Effects of Systematic Psychological Intervention Based on S-ABC Framework on Perioperative Psychological Distress and Immune Function in Patients with Primary Liver Cancer
-
摘要:
目的 构建循S-ABC框架的系统心理干预措施，并探讨其对原发性肝癌患者围术期的心理痛苦及免疫功能的影响。 方法 组建医护管理团队，循证构建循S-ABC框架的系统心理干预措施。选择2021年1月至2022年5月收治入院的原发性肝癌患者76例，根据围手术期处理方法不同（肝动脉化疗栓塞术26例、腹腔镜肝切除30例、开腹肝切除20例），采用随机数字法分为对照组和实验组，每组38例。在整体护理的基础上，对照组给予常规心理指导，实验组给予循S-ABC框架的系统心理干预措施。比较2组患者在入院时、干预后1、3、6个月的心理痛苦程度及免疫功能状态。 结果 2组患者在入院时、干预后1、3、6个月的心理痛苦评分[实验组：（6.53 ± 1.54）分、（3.66 ± 1.12）分、（2.13 ± 0.94）分、（0.87 ± 0.70）分；对照组：（6.16 ± 1.46）分、（4.45 ± 1.11）分、（3.95 ± 1.09）分、（2.26 ± 0.86）分]，入院时差异无统计学意义（P > 0.05）；干预后实验组心理痛苦评分下降更为明显，差异有统计学意义（P < 0.05）。2组患者入院时、干预后1、3、6个月的免疫功能指标CD3+、CD4+、CD8+、CD4+/CD8+，入院时各指标无统计学意义（P > 0.05），实施干预措施后实验组患者各项指标明显优于对照组，差异有统计学意义（P < 0.05）。 结论 循S-ABC框架的系统心理干预措施可有效减轻患者心理痛苦,提高机体免疫力,促进患者康复，是值得临床推广和借鉴的。 Abstract:Objective To establish a systematic psychological intervention based on S-ABC framework, and to explore its effects on perioperative psychological distress and immune function in patients with primary liver cancer. Methods A medical management team was established to construct systematic psychological intervention measures based on S-ABC framework. A total of 76 patients with primary liver cancer admitted from January 2021 to May 2022 were selected and divided into control group and experimental group by random number method according to different perioperative treatment methods（26 cases of hepatic arterial chemoembolization, 30 cases of laparoscopic hepatectomy, 20 cases of open hepatectomy）, with 38 cases in each group. On the basis of finishing nursing, the control group was given routine psychological guidance, and the experimental group was given systematic psychological intervention measures based on the S-ABC framework. The degree of psychological distress and immune function were compared between the two groups at admission, 1, 3, and 6 months after intervention. Results The psychological pain scores of two groups of patients at admission and 1, 3, and 6 months after intervention were [experimental group: （6.53 ± 1.54） points, （3.66 ± 1.12） points, （2.13 ± 0.94） points, and （0.87 ± 0.70） points; control group: （6.16 ± 1.46） points, （4.45 ± 1.11） points, （3.95 ± 1.09） points, and （2.26 ± 0.86） points], and showed no statistically significant difference in admission time （P > 0.05）; After intervention, the psychological pain score of the experimental group decreased significantly, and the difference was statistically significant （P < 0.05）. The immune function indicators of CD3+, CD4+, CD8+, CD4+/CD8+ at admission and 1, 3, and 6 months after intervention had no statistically significant differences （P > 0.05） between the two groups of patients. After implementing intervention measures, the experimental group of patients had significantly better indicators than the control group, with a statistically significant difference （P < 0.05）. Conclusion The systematic psychological intervention measures based on S-ABC framework can effectively reduce the psychological pain of patients, improve body immunity, and promote the rehabilitation of patients, which is worthy of clinical promotion and reference. -
