摘要
乳腺癌现已成为全球女性患病最高的重大疾病之一,而且死亡率极高。全球每年约有120万妇女被确诊为该病,并有50万女性因此而死亡,在我国乳腺癌患病女性约占各种恶性肿瘤的7%-10%,医院一般采用乳腺癌根治术进行治疗,然后进行化疗、放疗及生物免疫治疗等,但是单纯的医学治疗已远远不能很好的提高患者生存率,术后漫长的康复治疗便成了学者们研究的热点。研究表明,有氧运动能提高人体制造白细胞的能力,吞噬围歼剿灭癌细胞,有氧运动可使体温升高,阻止癌细胞的生成,癌细胞在其有丝分裂期和脱氧核糖核酸合成期容易被热杀伤,从而起到防癌治癌作用。研究表明,乳腺癌患者一系列的负面心理行为也能直接影响自己的康复治疗,积极的心理行为干预有助于改善乳腺癌患者的免疫功能,改善癌因性疲乏,帮助促进心理压力的转移,增强自尊感,提高生活自主性,改善疲劳、焦虑、沮丧等情绪以及减少异常心理状况,提高患者生活质量。
本文主要探讨有氧运动与心理干预对康复期乳腺癌患者体质,免疫机能及生活质量的影响。在江西省抗癌俱乐部通过基本情况调查直接选定58名乳腺癌患者进行实验研究,将58名乳腺癌患者分成运动加强+心理干预组(EDP-10人),运动加强组(ED-10人),运动+心理干预组(EP-11人),运动组(E-9人),心理组(CP-8人),对照组(C-10人)。测定干预前后实验对象的体质状况(测试指标包括:身高,体重,肺活量,握力,体前屈,血压)以及血细胞、T细胞亚群(CD3+,CD4+,CD8+,CD4+/CD8+)、NK细胞,免疫球蛋白(IgG,IgA,IgM)、白介素(IL-1β,IL-2,IL-6)和肿瘤标志物(CA15-3,CEA, E2)等,对测试结果进行统计学处理。有氧运动与心理干预时间为6个月,有氧运动干预包括郭林气功和体育舞蹈,郭林气功采用江西省癌症康复俱乐部提供的运动训练方法,主要练习自然行功和快功(具体包括三部分:开功,做功和收功);运动强度为中等强度;运动时间至少60min;.运动频率每天一次。体育舞蹈主要练习交际舞和华尔兹铜牌套路(具体包括三部分:准备活动阶段,正式运动阶段和整理活动阶段,运动强度为中等强度,运动时间至少30min(不包括准备活动和整理活动)。运动时的心率控制在110次/min,运动频率每周三次。在有氧运动干预期间渗透心理干预,心理干预分成心理讲座,集体讨论,小组互动,个别指导的形式,通过“乳腺癌生活质量量表”对患者的生活质量进行调查研究。主要结论:
(1)对照组在干预期间生活质量显著下降。EDP、ED、EP、E组在干预期间生活质量显著提高。有氧运动与心理干预相结合对康复乳腺癌患者康复治疗,提高生活质量,延长生存时间有显著效果。
(2)有氧运动可以维持和提高乳腺癌患者体质,改善BMI指数、增强肺活量,有氧运动与心理干预相结合能使BMI、肺活量、体前屈、握力有非常显著性的提高。
(3)坚持有氧运动且运动量适中,能使IgA、IgM显著性提高。从而促进机体的免疫力。
(4)一定负荷的有氧运动可以有效提高IL-1β、IL-2和降低IL-6。
(5)有氧运动能有效提高机体CD3+、CD4+、CD8+和NK细胞含量,促进患者免疫能力提高,但CD4+\CD8+比值下降,有氧运动与心理干预相结合能非常显著提高CD3+、NK细胞含量,CD4+在干预后明显高于干预前水平。
(6)乳腺癌患者进行有氧运动康复治疗,CEA、E2和CA15-3都能保持在一定水平,说明有氧运动能在一定范围内有效的抑制癌细胞生长与发展,增强机体的免疫能力。
(7)心理行为干预有助于改善乳腺癌患者的免疫功能,特别是有助于提高NK细胞活性,但不同的免疫指标呈现出不一致的改变。
建议:
(1)有氧运动能有效的提高人体免疫能力,有利于乳腺癌患者康复治疗。但因患者的性别、年龄、体质、病期的不同,有氧运动的强度和持续时间很难控制。建议创编一套能根据个体的需要而自己调节强度的有氧运动功法,让患者在运动康复中达到运动最佳化。
(2)抗癌俱乐部应聘请有关疾病心理专家定期对患者进行心理干预。或者动用社会力量,招募一批心理方面的志愿者,在俱乐部定期开展心理治疗活动,能更好的服务于患者,关心患者,使患者获得社会支持,加快病情康复。
(3)“群体抗癌”是很好的模式,患者可以在集体中快速地找到适合自己的运动康复手段,政府和社会组织应给予积极的支持。
(4)乳腺癌患者配偶和家人的理解与支持,直接影响到患者的心理和生活质量,甚至关系到患者的生存时间,所以,加强患者、配偶或家人的沟通尤为重要。
(5)有氧运动干预时,加强医务监督。
On the international scale, breast carcinoma has already been the highest rate of female disease ,which is also the leading cause of female death .Annually, there are about 1.2 million women who are finally diagnosed with breast carcinoma, and 0.5 million women died of the disease. In China, breast carcinoma accounts for 7% to 10% of various malignant female cancers. Generally, the hospital adopts total correction to treat breast carcinoma, then chemotherapy, radiotherapy and biological immunotherapy. However simple treatment of medical science have far from increased the survival ,so the long period of rehabilitative treatment become the hot topic among the scholars. The research indicated that aerobic exercise can improve the ability of leukocytotic production, phagocytize and destroy cancer cell, and raise body temperature to prevent the cancer cells from generation .In its mitotic phase(M phase) and the synthesis period of deoxyribonucleic acid( DNA) ,cancer cells could be easily wound or killed by heat ,thus to against and govern cancer .The negative psychology also can impact on patients’rehabilitative treatment The survey showed that mental intervention conduce to improve the immune function of breast carcinoma patients and to reduce the lassitude; help to divert the mental pressure ; enhance the self-esteem ;increase the independence of life ;ameliorate the feeling of fatigue, anxieties and depression ,in addition to reduce the abnormal psychological status in order to improve the life quality.
