丰富环境对食管癌患者围术期心理状况 及认知功能影响

Influence of enriched environment on perioperative mental status and cognitive function of patients with esophageal cancer

摘要:

目的 探讨食管癌患者围手术期实施丰富环境管理对焦虑抑郁心理状况及术后认知功能的影响。方 法 选取2015 年6 月-2016 年6 月该院行食管癌手术患者80 例，并随机分为丰富环境组和对照组。丰富环境 组入院后即实施丰富环境方案；对照组常规处理。入院时、术前1 天及术后第3、7 天访视患者，使用ZUNG 氏焦虑自评量表（SAS）和抑郁自评量表（SDS）。术前1 天和术后第7 天对患者进行神经精神功能测验及外周 静脉血白细胞介素6（IL-6）、白细胞介素8（IL-8）及肿瘤坏死因子α（TNF-α）检测。结果 两组入院时 SAS 高于全国常模。丰富环境组SAS 术前1 d 和术后第3、7 天低于入院时评分（P <0.05），SDS 术后第3、7 天 低于入院时评分（P <0.05）。与对照组比较，SAS 术前1 d 和术后3、7 d 均降低（P <0.05），SDS 术后第7 天 降低（P <0.05）；术后第3、7 天SDS 与常模比较，差异无统计学意义（P >0.05）。两组术后第7 天与基础值比 较IL-6、IL-8 及TNF-α 均增高，对照组IL-6 和TNF-α 比丰富环境组相对更高。结论 食管癌患者围手 术期实施丰富环境方案，有助于改善焦虑抑郁心理状况及减少术后认知功能障碍发生。

Abstract:

Objective To study the influence of enriched environment on perioperative mental status and cognitive function of patients with esophageal cancer. Methods A total of 80 patients with esophageal cancer from June 2015 to June 2016 in our hospitalwere randomly divided into enriched environment group (group EE, n = 40) and control group (group C, n = 40). Patients in enriched environment group received enriched environment after admission, while control group received routine nursing. Collected ZUNG’s depression self-assessment scale (SAS) and anxiety self-assessment scale (SDS) scores were recorded1 day before surgery and 3 and 7 days after surgery. Neuropsychological function test and concentration of IL-6, IL-8 and TNF-α in peripheral blood 1 day before surgery and the 7 days after surgery were tested. Results SAS in both groups were obviously higher than national normon admission. SAS scores in group EE1 day before surgery and 3 and 7 days after surgery were significantly lower than those on admission (P < 0.05); the SDS scores 3 and 7 days after surgery were significantly lower than those on admission (P < 0.05); compared with control group, SAS scores on the 1st preoperative day and the 3rd and 7th postoperative days were significantly reduced (P < 0.05), SDS scores were significantly lower on the 7th postoperative day; compared with the norm, there were no significantly statistical differences in SDS scores on the 3rd and 7th postoperative days. On the 7th postoperative day, IL-6, IL-8 and TNF-α were significantly higher than baseline in two groups (P < 0.05), IL-6 and TNF-α in group C were higher than those in group EE. Conclusion Perioperative enriched environment may improve the anxiety and depression psychological state and reduce incidence of postoperative cognitive dysfunction (POCD) in esophageal cancer patients.