心理支持及认知干预在腹膜后恶性肿瘤患儿围手术期应用的研究
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摘要
目的探讨心理支持及认知干预在腹膜后恶性肿瘤患儿围手术期应用的价值。方法回顾性分析70例接受腹膜后恶性肿瘤切除术患儿的临床资料。根据围手术期干预方法不同,分为观察组(常规护理干预+心理支持及认知干预)35例和对照组(常规护理干预)35例。比较两组患儿围手术期的生活质量、转化生长因子-β(TGF-β)水平、CD4+/CD8+值及术后并发症的发生情况。结果入院时,两组患儿的生理功能、情感功能、社会功能、角色功能评分及总分比较,差异均无统计学意义(P﹥0.05);术后28天,观察组患儿的生理功能、情感功能、社会功能、角色功能评分及总分均明显高于对照组,差异均有统计学意义(P﹤0.01)。入院时,两组患儿的TGF-β水平、CD4+/CD8+值比较,差异均无统计学意义(P﹥0.05);与入院时比较,术前及术后1、28天,两组患儿的TGF-β水平均呈下降趋势;与入院时比较,术前两组患儿的CD4+/CD8+值均略升高,术后1天均略降低,术后28天均明显升高;术后28天,观察组患儿的TGF-β水平为(132.5±46.5)ng/ml,低于对照组的(166.8±49.8)ng/ml,差异有统计学意义(P﹤0.05);术后28天,观察组患儿的CD4+/CD8+值为(1.49±0.47),高于对照组的(1.23±0.38),差异有统计学意义(P﹤0.05)。两组患儿术后并发症的总发生率比较,差异无统计学意义(P﹥0.05)。结论腹膜后恶性肿瘤患儿围手术期接受心理支持及认知干预,可以改善免疫功能,提高生活质量。
Objective To explore the value of applying psychological support and cognitive intervention during the perioperative period for children with retroperitoneal malignant tumor. Method The retrospective analysis included the clinical data of 70 cases of children with retroperitoneal malignant tumor, who were stratified as study group and control group, receiving conventional nursing care plus psychological support and cognitive intervention, or conventional nursing care alone, respectively, with 35 cases in each. The perioperative quality of life, transforming growth factor-β(TGF-β),CD4+/CD8+value and occurrence of postoperative complications of these children were compared. Result When admitted to hospital, there were no significant differences in the physiological function, emotional function, social function,role function and overall rating scores between the two groups(P>0.05); in 28 days after surgery, the physiological function, emotional function, social function, role function and overall rating scores of study group were higher than those of control group, demonstrating statistically significant differences(P<0.01). When admitted to hospital, the two groups of children had similar level of TGF-β and CD4+/CD8+value(P>0.05); before surgery and on 1 stand 28 thday after surgery,the TGF-β level in both groups showed decreasing trend compared with that at the time of admission; CD4+/CD8+slightly increased while modestly reduced on 1 stday after surgery, and exhibited significant increase in 28 days after surgery compared with that at the time of admission; in 28 days after surgery, the TGF-β in study group was(132.5 ± 46.5) ng/ml,which was lower than the(166.8±49.8) ng/ml in control group, with statistically significant difference observed(P<0.05);during the same period, the CD4+/CD8+value was(1.49±0.47) in study group, and was higher than that in control group at(1.23±0.38), indicating statistical significance(P<0.05). There was no significant difference in regard of the incidence of postoperative complications between the two groups(P>0.05). Conclusion Psychological support and cognitive intervention can improve the quality of life and immune function in children with retroperitoneal malignancies during perioperative period.
Objective To explore the value of applying psychological support and cognitive intervention during the perioperative period for children with retroperitoneal malignant tumor. Method The retrospective analysis included the clinical data of 70 cases of children with retroperitoneal malignant tumor, who were stratified as study group and control group, receiving conventional nursing care plus psychological support and cognitive intervention, or conventional nursing care alone, respectively, with 35 cases in each. The perioperative quality of life, transforming growth factor-β(TGF-β),CD4+/CD8+value and occurrence of postoperative complications of these children were compared. Result When admitted to hospital, there were no significant differences in the physiological function, emotional function, social function,role function and overall rating scores between the two groups(P>0.05); in 28 days after surgery, the physiological function, emotional function, social function, role function and overall rating scores of study group were higher than those of control group, demonstrating statistically significant differences(P<0.01). When admitted to hospital, the two groups of children had similar level of TGF-β and CD4+/CD8+value(P>0.05); before surgery and on 1 stand 28 thday after surgery,the TGF-β level in both groups showed decreasing trend compared with that at the time of admission; CD4+/CD8+slightly increased while modestly reduced on 1 stday after surgery, and exhibited significant increase in 28 days after surgery compared with that at the time of admission; in 28 days after surgery, the TGF-β in study group was(132.5 ± 46.5) ng/ml,which was lower than the(166.8±49.8) ng/ml in control group, with statistically significant difference observed(P<0.05);during the same period, the CD4+/CD8+value was(1.49±0.47) in study group, and was higher than that in control group at(1.23±0.38), indicating statistical significance(P<0.05). There was no significant difference in regard of the incidence of postoperative complications between the two groups(P>0.05). Conclusion Psychological support and cognitive intervention can improve the quality of life and immune function in children with retroperitoneal malignancies during perioperative period.
