袁燚

[摘要]目的對原发性肝癌（PLC）介入治疗患者的感知控制和创伤后应激障碍（PTSD）的关系进行调查，分析 PTSD 的影响因素。方法以2017年7月至2020年7月于广州市第十二人民医院接受介入治疗的60例 PLC 患者为研究对象，借助修订版控制态度量表（CAS-R）、PTSD 症状清单平民版（PCL-C）调查患者的感知控制与 PTSD 情况，分析 PTSD 的影响因素。结果行介入治疗的60例 PLC 患者的 CAS-R 控制态度量表得分为（21.28±3.69）分; PCL-C 量表的得分为（32.17±12.25）分，得分≥38分有17例（28.33%）。本次研究中明确诊断为 PTSD 者17例（28.33%），非 PTSD 者43例（71.67%）。Pearson 相关性分析显示， CAS-R 总分与创伤后应激障碍评分呈负相关（ r=-0.257，P <0.05）。单因素分析显示，年龄、知识水平、疾病认知水平、慢性病史、应对方式、CAS-R 总分、焦虑和抑郁情绪是 PLC 介入治疗患者 PTSD 发生的相关因素，差异有统计学意义（ P <0.05）。借助二元 Logistic 回归模型分析，结果显示，PLC 患者行介入治疗后发生 PTSD 的危险因素包括疾病认知水平、焦虑和抑郁情绪，而应对方式、感知控制（CAS-R 总分）是保护因素（P <0.05）。结论原发性肝癌行介入治疗的患者感知控制处于较低水平，治疗后发生 PTSD 是多因素综合作用的结果，临床医护工作者应为高风险患者提供全面、规范化的护理，尽量规避危险因素。

[关键词]原发性肝癌;介入治疗;感知控制;创伤后应激障碍;影响因素

[中图分类号] R735.7 [文献标识码] A  [文章编号]2095-0616（2021）22-0157-05

A study of the relationship between perceptual control and post-traumatic stress disorder of the patients with liver cancer undergoing interventional therapy

YUAN  Yi

Department ofTumor Intervention， Guangzhou Twelfth People's Hospital， Guangdong， Guangzhou 510620， China

[Abstract] Objective To investigate the relationship between perceptual control and post-traumatic stress disorder （PTSD） of the patients with primary liver cancer （PLC） undergoing interventional therapy， and to analyze the influencing factors of PTSD. Methods A total of 60 patients with PLC receiving interventional therapy in Guangzhou Twelfth People's Hospital from July 2017 to July 2020 were taken as the subjects of research. The patients' perception control and PTSD were investigated through revised Control Attitudes Scale-Revised （CAS-R） and the PTSD Checklist-Civilian Version （PCL-C）， and the influencing factors of PTSD were analyzed. Results The CAS-R scores of the 60 patients with PLC receiving interventional therapy were （21.28±3.69） scores; their PCL-C scores were （32.17±12.25） scores， with 17 patients' scores ≥38 scores （28.33%）. In this study， 17 people （28.33%） were clearly diagnosed as the patients with PTSD， and 43 people （71.67%） were without PTSD. Pearson correlation analysis showed that there was a negative correlation between CAS-R total score and PTSD score （r=-0.257， P <0.05）. Univariate analysis showed that age， knowledge level， disease cognition level， the history of chronic diseases， coping style， total score of CAS-R， anxiety and depression were the related factors of PTSD among the patients with PLC receiving interventional therapy， and the differences were statistically significant （P <0.05）. According to the analysis through binary Logistic regression model， the risk factors of PTSD among the patients with PLC after interventional therapy included disease cognition level， anxiety and depression， while coping style and perceptual control （CAS-R total score） were protective factors （P <0.05）. Conclusion The perceptual control of the patients with PLC undergoing interventional therapy is at a low level， and PTSD after the treatment is the result of multiple factors. Clinical medical workers should provide comprehensive and standardized nursing care for high-risk patients and try to avoid risk factors.

[Key words] Primary liver cancer; Interventional therapy; Perceptual control; Post-traumatic stress disorder; Influencing factor

原发性肝癌（primary liver cancer，PLC）是消化系统常见的恶性肿瘤之一，具有早期发病隐匿、易转移、进展迅速等特点，在我国所有癌症中病死率位居第二[1]。约80%的患者发现时已处于中晚期，导致错过最佳外科手术时机。近年来，伴随着医疗技术、仪器设备的不断发展，介入治疗已逐渐被用于 PLC 的治疗，它具有创伤小、疗效明显的优势，但也是一种强烈的应激源。创伤后应激障碍（post- traumatic stress disorder， PTSD）指机体受到突如其来的应激事件的刺激而造成的持续性或延迟出现的精神障碍，严重影响患者的心理健康。有报道提及，并发 PTSD 后自杀发生率较普通人群高19%[2]。感知控制能力是患者感知外界应激反应，并及时调节自身情绪与心理以适应外界环境变化的能力，感知控制能力强的患者更能积极地自我护理，以抵御 PTSD 带来的负面影响。……