摘要
目的 探讨基于认知行为疗法(CBT)的护理干预对老年患者胸腔镜肺癌根治术后谵妄(POD)及负性情绪的影响。方法 选取2021年11月至2022年12月于河南省胸科医院接受胸腔镜肺癌根治术的110例老年患者,依据随机数字表法分为对照组和研究组,各55例。对照组患者接受常规治疗和护理措施,研究组在对照组的基础上接受CBT。术后3 d采用重症监护室(ICU)意识障碍评估法(CAM-ICU)进行POD评估。入院当天、术前1 d和术后1、3、7 d时采用汉密尔顿焦虑量表(HAMA)和汉密顿抑郁量表(HAMD)评估患者的焦虑和抑郁状态。记录首次下地活动时间、术后住院时间和患者及家属满意度评分。出院前1 d,使用欧洲五维健康评价量表(EQ-5D)评估患者的生活质量,采用匹兹堡睡眠质量指数(PSQI)量表和阿森斯失眠量表(AIS)评估患者睡眠状况。结果 术后3 d内研究组POD发生率低于对照组(P<0.05)。两组POD严重程度和平均持续时间比较,差异无统计学意义(P>0.05)。与入院当天比较,对照组术后1、3、7 d时HAMD评分下降(P<0.05),术前1 d、术后7 d时HAMA评分下降,术后1 d时HAMA评分升高(P<0.05);与入院当天比较,研究组术前1 d和术后1、3、7 d时HAMD评分和HAMA评分均下降(P<0.05)。与对照组同一时间点比较,研究组术前1 d和术后1 d、3、7 d时HAMD评分和HAMA评分较均降低(P<0.05)。相较于对照组,研究组患者首次下地活动时间及术后住院时间缩短,患者及家属满意度评分、EQ-5D评分升高,PSQI、AIS总分降低(P<0.05)。结论 基于CBT的护理干预可降低胸腔镜肺癌根治术老年患者POD发生率,缓解负性情绪,促进术后康复。
Objective To investigate the effect of nursing intervention based on cognitive behavior therapy(CBT)on postoperative delirium(POD)and negative emotions in elderly patients undergoing thoracoscopic radical resection of lung cancer.Methods A total of 110 elderly patients aged 65-80 years and scheduled to thoracoscopic radical resection of lung cancer were recruited from November 2021 to December 2022 at Henan Provincial Chest Hospital.The patients were divided into control group and test group according to the random number table method,with 55 cases in each group.The patients in the control group were given routine treatment and nursing measures from the day of admission,while the patients in the study group were given CBT on the basis of the control group.POD was assessed by the confusion assessment method for the intensive care unit(CAM-ICU)within 3 days after operation.Hamilton anxiety scale(HAMA)and Hamilton depression scale(HAMD)were used to assess the anxiety and depression of patients on the day of admission,1 day before operation,1 day,3 days and 7 days after operation.The time of the first activity in the field,the length of hospital stay after the operation,and the satisfaction scores of patients and their families were recorded.One day before discharge,the quality of life of the patients was assessed with the Euroqol five-dimensional questionnaire(EQ-5D),and the sleep status of the patients was assessed with the Pittsburgh sleep quality index(PSQI)and the Ascens insomnia scale(AIS).Results The incidence of POD in the study group was lower than that in the control group within 3 days after surgery(P<0.05).There were no statistically significant differences in the severity and average duration of POD between the two groups of patients(P>0.05).Compared with the day of admission,the control group had a decrease in HAMD scores on the 1st,3rd,and 7th postoperative days(P<0.05),a decrease in HAMA scores on the 1st and 7th postoperative days,and an increase in HAMA scores on the 1st postoperative day(P<0.05).Compared with the day of admission,the HAMD score and HAMA score in the study group decreased 1 day before surgery and 1,3,and 7 days after surgery(P<0.05).Compared with the control group at the same time point,the HAMD score and HAMA score in the study group decreased significantly at 1 day before surgery,1 day after surgery,3 days,and 7 days after surgery(P<0.05).Compared with the control group,the study group showed a shorter time for initial physical activity and postoperative hospitalization,an increase in patient and family satisfaction scores,EQ-5D scores,and a decrease in total PSQI and AIS scores(P<0.05).Conclusion Nursing intervention based on CBT can reduce the incidence of POD in elderly patients undergoing thoracoscopic radical resection of lung cancer,alleviate negative emotions,and promote postoperative rehabilitation.
作者
师玉霞
宋静超
SHI Yuxia;SONG Jingchao(The Sixth Disease Districts of Thoracic Surgery Department,Henan Provincial Thoracic Hospital,Zhengzhou 450000,China)
出处
《河南医学研究》
CAS
2023年第18期3443-3449,共7页
Henan Medical Research
基金
河南省医学科技攻关计划联合共建项目(LHGJ20190739)。
关键词
肺癌
认知行为疗法
老年人
术后谵妄
负性情绪
lung cancer
cognitive behavioral therapy
the elderly
postoperative delirium
negative emotion