引文
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[14]蒋璐杏,邹欣,刘少红,等.临床护理路径在小儿腹膜后肿瘤围手术期护理中的应用效果[J].护理实践与研究,2012, 9(22):12-13.
[15]杜鸿昌,王华春,陈淑静.介入术与开胸术对室间隔缺损患儿认知及心理行为能力的影响[J].河北医药, 2018, 40(7):1046-1050.
[16] Mikkelsen HE, Brovold KV, Berntsen S, et al. Palliative cancer patients’experiences of participating in a lifestyle intervention study while receiving chemotherapy[J]. Cancer Nurs, 2015, 38(6):E52-58.
[17] Todd BL, Moskowitz MC, Ottati A, et al. Stressors, stress response, and cancer recurrence:a systematic review[J].Cancer Nurs, 2014, 37(2):114-125.
[18]宋双生,徐之良.肾母细胞瘤组织中TGF-β和IGF-1信号通路表达与细胞增殖活力及侵袭活力的相关性[J].海南医学院学报, 2017, 23(24):3419-3421; 3425.
[19]张泉,邱思芳,赵逵,等.结直肠癌及腺瘤患者CD4+、CD8+和CD28+T淋巴细胞的亚群变化及临床意义[J].中国癌症杂志, 2018, 28(8):577-583.
[2]张金山,李龙,李颀,等.小儿腹腔镜下腹膜后肿物切除术14例报告[J].中国微创外科杂志, 2017, 17(9):783-786;789.
[3]王丽.术前心理护理和人文关怀在儿童手术室护理工作中应用的具体措施及临床效果[J].四川医学, 2018, 39(12):1425-1428.
[4] Liu Y, Mo L, Tang Y, et al. The application of an evidencebased clinical nursing path for improving the preoperative and postoperative quality of care of pediatric retroperitoneal neuroblastoma patients:a randomized controlled trial at a tertiary medical institution[J]. Cancer Nurs, 2017, 40(4):314-322.
[5]苏蕾,韩炜,杨维,等.知信行健康教育在神经母细胞瘤患儿术后PICC置管中的临床应用价值[J].癌症进展, 2017,15(9):1106-1108.
[6] Punpanich W, Boon-Yasidhi V, Chokephaibulkit K, et al.Health-related quality of life of Thai children with HIV infection:a comparison of the Thai quality of life in children(ThQLC)with the pediatric quality of life inventory?version 4.0(PedsQL?4.0)generic core scales[J]. Qual Life Res, 2010, 19(10):1509-1516.
[7]肖慧,郭霞,万智,等.儿童神经母细胞性肿瘤的临床特征及预后分析的单中心研究[J].国际输血及血液学杂志,2017, 40(5):378-386.
[8]宋东建,岳丽芳,杨合英,等.腹膜后肾肿瘤切除术与经腹肾肿瘤切除术治疗小儿双侧肾母细胞瘤的疗效比较及预后分析[J].中华实用儿科临床杂志, 2016, 31(20):1571-1574.
[9]王旭梅,张荣,冯涛,等.自体造血干细胞移植治疗Ⅳ期神经母细胞瘤患儿23例术后并发症预防及护理[J].齐鲁护理杂志, 2013, 19(10):39-40.
[10]屈文倩,唐文娟,陆群峰,等. PFCC护理模式对神经母细胞瘤患儿生活质量的影响[J].全科护理, 2017, 15(8):900-903.
[11]樊婷.心理支持辅助治疗对单侧唇裂儿童及其家属负性情绪和生活质量的影响[J].中国健康心理学杂志, 2018,26(8):1156-1161.
[12]杨红梅,徐宏宇,刘琴.全程护理对腹腔镜先天性胆总管囊肿患儿手术后康复的影响分析[J].临床医学工程,2016, 23(10):1387-1388.
[13]张微竹.伦理干预对隐睾儿童及其家属心理状态和疾病认知程度的影响[J].中国健康心理学杂志, 2018, 26(9):1415-1419.
[14]蒋璐杏,邹欣,刘少红,等.临床护理路径在小儿腹膜后肿瘤围手术期护理中的应用效果[J].护理实践与研究,2012, 9(22):12-13.
[15]杜鸿昌,王华春,陈淑静.介入术与开胸术对室间隔缺损患儿认知及心理行为能力的影响[J].河北医药, 2018, 40(7):1046-1050.
[16] Mikkelsen HE, Brovold KV, Berntsen S, et al. Palliative cancer patients’experiences of participating in a lifestyle intervention study while receiving chemotherapy[J]. Cancer Nurs, 2015, 38(6):E52-58.
[17] Todd BL, Moskowitz MC, Ottati A, et al. Stressors, stress response, and cancer recurrence:a systematic review[J].Cancer Nurs, 2014, 37(2):114-125.
[18]宋双生,徐之良.肾母细胞瘤组织中TGF-β和IGF-1信号通路表达与细胞增殖活力及侵袭活力的相关性[J].海南医学院学报, 2017, 23(24):3419-3421; 3425.
[19]张泉,邱思芳,赵逵,等.结直肠癌及腺瘤患者CD4+、CD8+和CD28+T淋巴细胞的亚群变化及临床意义[J].中国癌症杂志, 2018, 28(8):577-583.