【作者】 穆玉；

【导师】 郭丽；

【作者基本信息】 吉林大学 ， 公共卫生， 2010， 硕士

【摘要】 甲状腺癌是常见的内分泌肿瘤,在全球甲状腺癌发病率呈现逐年上升的趋势,女性高于男性,男女发病比例约为1:3。癌症作为严重的负性生活事件,一旦被确诊为癌症,患者的心理会受到很大的冲击,出现焦虑、恐惧、绝望等心理反应。外科手术是临床治疗甲状腺癌主要方法,手术作为一种强烈的应激源,常导致患者产生以焦虑为代表的心理应激反应。患者迫切希望能通过手术治疗拯救自己的生命,同时又因为手术将导致躯体功能的完整性受损,而产生焦虑、恐惧、抑郁心理状态。近年来,随着心身医学的发展以及生理-心理-社会医学模式的转变,许多疾患和症状的发生、发展、预后与心理社会因素的密切关系正逐渐被人们所认识。焦虑作为患者一种常见的情绪反应也越来越受到国内外护理专家的关注,并为此做了大量的研究。焦虑心理作为一种应激源,可以引起一系列生理上的变化,同时对手术的顺利进行,患者术后的康复,疼痛与睡眠均会带来不良影响,与疾病的发生、发展、预后有着密切的关系。因此,我们护理工作者要重视患者的焦虑心理,寻找焦虑的原因,探索焦虑的护理干预措施,帮助患者以积极的心态面对疾病,顺利渡过围手术期,提高预后的生活质量,迎接新生活的明天。因此探索系统化的护理干预措施,就成为现代护理研究领域的一个热点。目的:本课题旨在研究在甲状腺癌患者护理过程中,对患者焦虑心理给予的护理干预手段,及取得的效果评价,为进一步解决甲状腺癌患者焦虑问题提供实验依据,进而能使护理工作者们更加有效的给予干预手段,最大限度的降低甲状腺癌患者的焦虑程度。方法:本研究按随机分组的方法将符合纳入标准的患者随机分为对照组(给予常规治疗和护理)和干预组(给予系统化的护理干预措施进行综合干预)。系统化的护理干预措施包括信息支持、行为干预、社会支持、改善睡眠。测量入院血压、心率、焦虑自评量表(SAS)、抑郁自评量表(SDS);测量术前血压、心率;测量术后血压、心率、焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数(PSQ I)。将手术后病理未诊断为甲状腺癌的患者排除,共余103例患者,其中52例为对照组,51例为干预组,描述患者的一般情况,通过统计学分析,比较两组术前血压、心率;术后血压、心率、SAS、SDS、PSQI。结果:调查结果显示甲状腺癌患者与国内常模比较存在焦虑、抑郁、睡眠障碍,而且焦虑、抑郁、睡眠障碍程度明显高于国内常模。通过系统化护理干预,干预组甲状腺癌患者术前收缩压、舒张压、心率(134.3±8.1mmHg、86.1±6.2mmHg、84.8±6.8次∕分)均低于对照组(145.0±8.0mmHg、92.1±7.9mmHg、89.3±4.4次∕分),差异有显著性(p<0.05);干预组甲状腺癌患者术后收缩压、舒张压、心率(140.7±6.5mmHg、92.2±10.5mmHg、90.5±5.8次∕分)、SAS、SDS(40.86±6.16、41.27±7.39)均低于对照组术后收缩压、舒张压、心率(150.8±9.9 mmHg、98.4±13.4 mmHg、98.2±8.4次∕分)、SAS、SDS(55.00±8.45、54.29±6.40),差异有显著性(p<0.05);干预组甲状腺癌患者术后PSQ (I5.23±1.16)低于对照组(7.73±1.68),差异有显著性(p<0.05),在入睡时间、睡眠时间、睡眠效率、睡眠障碍、催眠药物、日间功能障碍等方面均有显著性差异(p<0.05)。说明系统化护理干预能提高甲状腺癌患者的心理应激能力,正确面对手术,明显改善患者睡眠,降低患者焦虑情绪。结论:1.本研究中甲状腺癌患者与国内常模比较,焦虑程度显著高于国内常模,表明甲状腺癌患者存在焦虑情绪。2.本研究中甲状腺癌患者与国内常模比较,抑郁程度显著高于国内常模,表明甲状腺癌患者存在抑郁情绪。3.干预组的术前血压、心率;术后血压、心率均显著低于对照组(p<0.05),干预组的术后SAS、SDS、PSQ I均显著低于对照组(p<0.05),表明采用系统化护理干预措施对于改善甲状腺癌患者的焦虑情绪效果显著,使患者能有效地应对疾病和手术,促进患者的术后恢复,提高生活质量。更多还原