表 1 2组患者基本情况比较[（
$ \bar x \pm s $ ）/n]Table 1. Comparison of basic information between the two groups [（
$ \bar x \pm s $ ）/n]组别 年龄（岁） 性别（男/女） 围手术期处理（肝动脉化疗栓塞术/
腹腔镜肝切除/开腹肝切除）肿瘤直径（cm） 实验组（n = 38） 51.68 ± 9.95 25/13 13/17/8 6.81 ± 4.2 对照组（n = 38） 52.13 ± 10.95 27/11 13/12/13 7.30 ± 4.36 t/x2 −0.186 0.000 1.333 −0.508 P 0.853 1.000 0.513 0.613 
下载: 导出CSV
表 2 2组入院时、干预后1、3、6个月时患者心理痛苦评分比较（
$ \bar x \pm s $ ）Table 2. Comparison of psychological pain scores between two groups of patients at admission，1，3，and 6 months after intervention（
$ \bar x \pm s $ ）组别 n 入院时 1个月 3个月 6个月 实验组 38 6.53 ± 1.54 3.66 ± 1.12 2.13 ± 0.94 0.87 ± 0.70 对照组 38 6.16 ± 1.46 4.45 ± 1.11 3.95 ± 1.09 2.26 ± 0.86 t 1.071 −3.087 −7.798 −7.735 P 0.288 0.003* < 0.001* < 0.001* *P < 0.05。
下载: 导出CSV
表 3 2组入院时、干预后1、3、6个月时患者免疫功能比较（
$ \bar x \pm s $ ）Table 3. Comparison of immune function between two groups of patients at admission，1 ，3 ，and 6 months after intervention（
$ \bar x \pm s $ ）项目 时间 实验组（n = 38） 对照组（n = 38） t P CD3+
（个/μL）入院时 666.08 ± 354.96 706.45 ± 328.54 −0.514 0.608 1个月 954.37 ± 302.32 734.53 ± 282.88 3.273 0.02 3个月 1054.13 ± 305.70 815.34 ± 364.55 3.094 0.003 6个月 1205.03 ± 296.50 891.11 ± 337.01 4.311 < 0.001* CD4+（个/μL
）入院时 400.66 ± 200.12 433.74 ± 222.80 −.681 0.498 1个月 612.53 ± 198.34 455.66 ± 215.92 3.298 0.001 3个月 702.97 ± 197.91 521.53 ± 228.27 3.702 < 0.001* 6个月 837.21 ± 223.28 601.11 ± 244.23 4.398 < 0.001* CD8+（个/μL） 入院时 425.58 ± 103.61 472.11 ± 102.95 −1.964 0.053 1个月 302.84 ± 94.93 390.53 ± 110.38 −3.713 < 0.001* 3个月 227.05 ± 98.06 331.53 ± 118.44 −4.188 < 0.001* 6个月 193.11 ± 93.07 272.11 ± 113.76 −3.313 0.001 CD4+/CD8+ 入院时 0.98 ± 0.50 1.01 ± 0.65 −0.191 0.849 1个月 2.27 ± 1.23 1.37 ± 0.87 3.677 < 0.001* 3个月 3.88 ± 2.34 1.79 ± 1.09 4.988 < 0.001* 6个月 5.43 ± 3.24 2.54 ± 1.35 5.088 < 0.001* *P < 0.05。
下载: 导出CSV
-
[1] 张英,郭敬,冯涛,等. 医护患共同决策模式在原发性肝癌患者围手术期的应用[J]. 昆明医科大学学报,2021,42(8):177-180. doi: 10.12259/j.issn.2095-610X.S20210832 [2] 金保,杜顺达,毛一雷,等. 《原发性肝癌诊疗指南(2022年版)》更新要点解读[J]. 协和医学杂志,2022,13(5):789-795. doi: 10.12290/xhyxzz.2022-0274 [3] 程远,徐子令,荚卫东. 肝细胞癌转化治疗临床策略与指南解读[J]. 肝胆外科杂志,2023,31(1):16-19. [4] 李春飞,刘艳坤,李玉凤. 外泌体circRNAs在肝癌中的研究进展及临床应用价值[J]. 中华肝脏病杂志,2022,30(11):1248-1252. doi: 10.3760/cma.j.cn501113-20211018-00513 [5] 王智慧,张水军. 肝癌多学科联合治疗对疗效的影响[J]. 肿瘤防治研究,2022,49(9):880-885. [6] 纪璐,王晓燕,赵娜,等. 肝癌患者经动脉化疗栓塞术治疗后心理痛苦水平调查及影响因素分析[J]. 中西医结合肝病杂志,2018,28(04):217-219. [7] Lee H H,Chiu C C,Lin J J,et al. Impact of preoperative anxiety and depression on quality of life before and after resection of hepatocellular carcinoma[J]. J Affect Disord,2019,246:361-367. doi: 10.1016/j.jad.2018.12.085 [8] B M R,A K D,Barbara A,et al. Distress management,version3.2019,NCCN clinical practice guidelines in oncology[J]. Journal of the National Comprehensive Cancer Network,2019,17(10):1229-1249. doi: 10.6004/jnccn.2019.0048 [9] Satoshi U. Mechanisms of psychological pain.[J]. Brain and Nerve,2023,75(3):243-252. [10] 周晗,郭明. 杏仁核抑制性神经元与焦虑的研究进展[J]. 中国病理生理杂志,2023,39(7):1296-1301. doi: 10.3969/j.issn.1000-4718.2023.07.017 [11] 刘风雨(译),Sudimac S,Sale V,Kühn S. 享受大自然: 在大自然中行走减少杏仁核的活动[J]. 