基于正念的减压联合穴位按压对化疗期伴失眠的乳腺癌患者睡眠质量的影响：一项随机对照试验。

Mindfulness-based stress reduction with acupressure for sleep quality in breast cancer patients with insomnia undergoing chemotherapy: A randomized controlled trial.

机构信息

The School of Nursing, Fujian Medical University, No. 1 of Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China; Mindong Hospital Affiliated to Fujian Medical University, No.89 of Heshan Road, Fu'an City, Fujian Province, China.

The School of Nursing, Fujian Medical University, No. 1 of Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China.

出版信息

Eur J Oncol Nurs. 2022 Dec;61:102219. doi: 10.1016/j.ejon.2022.102219. Epub 2022 Oct 5.

DOI:10.1016/j.ejon.2022.102219

PMID:36257214

Abstract

PURPOSE

The objective of this randomized controlled trial was to evaluate and compare the effectiveness of mindfulness-based stress reduction (MBSR), acupressure, and MBSR combined with acupressure in improving sleep quality in breast cancer patients with sleep disorders, as well as the potential effects of these interventions on relieving fatigue, anxiety, and depression.

METHODS

A four-arm parallel-group randomized controlled trial was conducted in a tertiary hospital in Fujian between July 2019 and January 2021. A total of 147 breast cancer patients were randomly assigned to a usual care group (n = 34), a MBSR group (n = 38), an acupressure group (n = 36), or a combined group (n = 39). We assessed patients' sleep quality (Pittsburgh Sleep Quality Index-PSQI and 6 actigraphy indices), fatigue, anxiety, and depression at baseline and at the mid-intervention (fourth week) and the end of intervention (eighth week).

RESULTS

The ANOVA showed a significant difference (p < 0.05) in PSQI, and all sleep parameters measured by wrist actigraphy, and anxiety between groups. The three active treatments led to better PSQI outcomes (p < 0.001), reduced fatigue (p < 0.001), decreased anxiety (p < 0.05), and improved sleep measured by all actigraphy indices with two exceptions (MBSR did not differ from control on Sleep Latency (p = 0.235) and mean waking by time (MWBT) (p = 0.058)). Both acupressure and the combined intervention outperformed MBSR on four actigraphy indices: Sleep Efficiency (SE), Sleep Latency (SL), Totatl Sleep Time (TST), and Wake after sleep onset (WASO) (p < 0.05), and the combined intervention further outperformed MBSR on PSQI (p = 0.03) and Number of awakings (NOA) (p = 0.003). Moreover, there was no significant difference across all outcomes between acupressure and combined intervention (p ≥ 0.05).

CONCLUSIONS

MBSR, acupressure, and combined therapy all show a remarkable advantages in allemiating sleep quality, fatigue, and anxiety. Acupressure and combined therapy outperformed MBSR in improving sleep quality.

摘要

目的

本随机对照试验旨在评估和比较正念减压（MBSR）、穴位按压和 MBSR 联合穴位按压对改善睡眠障碍乳腺癌患者睡眠质量的效果，以及这些干预措施对缓解疲劳、焦虑和抑郁的潜在影响。

方法

2019 年 7 月至 2021 年 1 月，在福建省一家三级医院进行了一项四臂平行组随机对照试验。共纳入 147 例乳腺癌患者，随机分为常规护理组（n=34）、MBSR 组（n=38）、穴位按压组（n=36）和联合组（n=39）。我们在基线和干预中期（第 4 周）和干预结束时（第 8 周）评估患者的睡眠质量（匹兹堡睡眠质量指数-PSQI 和 6 项活动记录仪指标）、疲劳、焦虑和抑郁。

结果

方差分析显示，PSQI 以及手腕活动记录仪测量的所有睡眠参数和焦虑在组间存在显著差异（p<0.05）。三种主动治疗方法均导致 PSQI 结果改善（p<0.001），疲劳减轻（p<0.001），焦虑减轻（p<0.05），除两项指标外（MBSR 与对照组在睡眠潜伏期（p=0.235）和平均觉醒时间（MWBT）（p=0.058）方面无差异），所有活动记录仪指标的睡眠均得到改善。穴位按压和联合干预在四项活动记录仪指标上优于 MBSR：睡眠效率（SE）、睡眠潜伏期（SL）、总睡眠时间（TST）和睡眠后觉醒时间（WASO）（p<0.05），联合干预在 PSQI（p=0.03）和觉醒次数（NOA）（p=0.003）方面进一步优于 MBSR。此外，穴位按压和联合干预在所有结局指标上均无显著差异（p≥0.05）。