Hayashi Kazuhiro, Inoue Takayuki, Nagaya Motoki, Ito Satoru, Nakajima Hiroki, Hattori Keiko, Kadono Izumi, Yokoi Kohei, Nishida Yoshihiro
Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan.
Department of Rehabilitation, Nagoya University Hospital, Nagoya, Japan; Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Case Rep Med. 2017;2017:4743952. doi: 10.1155/2017/4743952. Epub 2017 Feb 9.
Postoperative pulmonary complications are a risk associated with thoracic surgery. However, there have been few reports on cases at high risk of postoperative complications. Cancer patients often have negative automatic thoughts about illness, and these negative automatic thoughts are associated with reduced health behavior and physical activity. This case series demonstrates the successful combination treatment of perioperative rehabilitation and psychoeducation for negative automatic thoughts in two cancer patients who underwent thoracic surgery. One patient underwent pneumonectomy with laryngeal recurrent nerve paralysis; the other patient, who had a history of recurrent hepatic encephalopathy and dialysis, underwent S6 segmentectomy. Both patients had negative automatic thoughts about cancer-related stress and postoperative pain. The physical therapists conducted a perioperative rehabilitation program in which the patients were educated to replace their maladaptive thoughts with more adaptive thoughts. After rehabilitation, the patients had improved adaptive thoughts, increased physical activity, and favorable recovery without pulmonary complications. This indicates that the combination treatment of perioperative rehabilitation and psychoeducation was useful in two thoracic cancer surgery patients. The psychoeducational approach should be expanded to perioperative rehabilitation of patients with cancer.
术后肺部并发症是胸外科手术的一项风险。然而，关于术后并发症高风险病例的报道较少。癌症患者常常对疾病有消极的自动思维，而这些消极的自动思维与健康行为和体力活动的减少有关。本病例系列展示了对两名接受胸外科手术的癌症患者进行围手术期康复和针对消极自动思维的心理教育的成功联合治疗。一名患者接受了肺切除术并伴有喉返神经麻痹；另一名患者有复发性肝性脑病和透析史，接受了S6段切除术。两名患者都对癌症相关压力和术后疼痛有消极的自动思维。物理治疗师开展了一项围手术期康复计划，在此过程中指导患者用更具适应性的思维取代适应不良的思维。康复后，患者的适应性思维得到改善，体力活动增加，恢复良好且无肺部并发症。这表明围手术期康复和心理教育的联合治疗对两名胸段癌症手术患者有效。心理教育方法应扩展至癌症患者的围手术期康复。
