基于同感心的心理支持方法对晚期癌症患者情绪障碍调解的效果评估  

Psychological supportive therapy based on empathy for the emotional disorders in patients with advanced malignant tumor

作　　者：钟进才[1] 阙铁生[1] 周晓敏[1] 张华萍[1] 林章华[1] 韦美怡[1] 韦永凤[1] 

机构地区：[1]广西医科大学第一附属医院宁养院,广西壮族自治区南宁市530021

出　　处：《中国临床康复》2005年第40期51-53,共3页Chinese Journal of Clinical Rehabilitation

基　　金：广西自然科学基金资助项目(桂科自0447064)~~

摘　　要：目的:建立基于同感心的心理支持方法,评价其对晚期癌症患者的应用效果,并与常规心理支持方法相比较。方法:选择2001/3-2002/5在广西医科大学第一附属医院宁养院接受服务的家居晚期癌症患者325例为对照组,并选择2003/12-2004/6在宁养院接受服务的家居晚期癌症患者329例为观察组,两组在接受癌痛控制、症状处理(宁养服务)的同时分别接受基于同感心的心理支持和常规的心理支持治疗。基于同感心的心理支持方法为按同感心的原理,设身处地患者的情境,感同身受患者的情绪和需求,医务人员及患者家属以平等、尊重、接纳的态度,站在患者的立场对待患者,使患者能表达自己的感受,渲泻情绪等。分别于治疗前及治疗后1个月采用问卷调查法对患者的焦虑、抑郁、孤独、愤怒、绝望、自杀倾向进行评估。①汉密顿焦虑量表:评估患者的焦虑状况,包括14个项目,分界值为14分,总分>14分肯定有焦虑存在;②汉密顿抑郁量表:包括24项,主要评估患者的抑郁状况、绝望及自杀倾向,采用04的5级评分,总分>20分,肯定有抑郁存在;③自拟调查表:调查患者的一般资料、孤独感、愤怒情绪、对宁养服务的满意度(仅在心理支持治疗1个月后调查),均采用0-4级评分,均以2分以上为肯定(阳性)。主要观察不同心理支持治疗对两组患者情绪障碍的治疗有效率[有效率=(治疗前该情绪的阳性人数—治疗后阳性人数/治疗前该情绪的阳性人数)×100%],计数资料用χ2检验,计量资料用u检验。结果:对照组、观察组分别有13例、9例患者因死亡而心理支持治疗不足1个月而被剔除,因此两组分别有312例、320例纳入结果分析。观察组焦虑、孤独、抑郁、愤怒的治疗有效率显著优于对照组(χ2=4.117～5.788,P<0.05)。观察组患者对宁养服务感到满意的有304例,占95.0%,对照组感到满意的有281例,占90.1%,两组比较差异�AIM： To establish the psychological supportive therapy based on empathy, evaluate its effects terminally ill patients with malignant tumors, and compare with routine psychological supportive therapy. METHODS： Totally 325 dying patients with malignant tumors between March 2001 and May 2002 （control group） and 329 dying patients between December 2003 and June 2004 （study group） in hospice were selected. All patients were treated with analgesic and symptom control, meanwhile, psychological supportive therapy based on empathy and routine psychological supportive therapy were given in the study group and control group respectively. The measures of psychological supportive therapy based on empathy, which put oneself in patients else＇s position and feels indebted as if it was received in person, was that medical personnel treated patients with equality, respect, admitting attitude, let patients express their thoughts and get depression off their chest. Before psychological therapy and after one month, the anxiety, depression, anger, despair and suicidal inclination were assessed by means of questionnaire. ① Hamilton anxiety scale （HAMA）： It was used to assess the anxiety status of the patients, including 14 items, delimitation score was 14 points, the total score 〉14 points was taken as had anxiety definitely. ② Hamilton depression scale （HAMD）： It was used mainly to evaluate the depression, anger, despair and suicidal inclination, including 24 items, scored by 5 grades （0-4）, the total score〉 20 points as had depression definitely. ③ Self-designed inventory： The general information, lonely feeling, indignation and satisfactory degree to the hospice care （only at one month after psychological therapy） of the patients were investigated, scored by 0-4 grades, 〉 2 points as definite （positive）. The effective rates on the psychological obstacles in terminally ill patients with malignant tumors by two kinds of psychological supportive therapies were mainly studied [effectiv

关 键 词：肿瘤 情绪障碍 姑息疗法 

分 类 号：R395[哲学宗教—心理学]