归因心理调适联合渐进性肌肉放松训练对乳腺癌化疗伴失眠患者身心健康的影响

刘海凤; 戴晓燕; 桑娟; 马英芝; 蔺波; 候燕

doi:10.16766/j.cnki.issn.1674-4152.003484

归因心理调适联合渐进性肌肉放松训练对乳腺癌化疗伴失眠患者身心健康的影响

doi: 10.16766/j.cnki.issn.1674-4152.003484

刘海凤¹,
戴晓燕¹,
桑娟¹,
马英芝²,
蔺波¹,
候燕^1, ,

1.
新疆维吾尔自治区人民医院放疗中心，新疆乌鲁木齐 830000
2.
新疆维吾尔自治区人民医院重症医学科

基金项目:

新疆维吾尔自治区自然科学基金面上项目 2020311A054

详细信息

通讯作者:
候燕，E-mail：13239914169@163.com

中图分类号: R737.9 R473.73
计量
- 文章访问数: 242
- HTML全文浏览量: 100
- PDF下载量: 9
- 被引次数: 0
出版历程
- 收稿日期: 2024-01-06
- 网络出版日期: 2024-05-29

Effect of attributed psychological adjustment combined with progressive muscle relaxation training on physical and mental health of patients with breast cancer chemotherapy and insomnia

1.
Radiotherapy Center, People ' s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang 830000, China

摘要

摘要: 目的乳腺癌化疗易出现失眠等多种不良反应，需予以高度重视。本研究旨在探讨归因心理调适联合渐进性肌肉放松训练(PMR)对乳腺癌化疗伴失眠患者的应用效果。方法选取新疆维吾尔自治区人民医院2022年1月—2023年8月收治的乳腺癌化疗伴失眠患者共325例，采用随机数表法分为对照组(162例)和研究组(163例)。在常规护理基础上，对照组接受PMR，研究组接受归因心理调适联合PMR，均干预6周，并比较2组匹兹堡睡眠质量指数(PSQI)、心理弹性量表(CD-RISC)、癌因性疲乏量表(CFS)和乳腺癌生命质量量表(FACT-B)变化情况。结果对照组、研究组分别有117、132例成功完成研究。干预6周后，2组PSQI评分均较干预前明显下降(P＜0.05)，但研究组PSQI评分[(7.70±2.08)分vs.(9.81±3.10)分]、睡眠障碍发生率[41.67%(55/132)vs.55.56%(65/117)]低于对照组，差异均有统计学意义(P＜0.05)。干预6周后，2组CD-RISC、CFS、FACT-B评分均有明显改善(P＜0.05)，且研究组CD-RISC、FACT-B评分明显高于对照组，CFS评分显著低于对照组，差异均有统计学意义(P＜0.05)。结论归因心理调适联合PMR能有效缓解乳腺癌化疗伴失眠患者的睡眠障碍，提高心理弹性水平和减轻癌因性疲乏，改善患者化疗期间的生活质量。
- 乳腺癌 /
- 化疗 /
- 失眠 /
- 归因心理调适 /
- 渐进性肌肉放松训练
Abstract: Objective Breast cancer chemotherapy is prone to insomnia and other adverse reactions, necessitating close attention. This study investigated the effect of attributive psychological adjustment combined with progressive muscle relaxation (PMR) on breast cancer patients undergoing chemotherapy and experiencing insomnia. Methods A total of 325 breast cancer patients with chemotherapy and insomnia admitted to the People ' s Hospital of Xinjiang Uygur Autonomous Region from January 2022 to August 2023 were selected and divided into control group (162 cases) and study group (163 cases) by random number table method. On the basis of routine care, the control group received PMR, and the study group received attributional psychological adjustment combined with PMR. The intervention lasted for 6 weeks, and the changes of Pittsburgh sleep quality index (PSQI), Connor-Davidson resilience scale (CD-RISC), cancer fatigue scale (CFS) and functional assessment of cancer therapy-breast (FACT-B) were compared between the two groups. Results A total of 117 cases in control group and 132 cases in study group successfully completed the study. After 6 weeks of intervention, both groups showed significant decrease in PSQI scores after intervention (P < 0.05). The study group exhibited significantly lower PSQI scores [(7.70±2.08) points vs. (9.81±3.10) points] and a lower incidence of sleep disorders [41.67% (55/132) vs.55.56% (65/117)] compared to the control group, with statistically significant differences (P < 0.05). After 6 weeks of intervention, the scores of CD-RISC, CFS and FACT-B in both groups were significantly improved (P < 0.05), and the scores of CD-RISC and FACT-B in the study group were significantly higher than those in the control group, while the CFS scores were significantly lower than those in the control group, with statistical significance (P < 0.05). Conclusion Attributive psychological adjustment combined with PMR can effectively alleviate sleep disorders, improve mental resilience, reduce cancer-related fatigue, and improve patients ' quality of life during chemotherapy.
- Breast cancer /
- Chemotherapy /
- Insomnia /
- Attribution psychological adjustment /
- Progressive muscle relaxation training

