家长参与的绘画疗法在白血病患儿中的应用研究

doi:10.3761/j.issn.0254-1769.2023.08.002

摘要/Abstract

摘要：

目的探讨家长参与的绘画疗法对白血病患儿心理状态、家庭功能及生活质量的影响。方法采用非同期对照临床试验设计，便利选取2021年7月—2022年1月安徽省某三级甲等肿瘤专科医院收治的40例白血病患儿及其家长作为试验组，在常规护理的基础上接受家长参与的绘画疗法；将2020年12月—2021年6月收治的40例白血病患儿及其家长作为对照组，予以常规护理。于干预前及干预3、6周后，采用中文版儿童焦虑性情绪障碍筛查表、儿童抑郁障碍自评量表、家庭亲密度和适应性量表、儿童生存质量癌症模块量表评估两组患儿的焦虑水平、抑郁水平、家庭功能及生活质量。结果共脱落6例，最终试验组36例、对照组38例完成研究。两组不同时间点焦虑水平、家庭功能比较，时间效应、组间效应及交互效应均具有统计学意义（P<0.05）；抑郁水平、生活质量比较，时间效应、组间效应及交互效应均无统计学意义（P>0.05）。简单效应分析结果显示，干预3、6周后试验组焦虑水平低于对照组，干预6周后试验组家庭功能优于对照组，差异具有统计学意义（P<0.05）。结论实施家长参与的绘画疗法可有效减轻白血病患儿的焦虑情绪，改善其家庭功能。

关键词: 绘画, 白血病, 焦虑, 抑郁, 生活质量, 儿科护理学

Abstract:

Objective To explore the effects of parent-involved painting therapy on psychological state，quality of life and family function for children with leukemia. Methods Using a non-parallel controlled clinical trial design，a total of 40 children with leukemia and their parents who were admitted to a tertiary cancer hospital in Anhui Province from July 2021 to January 2022 were selected as the experimental group by convenience sampling，and the parent-involved painting therapy intervention program was implemented on the basis of routine care. 40 children with leukemia admitted from December 2020 to June 2021 and their parents were selected as the control group with routine care. The intervention time lasted 6 weeks for both groups. The anxiety level，depression level，quality of life and family function of the 2 groups were evaluated by the Screen for Child Anxiety Related Emotional Disorders（SCARED），the Depression Self-rating Scale for Children（DSRSC），the Family Adaptability and Cohesion Scale（PedsQL^TM 3.0） and the Pediatric Quality of Life Inventory 3.0 Cancer Module（FACES Ⅱ-CV） before intervention，after 3 weeks and 6 weeks of intervention. Results A total of 6 cases dropped out，and finally 36 cases were included in the experimental group and 38 cases in the control group. The comparison of anxiety level and family function at different time points between the 2 groups showed that the time effect, between-group effect and interaction effect were statistically significant（P<0.05）. There was no significant difference in depression level and quality of life among time effect, between-group effect and interaction effect（P>0.05）. The simple effect analysis showed that the anxiety level of the experimental group was lower than that of the control group after 3 weeks and 6 weeks, and the family function of the experimental group was better than that of the control group after 6 weeks, and the difference was statistically significant（P<0.05）. Conclusion Implementing parent-involved painting therapy can effectively reduce the anxiety of children with leukemia and improve their family function.

Key words: Paintings, Leukemia, Anxiety, Depression, Quality of Life, Pediatric Nursing

刘群慧, 方敏, 黄洁, 刘筝筝, 孙丽, 韦琦, 单媛媛, 黄家丽. 家长参与的绘画疗法在白血病患儿中的应用研究[J]. 中华护理杂志, 2023, 58(8): 907-914.

LIU Qunhui, FANG Min, HUANG Jie, LIU Zhengzheng, SUN Li, WEI Qi, SHAN Yuanyuan, HUANG Jiali. A study on the effects of parent-involved painting therapy in children with leukemia[J]. Chinese Journal of Nursing, 2023, 58(8): 907-914.