中国疼痛医学杂志,2022,28(10):723-723. [12] 程绪平,陈萍,冯丹,等. NCCN指南2018心理痛苦管理第二版对我国癌症患者心理痛苦管理实践的启示[J]. 中华肺部疾病杂志,2019,12(4):536-538. [13] 邵晓丽,江锦芳. 癌症病人心理痛苦筛查与干预研究进展[J]. 护理研究,2015,29(10):3469-3473. [14] Russ T C,Kivimäki M,Morling J R,et al. Association between psychological distress and liver disease mortality: A meta-analysis of individual study participants[J]. Gastroenterology,2015,148(5):958-966.e4. doi: 10.1053/j.gastro.2015.02.004 [15] 杨静静,刘均娥. 心理干预对乳腺癌患者免疫功能影响的研究进展[J]. 中华护理杂志,2014,49(10):1243-1248. doi: 10.3761/j.issn.0254-1769.2014.10.020 [16] 黄英. 心理干预对肿瘤患者化疗后免疫功能的影响[J]. 现代中西医结合杂志,2011,20(35):4553-4554. doi: 10.3969/j.issn.1008-8849.2011.35.059 [17] 赵新华,赵凌云,韦珏伶,等. 短期结构式心理教育对巴塞罗那临床肝癌分期为B/C期的肝癌患者抑郁情绪及免疫功能的影响[J]. 中华现代护理杂志,2019,25(14):1764-1768. doi: 10.3760/cma.j.issn.1674-2907.2019.14.011 [18] Chao Ariana M,Jastreboff Ania M,White Marney A. et al. Stress,cortisol,and other appetite-related hormones: Prospective prediction of 6-month changes in food cravings and weight.[J]. Obesity (Silver Spring,Md. ),2017,25(4):713-720. doi: 10.1002/oby.21790 [19] 刘星,王磊石,李鲁平,等. TCR基因多样性评估肝细胞癌患者免疫力的临床研究[J]. 分子诊断与治疗杂志,2023,15(2):290-293,297. doi: 10.3969/j.issn.1674-6929.2023.02.028 [20] Halkett G,O'Connor M,Jefford M. et al. RT prepare: A radiation therapist-delivered intervention reduces psychological distress in women with breast cancer referred for radiotherapy[J]. British Journal of Cancer,2018,118(12):1549-1558. doi: 10.1038/s41416-018-0112-z [21] Porter L S,Gao X,Lyna P,et al. Pilot randomized trial of a couple-based physical activity videoconference intervention for sedentary cancersurvivors[J]. Health Psychol,2018,37(9):861-865. doi: 10.1037/hea0000608 [22] Liu J,Zong G,Zhang C,et al. Anxiety and serum catecholamines as predictors of survival and recurrence in hepatocellular carcinoma[J]. Psycho-oncology,2017,26:1347-1353. doi: 10.1002/pon.4305 [23] Schell J T,Petermann-Meyer A,Kloss-Brandstätter A,et al. Distress thermometer for preoperative screening of patients with oral squamous cell carcinoma[J]. J Craniomaxillofac Surg,2018,46(7):1111-1116. doi: 10.1016/j.jcms.2018.04.022 [24] Raz D J,Sun V,Kim J Y,et al. Long-term effect of an interdisciplinary supportive care intervention for Lung cancer survivors after surgical procedures[J]. The Annals of Thoracic Surgery,2016,101(2):495-503. doi: 10.1016/j.athoracsur.2015.07.031 [25] Mertz B G,Duriaud H M,Kroman N,et al. Pain,sensory disturbances,and psychological distress among danish women treated for ductal carcinoma in situ: An exploratory study[J]. Pain Manag Nurs.,2017,18(5):309-317. doi: 10.1016/j.pmn.2017.03.004 [26] Wang A W,Bouchard L C,Gudenkauf L M,et al. Differential psychological effects of cognitive-behavioral stress management among breast cancer patients with high and low initial cancer-specific distress[J]. J Psychosom Res,2018,113:52-57. doi: 10.1016/j.jpsychores.2018.07.011 [27] 温鑫,邹伟. 针灸治疗焦虑症的机制研究进展[J]. 湖南中医药大学学报,2023,43(3):532-537. doi: 10.3969/j.issn.1674-070X.2023.03.023 [28] Kenne Sarenmalm E,Mårtensson L B,Andersson B A,et al. Mindfulness and its efficacy for psychological and biological responses in women with breast cancer[J]. Cancer Medicine,2017,6(5):1108-1122. doi: 10.1002/cam4.1052 -
