles questionnaire(TCSQ) and Eysenck Personality Questionnaire(EPQ) has been investigated and analyzed respectively. With anxiety for dependent variable, General Information, quality of life,trait coping styles,and Personality for independent variable, influence factor of anxiety has been analyzed by linear regression. 87 anxiety digestive system tumor patients selected before operation were recruited and divided randomly into experimental group (n=41) and control group(n=46). The control group was given routine preoperative care and clinical common communication, in addition to this, the experimental group was given therapeutic communication system. Before and after intervention (the day of admission and the day before operation), SAS, EORTC QLQ- C30 and TCSQ were used to investigate the patients respectively.【Result】cross section study reveal that the digestive system tumor patients, anxiety score is 44.33±8.644,higher than domestic norm,and there are 145(35%) patients suffer anxiety. The fuction dimensionality and totality quality of life of quality of life are negatively correlated with anxiety, symptom and singleness dimensionality are positive correlated with anxiety. Quality of life is statistic different between anxiety patients and not anxiety patients. positive coping score is 34.224±8.185,and negative coping score is 30.446±8.329. positive coping is negatively correlated with anxiety, and negative coping is positive correlated with anxiety. trait coping styles is statistic different between anxiety patients and not anxiety patients. For personality, psychoticism and lie are higher than domestic norm. introversion and extroversion and lie are negatively correlated with anxiety, neurotic is positive correlated with anxiety, Personality is statistic different between anxiety patients and not anxiety patients. After linear regression, gender,standard of culture,main care giver, Emotional Functioning,sleeplessness,anepithymia,positive coping are influence factor of anxiety of digestive system tumor patients. experimental study revealed that,Before intervention, the result showed that there were not significant differences between the general data, anxiety, quality of life and trait coping styles in the two groups. There were significant melioration on anxiety, physical functioning, emotional functioning, social function, cognitive function, overall quality of life, fatigue, constipation, financial impact, positive coping and negative coping in the experimental group than before, while significant exacerbation on social function, appetite loss and positive coping in the control group. Moreover, the significant differences has come to light between the two groups after the intervention on anxiety, function, overall quality of life, symptom, appetite loss, financial impact, positive coping and negative coping.【Conclusion】It’s worth to pay more attention to digestive system tumor patients before operation because of the higher anxiety , lower quality of life,weaker trait coping styles. gender,standard of culture,main care giver, Emotional Functioning,sleeplessness,anepithymia,positive coping can influence the anxiety of this kind of patient. Moreover, Therapeutic communication system has positive effect on the anxiety, quality of life and trait coping styles of digestive system tumor patients before operation while clinical common communication does not have the effectiveness.更多还原