图/表 4

表1 家长参与的绘画疗法干预方案

Table 1 Parent-involved painting therapy program

表2 两组一般资料比较

Table 2 Comparison of general data in the 2 groups

表3 两组不同时间点焦虑、抑郁水平比较[分，M（P25，P75）]

Table 3 SCARED and DSRSC value at different time points in 2 groups[score，M（P25，P75）]

表4 两组不同时间点家庭功能比较（分，$\bar{x}±s$）

Table 4 FACES Ⅱ-CV value at different time points in 2 groups（score，$\bar{x}±s$）

参考文献 26

[1]	Boyes AW, Clinton-Mcharg T, Waller AE, et al. Prevalence and correlates of the unmet supportive care needs of individuals diagnosed with a haematological malignancy[J]. Acta Oncol, 2015, 54(4):507-514. DOI PMID
[2]	Zheng RS, Zhang SW, Zeng HM, et al. Cancer incidence and mortality in China,2016[J]. J Natl Cancer Cent, 2022, 2(1):1-9.
[3]	Aguilar BA. The efficacy of art therapy in pediatric oncology patients:an integrative literature review[J]. J Pediatr Nurs, 2017, 36:173-178. DOI PMID
[4]	张静, 田桂平, 李林林. 基于生态系统理论为指导的家庭管理联合互动式健康教育在白血病患儿护理中的应用[J]. 中华现代护理杂志, 2022, 28(8):1075-1079.
	Zhang J, Tian GP, Li LL. Effect of family management combined with interactive health education guided by ecological systems theory in nursing of children with leukemia[J]. Chin J Mod Nurs, 2022, 28(8):1075-1079.
[5]	姜庆平. 探讨以需求为导向的个性化护理在学龄期白血病儿童中的应用价值[J]. 国际护理学杂志, 2021, 40(9):1677-1680.
	Jiang QP. To explore the application value of demand-oriented personalized nursing in school-age children with leukemia[J]. Int J Nurs, 2021, 40(9):1677-1680.
[6]	于萍. 团体游戏干预在学龄期白血病儿童心理社会功能中的应用效果研究[D]. 青岛: 青岛大学, 2021.
	Yu P. Study on the effect of group play intervention in the psychosocial function of school-age children with leukemia[D]. Qingdao: Qingdao University, 2021.
[7]	Emery MJ. Art therapy as an intervention for autism[J]. Art Ther, 2004, 21(3):143-147. DOI URL
[8]	周成成, 王翠玲, 任俏丽, 等. 绘画疗法对女性肺癌病人化疗相关性恶心呕吐和生活质量的影响[J]. 护理研究, 2020, 34(15):2788-2792.
	Zhou CC, Wang CL, Ren QL, et al. Effects of painting therapy on chemotherapy-induced nausea and vomiting and quality of life in female patients with lung cancer[J]. Chin Nurs Res, 2020, 34(15):2788-2792.
[9]	郝婷, 李红梅, 张俊, 等. 视觉艺术疗法对老年乳腺癌患者认知障碍和负性情绪的影响[J]. 中国护理管理, 2022, 22(2):201-206.
	Hao T, Li HM, Zhang J, et al. The effect of visual art therapy on cognitive impairment and negative emotion of elderly patients with breast cancer[J]. Chin Nurs Manag, 2022, 22(2):201-206.
[10]	Favara-Scacco C, Smirne G, Schilirò G, et al. Art therapy as support for children with leukemia during painful procedures[J]. Med Pediatr Oncol, 2001, 36(4):474-480. PMID
[11]	沈悌, 赵永强. 血液病诊断及疗效标准[M]. 4版. 北京: 科学出版社, 2018:87-96.
	Shen T, Zhao YQ. Blood disease diagnosis and curative effect standard[M]. 4th ed. Beijing: Science Press, 2018:87-96.
[12]	蔡佳佳. 家属参与式绘画疗法对精神分裂症患者功能康复及家庭亲密适应性的效果研究[D]. 石家庄: 河北医科大学, 2016.
	Cai JJ. The effect on family participation type painting therapy on function rehabilitation and the family cohesion adaptability in patients with schizophrenia[D]. Shijiazhuang: Hebei Medical University, 2016.
[13]	郑甲平. 浅析皮亚杰的认知发展理论[J]. 报刊荟萃, 2017(9):20.
	Zheng JP. On Piaget’s cognitive development theory[J]. J Seek Knowl Guide, 2017(9):20.
[14]	崔益鸿, 王德琴. 团体动力学干预应用于中青年血液透析患者的效果[J]. 中国医药导报, 2020, 17(1):194-197.