HTML全文

表 1 2组乳腺癌化疗伴失眠患者的一般资料比较

Table 1. Comparison of general data of patients with breast cancer chemotherapy combined with insomnia between the two groups

组别	例数	年龄(x±s, 岁)	术后4周内化疗[例(%)]	在婚状态/其他(例)	汉族/少数民族(例)	受教育年限(x±s，年)	职场女性/其他(例)	城市/农村(例)
对照组	117	45.37±9.51	92(78.63)	96/21	91/26	11.78±3.40	75/42	72/45
研究组	132	45.70±10.23	106(80.30)	104/28	101/31	11.92±3.51	82/50	78/54
统计量		0.263^a	0.106^b	0.418^b	0.056^b	0.319^a	0.105^b	0.155^b
P值		0.793	0.744	0.518	0.813	0.750	0.746	0.694
注：^a为t值，^b为χ²值。

下载: 导出CSV

表 2 2组乳腺癌化疗伴失眠患者PSQI评分比较

Table 2. Comparison of PSQI scores between two groups of patients with breast cancer chemotherapy and insomnia

组别	例数	PSQI评分(x±s，分)		PSQI评分＞7分[例(%)]
组别	例数	干预前	干预后	PSQI评分＞7分[例(%)]
对照组	117	14.15±3.13	9.81±3.10^b	65(55.56)
研究组	132	14.09±3.25	7.70±2.08^b	55(41.67)
统计量		0.148^a	8.126^c	4.792^d
P值		0.883	＜0.001	0.029
注：^a为t值, ^c为F值，^d为χ²值。与同组干预前比较, ^bP < 0.05。

下载: 导出CSV

表 3 2组乳腺癌化疗伴失眠患者CD-RISC评分比较(x±s，分)

Table 3. Comparison of CD-RISC scores between two groups of patients with breast cancer chemotherapy and insomnia(x±s, points)

组别	例数	坚韧		自强		乐观		D-RISC总分
组别	例数	干预前	干预后	干预前	干预后	干预前	干预后	干预前	干预后
对照组	117	25.47±5.12	28.39±5.74^b	18.70±4.03	21.35±4.91^b	8.71±2.47	10.23±2.81^b	52.88±8.63	59.97±9.31^b
研究组	132	26.03±5.08	34.02±6.18^b	18.49±4.21	24.87±5.23^b	8.80±2.54	12.17±3.02^b	53.32±9.25	71.03±10.08^b
统计量		0.865^a	12.516^c	0.401^a	7.013^c	0.283^a	4.528^c	0.387^a	7.596^c
P值		0.388	＜0.001	0.689	＜0.001	0.778	＜0.001	0.699	＜0.001
注：^a为t值, ^c为F值；与同组干预前比较，^bP＜0.05。

下载: 导出CSV

表 4 2组乳腺癌化疗伴失眠患者CFS、FACT-B评分比较(x±s，分)

Table 4. Comparison of CFS and FACT-B scores between two groups of patients with breast cancer chemotherapy and insomnia(x±s, points)

组别	例数	CFS		FACT-B
组别	例数	干预前	干预后	干预前	干预后
对照组	117	29.18±5.12	26.40±4.35^b	75.63±7.42	78.47±8.13^b
研究组	132	28.75±5.20	23.27±3.63^b	76.01±7.51	83.20±8.40^b
统计量		0.656^a	7. 087^c	0.401^a	8. 423^c
P值		0.513	＜0.001	0.689	＜0.001
注：^a为t值，^c为F值; 与同组干预前比较，^bP＜0.05。

下载: 导出CSV

参考文献(19)