The paper mainly approaches how aerobic exercise and mental intervention affect body immune function in the rehabilitative period of breast carcinoma patients. In the anticancer club of jiang xi province, we chosen 58 patients to carry out the experiment through investigating their basic information .we divided the 58 patients into exercise intension + mental intervention group(10 persons) ,exercise intension group(10 persons),exercise+ mental intervention group(11 persons),exercise group(9 persons) mental group(8 persons) and control group(10 persons)
Through the half -year intervention of aerobic exercise to detect experimental target’s pre-intervention and post-intervention physical condition, height , weight, lung capacity, grips strength, forward bending of body ,blood routine, T cell subset,(CD3+ , CD4+ , CD8+ , CD4+/CD8+),NK cellimmunoglobulin(IgG , IgA , IgM) ,interleukin(IL-1β,IL-2,IL-6) and tumor markers(CA15-3,CEA,E2),we undertook statistical treatment through collect blood test which collect the blood through vein in the morning when the patients' stomach are empty. Collecting 30 tubes in each indicatrix ,we tested the pre 150 tubes and post tubes .in all, 300 tubes in which have collected blood through blood routine(0,5ml) EDTA with anticoagulation, I interleukin(2ml)without anticoagulation, tumor markers(5ml) without anticoagulation. we used the centrifugal machine to separate blood-serum from the no anticoagulated blood and put it into the refrigerator in which is -70 centi-degree. The sample can not do haemolysis. Then we put the blood sample into the auto-computer to analysize the results with statistical treatment. The aerobic exercise intervention contains Guo lin breathing exercise and physical educational dance. The mode of exercise is to do moderate physical educational dance at least 30 minutes (do not include the warming-up and warming-down).The forms of the dance include social dancing, body building exercise dancing and the combination of the former dance. Then, the exercise prescription contains three parts: warming-up, exercise and warming-down .The heart rate should be controlled at 110/min per time in 10 minutes' exercise and the frequency of the exercise should be three days in per week. We permeated mental intervention with aerobic exercise intervention ,and divided the mental intervention into psychological lecture, group discussion, group interaction and individual instruction. Through the life quality of breast carcinoma's graph, we investigated the life quality of the patients. Analyzing the experimental data, we discussed the links of aerobic exercise, psychology and immunity.
引文
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