	Cui YH, Wang DQ. Effect of group dynamics intervention in young and middle-aged hemodialysis patients[J]. China Med Her, 2020, 17(1):194-197.
[15]	严虎, 陈晋东. 绘画心理咨询与治疗[M]. 长沙: 中南大学出版社, 2014:436-462.
	Yan H, Chen JD. Painting psychological consultation and therapy[M]. Changsha: Central South University Press, 2014:436-462.
[16]	刘桂华, 欧萍, 黄龙生, 等. 亲子绘画和创意手工疗法对学龄前期孤独症谱系障碍儿童及其母亲效果评价的前瞻性随机对照研究[J]. 中国当代儿科杂志, 2021, 23(8):779-785.
	Liu GH, Ou P, Huang LS, et al. Effects of parent-child painting and creative crafting therapy on preschool children with autism spectrum disorder and their mothers:a prospective randomized controlled trial[J]. Chin J Contemp Pediatr, 2021, 23(8):779-785.
[17]	王凯, 苏林雁, 朱焱, 等. 儿童焦虑性情绪障碍筛查表的中国城市常模[J]. 中国临床心理学杂志, 2002, 10(4):270-272.
	Wang K, Su LY, Zhu Y, et al. Norms of the Screen for Child Anxiety Related Emotional Disorders in Chinese urban children[J]. Chin J Clin Psychol, 2002, 10(4):270-272.
[18]	苏林雁, 王凯, 朱焱, 等. 儿童抑郁障碍自评量表的中国城市常模[J]. 中国心理卫生杂志, 2003, 17(8):547-549.
	Su LY, Wang K, Zhu Y, et al. Norm of the Depression Self-Rating Scale for Children in Chinese urban children[J]. Chin Ment Health J, 2003, 17(8):547-549.
[19]	尹慧芳, 徐改玲, 甄龙, 等. 儿童抑郁障碍自评量表的河南农村常模和信效度[J]. 临床精神医学杂志, 2012, 22(5):310-312.
	Yin HF, Xu GL, Zhen L, et al. Norms and reliability and validity of the Depression Self-Rating Scale for Children in rural children of Henan Province[J]. J Clin Psychiatry, 2012, 22(5):310-312.
[20]	费立鹏, 沈其杰, 郑延平, 等. “家庭亲密度和适应性量表”和“家庭环境量表”的初步评价:正常家庭与精神分裂症家庭成员对照研究[J]. 中国心理卫生杂志, 1991, 5(5):198-202,238.
	Fei LP, Shen QJ, Zheng YP, et al. Preliminary evaluation of Chinese version of FACES Ⅱ and FES:comparison of normal families and families of schizophrenic patients[J]. Chin Ment Health J, 1991, 5(5):198-202,238.
[21]	张洁文. 儿童生存质量癌症模块量表中文版PedsQL 3.0信度、效度分析及其初步应用[D]. 广州: 中山大学, 2009.
	Zhang JW. Reliability, validity analysis and preliminary application of PedsQL 3.0 Chinese version of Child Quality of Life Cancer Module Scale[D]. Guangzhou: Sun Yat-sen University, 2009.
[22]	彭昕, 陈杰, 黄莉, 等. 绘画疗法对乳腺癌化疗患者影响的研究[J]. 中华护理杂志, 2017, 52(10):1200-1203.
	Peng X, Chen J, Huang L, et al. Effects of painting therapy on chemotherapy induced nausea and vomiting in patients with breast cancer[J]. Chin J Nurs, 2017, 52(10):1200-1203.
[23]	潘小容, 莫霖, 刘倩, 等. 家庭正向行为支持方案的构建及应用研究[J]. 中华护理杂志, 2021, 56(11):1618-1626. DOI
	Pan XR, Mo L, Liu Q, et al. Construction and application of family-positive behavior support programme for preschool children with malignant tumors[J]. Chin J Nurs, 2021, 56(11):1618-1626. DOI
[24]	汪向东, 王希林, 马弘. 心理卫生评定量表手册[M]. 增订版. 北京: 中国心理卫生杂志社, 1999:307.
	Wang XD, Wang XL, Ma H. Rating scales for mental health[M]. Updated ed.ed. Beijing: Chin Ment Health J, 1999:307.
[25]	吴亚美, 张春梅, 郑小芬, 等. 急性白血病患儿照顾者疾病获益感的现象学研究[J]. 中华护理杂志, 2018, 53(6):674-678.
	Wu YM, Zhang CM, Zheng XF, et al. Phenomenological study on benefit finding of caregivers of children with acute leukemia[J]. Chin J Nurs, 2018, 53(6):674-678.
[26]	Bozcuk H, Ozcan K, Erdogan C, et al. A comparative study of art therapy in cancer patients receiving chemotherapy and improvement in quality of life by watercolor painting[J]. Complement Ther Med, 2017, 30:67-72. DOI PMID