【Abstract】 Thyroid cancer is a common endocrine tumor, the incidence of which is increasing every year. The number of female patients is more than male; the ratio is 1:3. As a serious negative event, once the person is diagnosed as cancer, the strong stressors from cancer and surgery usually can cause patients’psychological stress response, especially the anxiety. Surgery is the main method for treatment of thyroid cancer clinically, and operation, a strong stress source, often results in the occurrence of psychological stress reaction, such as anxiety, in patients. The patients urged to rescue themselves by the operations, while they may produce anxiety, fear, and depression because of damage of body from the operation.Recently, it is known that there is a closely relationship between the onset, development, prognosis and psychological social factors with the development of psychosoma medicine and the change of physiology-psychology-society pattern. A number of researches showed that as a common emotional reaction, anxiety was more and more focused by nursing experts in domestic and abroad. As a stress source, anxiety can cause a series of physiological change in patients, while produce the adverse effect on operation, the recovery, and pain and sleeping of patients, which is closely associated to the onset, development, and prognosis. Therefore, nursing workers should pay more attention to the anxiety psychology of patients, seek for the cause of anxiety, explore the nursing intervention measurement for it, help patients positively face to the disease, smoothly pass through pre-operative period, and improve the life qualities of prognosis. So it is a hot research in the modern nursing intervention measurement field to explore systemic nursing intervention measurement.Objective:To study on the effect of the nursing intervention measurement on patients’anxieties anxiety during nursing thyroid cancer, in order to provide the experimental basis for further resolving the anxiety of thyroid cancer, make the nurses work more effective, maximally decrease the anxiety of thyroid cancer.Methods:The eligible patients were randomly divide into control group with administration of regular treatment and nursing and intervention group in which patients were nursed with systemic nursing intervention measurement).Systemic nursing intervention measurement includes information support, behavior intervention, social support, improvement of sleeping. The hospital blood pressure, heart rate, self rating anxiety scale (SAS), self rating depression scale(SDS) ; pre-operation blood pressure and heart rate; post-operation blood pressure, heart rate, SAS, SDS and Pittsburgh sleep quality index(PSQ I) of the thyroid cancer patients were performed. The 103 patients expelled patients without thyroid cancer by pathological diagnosis were researched, of which 52 cases were control groups, and 51 cases were intervention groups. The general state of patients was described, and the pre-operation blood pressure and heart rate, post-operation blood pressure, heart rate, SAS, SDS, and PSQI were compared by statistical analysis.Results:The research results showed that the patients with thyroid cancer were anxious, depressive and sleep disorder and significantly more anxious, depressive and sleep disorder than the domestic normal persons. By systemic nursing intervention, in intervention group, the pre-operation blood pressure, heart rate(134.3±8.1 mmHg, 86.1±6.2 mmHg, 84.8±6.8 times/min) significantly lower than those in control group(145.0±8.0mmHg, 92.1±7.9mmHg, 89.3±4.4times/min)(p<0.05);the post-operation systolic pressure blood and diastolic blood pressure, heart rate(140.7±6.5mmHg, 92.2±10.5mmHg, 90.5±5.8 times/min), SAS, SDS(40.86±6.16, 41.27±7.39)significantly lower than those in control group(systolic pressure blood and diastolic blood pressure, heart rate :150.8±9.9 mmHg、98.4±13.4 mmHg、98.2±8.4 times/min; SAS, SDS: 55.00±8.45, 54.29±6.40 ) (p<0.05), and the post-operation PSQI (5.23±1.16)significantly lower than those in control group(7.73±1.68)(p<0.05). There were significantly different among sleep latency, sleep duration, habitual sleep efficiency, sleep disturbance, used sleep medication and daytime dysfunction between two groups. The above results showed that the systemic nursing intervention of anxiety for the patients with thyroid cancer improved the ability to psychological stress, altitude to face operation, patients’sleeping, decrease the patients’anxious feeling.Conclusion:1. In this study, the anxious degree of patients with thyroid cancer was significantly higher than that in domestic normal persons, compared with the domestic normal persons, which showed that the patients with thyroid cancer were anxious.2. In this study, the depression degree of patients with thyroid cancer was significantly higher than that in the domestic normal persons, compared with the domestic normal persons, which showed that the patients with thyroid cancer were depressive.3. In intervention group, the pre-operation blood pressure, heart rate significantly lower than those in control group(p<0.05);the post-operation blood pressure, heart rate, SAS, SDS, PSQI significantly lower than those in control group(p<0.05), which showed that the systemic nursing intervention of anxiety for the patients with thyroid cancer improved the anxious feeling of the patients, made the patients face operation and disease with positive altitude, improved the recovery of patients, improved the qualify of life in patients.更多还原