| Objective:The aim of the study was to develop a perioperative psychosomatic regulation system based on computer-assisted Cognitive Behavioral Therapy(cCET).And evaluated the effect on relieving perioperative psychosomatic symptoms such as adverse mood,insomnia and pain inpatients with rhinolaryngology surgery.Methods:1.The psychological experience of inpatients in oto-rhino-larynology department was surveyed by Inpatient Psychological Experience Questionnaire(IPEQ)to analyze the detection rate and influencing factors of negative emotion.2.The perioperative psychosomatic regulation program was developed and confirmed by Delphi method 20 clinical nursing experts and 10 psychological experts were selected to conduct 3 rounds of consultation respectively to form the final plan.With the help of software developers,materials and requirements were provided to develop the cCBT program.3.The cCBT program was applied in patients undergoing laryngectomy and functional nasal endoscopic surgery(FESS).The facilitate sampling were finished in inpatients in oto-rhino-laryngology department with laryngectomy or FESS.The participants were randomized and divided into the intervention group(usual care and cCBT)and the control group(usual care and perioperative education).Laryngeal cancer patients were allocated randomly to a CCBT group(n=40)or UC group(n=40).Subjective indicators(state anxiety,depression,insomnia and quality of life)were collected at baseline(T1),at an hour before surgery(T2),postoperative 3-day(13).7-day(T4),and 10-day(T5:after intervention completed).The patients undergoing FESS were allocated randomly to a CCBT group(n=60)or UC group(n=60).Subjective indicators(state anxiety,depression,insomnia and pain)and objective indicators {blood pressure,heart rate,serum cortisol,adrenocnrticotropic hormone(ACTH),function near infrared spectrum(fNRIS)were collected at baseline(T1).at an hour before surgery(T2).postoperative 2-day(T3),4-day(T4:after intervention completed)to compare the differences between the two groups.4 FBIRS on the prefrontal and temporal cortex was collected before and after intervention and the activation differences between the intervention group and the control group were compared to explore the influence on the brain cortex of the cCBT.Results:1.2294 inpatients in Otolaryngology department were surveyed from August 2019 to November 2020.The negative emotion of 206 patients(8.89%)were detected including 93 patients(4.05%)with the mild level,27 patients(1.18%)with the moderate level,86 patients(3.75%)with the severe level,55(2.40%)patients with suicide risk.-There were 252 patients with high-risk personality tendency(10.99%).The percentage of patients with rhinopharyngology surgery in 206 patients was higher than others.Correlation analysis results showed that negative emotions were significantly related to age,gender and the operation.The female patients who are young and middle-aged undergoing surgery have a higher risk of anxiety compared with other patients.2.The results of cCBT applied in patients with laryngeal tumor resection showed that group*time interaction and time effect for all scales scores were statistically significant(all P<0.01).The mean scores of State Anxiety Inquire(SAI)in CCBT group were lower than those of the control group from T2 to T5(all P<0.05).The mean scores of the Patients Health depression Questionnaire-9(PHQ-9)and Athens Insomnia Scale(AIS)scores were lower than those of the control group from T3 to T5(all P<0.05)The Functional Assessment of Cancer Therapy-Head&Neck(FACT-H&N)scores of the intervention group were higher than those of the control group from T2 to T5(all P<0.01).3.The resulta of cCBT program applied in patients with FESS group*time interaction and time effect for SAI and AIS scores was statistically significant(all P<0.01).Further simple effect analysis found to compare with UC group,the mean scores of SAI in CCBT group were lower from T2 to T4(all P<0.01);The mean scores of AIS in CCBT group were lower at T3 and T4(all P<0.01)The mean scores of VAS scores were lower than those of the control group at T3 and T4(all P<0.01).For PHQ-9 scores.group*time interaction was not statistically significant(P=0.06)and time effect was statistically significant(P<0.01).The positive rates of state anxiety and insomnia in the intervention group were lower than those of the control group at T3 and T4.The remission rate of state anxiety and insomnia in the intervention group was higher than those of the control group.In the indexes of systolic blood pressure(SBP),diastolic blood pressure {DBP)and heart rate(HR)in the intervention group were lower than those of control group at T2 and the trends of the intervention groups were gentle compared with the control groups.At half an hour before surgery,cortisol levels were significantly higher than baseline and those of intervention group After the intervention,the satisfaction of patients in the intervention group was higher than those of control group except for the disease nursing item.4 The result of fNIRS assessing the patients with FESS showed:(1)The numbers and effect sizes of activated channels after intervention were lower than those of before intervention.The numbers and effect sizes of activated channels in the intervention group were higher than those of control group.But there was no statistical difference.(2)Relative activation(AOxy-Hb)comparison after intervention,there were statistically differences for CH14,CH18,CH25,CH46,CH47,CH48,CH49 between two groups.(3)At baseline,the Pearson correlation analysis were performed among each channel with TAI,SAI and AIS scores and the result found that CH14 and CH25 were correlated with TAI scores.CH18,CH26,CH38,CH39,CH46,CH47,CH48,and CH49 were correlated with SAI scores.CH25,CH26,CH27,CH36,and CH37 were correlated with AIS scores.In the intervention group,CH46,CH47,CH48,CH49 were correlated with the SAI score difference(T2-T4)and CH25,CH48 were correlated with the AIS score difference(T3-T4).(4)Linear regression results showed that the difference value of SAI scores(T2-T4)after intervention could account for 37%difference value in the relative activation of CH49(orbitofrontal cortex,OFC)before and after intervention The difference value of AIS scores(T2-T4)after intervention could account for 40%difference value in relative activation of CH25(dorsolateral prefrontal cortex,DLPFC)before and after intervention.Conclusion:1.There is a certain proprtion of inpatients with negative emotion,risk of suicide.and tendency of high-risk personality disorder in Otolaryngology department.Among them,female patients undergoing surgery who are young and middle-aged are anxious easily and the elderly have a higher tendency of personality disorder.We should chose advisable methods to decrease negative feelings and avoid the conflict between nurses and patients.2.The patients with laryngeal tumor resection are prone to suffer from anxiety,depression,insomnia after surgery,and their quality of life is poor.CCBT can relieve the anxiety,depression,insomnia and improve the quality of life of the patients after surgery.3.The patients with FESS are prone to suffer from preoperative anxiety and postoperative insomnia.The cCBT can not only improve preoperative anxiety patients waiting for operation and postoperative insomnia,pain,also can reduce serum cortisol level at the preoperative waiting,stable hemodynamics,and improve the satisfaction of medical service.4.During the perioperative period,cCBT can affect the local cerebral blood flow in the orbitofrontal cortex(OFC)and dorsolateral prefrontal cortex(DLPFC)of the prefrontal cortex(PFC).The improvement of anxiety and insomnia was significantly correlated with the activation of OFC and DLPFC.However,further study is needed to determine whether the improvement of clinical symptoms is caused by local cortical activation or the increase of local cortical cerebral blood flow caused the improvement of clinical symptoms. |
PDF Full Text Request