[1]	韩雨廷, 陈凌, 杨旭, 等. 红颜杀手: 乳腺癌[J]. 中华流行病学杂志, 2022, 43(4): 608. https://xuewen.cnki.net/CCND-CFNB202401170071.html HAN Y T, CHEN L, YANG X, et al. Beauty killer: breast cancer[J]. Chinese Journal of Epidemiology, 2022, 43(4): 608. https://xuewen.cnki.net/CCND-CFNB202401170071.html
[2]	梁有沣, 郝明炫, 郭蕊, 等. 乳腺癌早期筛查和诊断生物标志物研究进展[J]. 生物工程学报, 2023, 39(4): 1425-1444. https://www.cnki.com.cn/Article/CJFDTOTAL-SHWU202304011.htm LIANG Y F, HAO M X, GUO R, et al. Biomarkers for early screening and diagnosis of breast cancer: a review[J]. Chinese Journal of Biotechnology, 2023, 39(4): 1425-1444. https://www.cnki.com.cn/Article/CJFDTOTAL-SHWU202304011.htm
[3]	DI NARDO P, LISANTI C, GARUTTI M, et al. Chemotherapy in patients with early breast cancer: clinical overview and management of long-term side effects[J]. Expert Opin Drug Saf, 2022, 21(11): 1341-1355. doi: 10.1080/14740338.2022.2151584
[4]	王锐, 朱航佳, 李万浪, 等. 抗阻运动联合渐进放松训练在老年原发性高血压患者中的效果[J]. 中国老年学杂志, 2022, 42(7): 1652-1654. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202207035.htm WANG R, ZHU H J, LI W L, et al. Effect of resistance exercise combined with progressive relaxation training in elderly patients with essential hypertension[J]. Chinese Journal of Gerontology, 2022, 42(7): 1652-1654. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ202207035.htm
[5]	STEVENSON M C, MCCRACKEN E, WATSON A, et al. An attribution theory-based content analysis of mock jurors ' deliberations regarding coerced confessions[J]. Law Hum Behav, 2023, 47(2): 348-366. doi: 10.1037/lhb0000529
[6]	宁凡, 王纹, 王效, 等. 乳腺癌患者归因方式对健康相关生活质量的中介作用分析[J]. 重庆医学, 2022, 51(21): 3629-3633. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX202221006.htm NING F, WANG W, WANG X, et al. Analysis of mediating effect of attributional style on health-related quality of life in patients with breast cancer[J]. Chongqing Medicine, 2022, 51(21): 3629-3633. https://www.cnki.com.cn/Article/CJFDTOTAL-CQYX202221006.htm
[7]	魏艳婷, 李书麟, 刘美姣. 冥想松弛疗法对乳腺癌化疗患者睡眠质量及情绪的影响[J]. 中华现代护理杂志, 2018, 24(24): 2930-2932. WEI Y T, LI S L, LIU M J. Effects of meditation relaxation therapy on sleep quality and emotion among breast cancer patients with chemotherapy[J]. Chinese Journal of Modern Nursing, 2018, 24(24): 2930-2932.
[8]	宋应群, 孙高红, 巫素青, 等. 渐进性肌肉放松训练在胃癌术后首次化疗患者疼痛-疲乏-睡眠障碍症状群中的应用研究[J]. 癌症进展, 2021, 19(3): 313-316. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202103026.htm SONG Y Q, SUN G H, WU S Q, et al. Application of progressive muscle relaxation exercise in the symptom cluster of pain-fatigue-somnipathy disorder in patients with first-time chemotherapy after gastric cancer surgery[J]. Oncology Progress, 2021, 19(3): 313-316. https://www.cnki.com.cn/Article/CJFDTOTAL-AZJZ202103026.htm
[9]	鞠珊, 欧阳艳琼, 王晓惠. 渐进性肌肉放松训练在护理领域的应用进展[J]. 护理学杂志, 2017, 32(13): 95-98. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201713035.htm JU S, OUYANG Y Q, WANG X H. Application of progressive muscle relaxation in nursing: a literature review[J]. Journal of Nursing Science, 2017, 32(13): 95-98. https://www.cnki.com.cn/Article/CJFDTOTAL-HLXZ201713035.htm
[10]	于肖楠, 张建新. 自我韧性量表与Connor-Davidson韧性量表的应用比较[J]. 心理科学, 2007, 30(5): 1169-1171. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX200705037.htm YU X N, ZHANG J X. A Comparison between the Chinese Version of Ego-Resiliency Scale and Connor-Davidson Resilience Scale[J]. Journal of Psychological Science, 2007, 30(5): 1169-1171. https://www.cnki.com.cn/Article/CJFDTOTAL-XLKX200705037.htm
