癌症患者心理痛苦动态评估及干预的实践  

The Clinical Practice of Dynamic Monitoring and Individualized Intervention of Mental Suffering Cancer Patients

作　　者：张照莉[1] 陈月梅[1] 唐玲[1] 阳仁美[1] 袁文秀[1] 江跃全[1] 

机构地区：[1]重庆市肿瘤研究所,重庆400030

出　　处：《昆明医科大学学报》2015年第6期109-111,130,共4页Journal of Kunming Medical University

基　　金：重庆市卫生局医学科研基金资助项目(2012-2-489)

摘　　要：目的评估运用心理痛苦管理筛查工具(DMSM)对癌症住院患者的心理痛苦进行动态评估及个性化干预的效果,初步构建癌症住院患者心理护理管理模式.方法采用美国国立综合癌症网推荐的DMSM,对重庆市某三级甲等肿瘤医院胸部肿瘤科2013年9月至2014年2月的557例癌症住院患者的心理痛苦采取初步筛查、每周动态评估、针对心理痛苦相关因素进行个性化干预,科室干预无效者请心理医师会诊等措施.结果557例癌症患者入院时心理痛苦程度平均值为(2.23±1.278)分,≥4分者76例,占13.64%.出院时552例(除死亡5例)心理痛苦程度分值平均为(0.12±0.533)分,≥4分者6例,占1.09%,出入院时心理痛苦程度分值差异有统计学意义(P<0.01).住院期间及时发现抑郁症患者2例,经治疗后均好转,无患者自杀发生.结论采用DMSM对癌症患者住院全程的心理痛苦实施动态评估及干预,可以有效减轻患者的心理痛苦,同时可以及早发现重度心理障碍的患者,有利于心理医师的早期介入,防止病情进一步恶化,初步构建了癌症住院患者心理痛苦的筛查-诊断-干预模式,为临床实施有效的心理护理管理提供了依据.Objective The clinical practice intends to evaluate the function of psychological pain management screening tool（DMSM） which has been used on hospitalized patients who suffer psychological pain. To ensure such goal, this practice has used dynamic monitoring and individualized intervention,which have initially built the psychological care management model.Methods From September 2013 to February 2014,557 cancer patients from the department of thoracic surgery in Chongqing cancer hospital were screened. The patients with psychological suffering were dynamic monitored by the DMSM,recommend by U.S. National Comprehensive Cancer Network,and treated with personalized intervention including psychiatrist consultation weekly.Results Medium psychological pain score of 557 cancer patients was（2.23±1.28） points,among which 76 cases were ≥4 points（13.64%）. The average psychological pain scores of discharged 552 cases（except 5 death cases） were（0.12±0.533） points,6 cases were ≥ 4 points（1.09%）（P〈0.01）. Two depression cases during hospitalization were improved after treatment, no patients suicide.Conclusion Dynamic monitoring and intervention of cancer patients with psychological distress by using DMSM can effectively alleviate the psychological suffering of patients,and detect severe mental disorders of patients at a early stage,help the psychiatrists early intervent to prevent further deterioration,establish suffering- diagnosis- intervention model of psychological screening for cancer patients and provide reference for the clinical management of the effective implementation.

关 键 词：癌症患者 心理痛苦 心理痛苦管理筛查工具 

分 类 号：R749.055[医药卫生—神经病学与精神病学]