[11]	张凤玲, 丁玥, 韩丽沙. 癌症疲乏量表中文版的信效度[J]. 中国心理卫生杂志, 2011, 25(11): 810-813. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201111004.htm ZHANG F L, DING Y, HAN L S. Reliability and validity of the Chinese version of Cancer Fatigue Scale[J]. Chinese Mental Health Journal, 2011, 25(11): 810-813. https://www.cnki.com.cn/Article/CJFDTOTAL-ZXWS201111004.htm
[12]	万崇华, 张冬梅, 汤学良, 等. 乳腺癌患者生命质量测定量表FACT-B中文版介绍[J]. 中国肿瘤, 2002, 11(6): 318-320. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU200206003.htm WAN C H, ZHANG D M, TANG X L, et al. Introduction of FACT-B, quality of life measurement scale for breast cancer patients[J]. China Cancer, 2002, 11(6): 318-320. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHLU200206003.htm
[13]	黄青梅, 耿朝辉, 吴傅蕾, 等. 乳腺癌患者化疗期间症状群特征及预测指标的研究[J]. 中华护理杂志, 2020, 55(9): 1297-1303. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202009004.htm HUANG Q M, GENG C H, WU F L, et al. Study on differential characters of symptom clusters and predictors of breast cancer patients during chemotherapy[J]. Chinese Journal of Nursing, 2020, 55(9): 1297-1303. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL202009004.htm
[14]	金慧英, 翟栋, 金善恩, 等. 耳穴贴压、穴位贴敷、经络艾灸联合情志疗法对乳腺癌根治术患者的效果研究[J]. 中华全科医学, 2019, 17(2): 329-332. doi: 10.16766/j.cnki.issn.1674-4152.000674 JIN H Y, ZHAI D, JIN S E, et al. Effect of auricular point sticking, acupoint sticking, meridian moxibustion combined with emotional therapy on patients undergoing radical mastectomy[J]. Chinese Journal of General Practice, 2019, 17(2): 329-332. doi: 10.16766/j.cnki.issn.1674-4152.000674
[15]	NE瘙塁E A, SAMANCIOǦLU BAǦLAMA S. The effect of progressive muscle relaxation and deep breathing exercises on dyspnea and fatigue symptoms of COPD patients: a randomized controlled study[J]. Holist Nurs Pract, 2022, 36(4): E18-E26. doi: 10.1097/HNP.0000000000000531
[16]	NGUYEN K T, HOANG H T X, BUI Q V, et al. Effects of music intervention combined with progressive muscle relaxation on anxiety, depression, stress and quality of life among women with cancer receiving chemotherapy: a pilot randomized controlled trial[J]. PLoS One, 2023, 18(11): e0293060. DOI: 10.1371/journal.pone.0293060.
[17]	周艳丽, 张丽娟, 董伟, 等. 渐进性肌肉放松训练对宫颈癌化疗患者的影响[J]. 北华大学学报: 自然科学版, 2022, 23(1): 103-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYY202201020.htm ZHOU Y L, ZHANG L J, DONG W, et al. Effect of Progressive Muscle Relaxation Training on Chemotherapy for Patients with Cervical Cancer[J]. Journal of Beihua University: Natural Science, 2022, 23(1): 103-105. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLYY202201020.htm
[18]	SATTLER S, MASKILEYSON D, RACINE E, et al. Stigmatization in the context of the COVID-19 pandemic: a survey experiment using attribution theory and the familiarity hypothesis[J]. BMC Public Health, 2023, 23(1): 521. doi: 10.1186/s12889-023-15234-5
[19]	李秋华, 李红芳, 滕鹏飞. 归因理论的双心护理在脑卒中后情绪障碍患者的应用及对心理弹性, 希望水平的影响[J]. 中国健康心理学杂志, 2023, 31(4): 519-524. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202304008.htm LI Q H, LI H F, TENG P F. Application of psycho-cardiology nursing based on attribution theory in patients with post-stroke emotional disorders and its influence on psychological resilience and hope level[J]. China Journal of Health Psychology, 2023, 31(4): 519-524. https://www.cnki.com.cn/Article/CJFDTOTAL-JKXL202304008.htm