探讨授权教育式"音乐氧吧"对乳腺癌患者术后焦虑及积极心理的影响。

根据纳入、排除标准，选取2017年4月至2019年1月在南京医科大学第一附属医院乳腺外科首次行乳腺癌改良根治术的124例患者作为研究对象进行前瞻性研究。用随机数字表法将患者分为对照组和观察组。观察组64例，由经培训的全程护士以授权教育理论为指导，开展实体及网络"音乐氧吧"团体辅导的术后康复指导；对照组60例，由经培训的全程护士在患者床边进行一对一的术后康复指导。2组患者出院后，跟踪其全程康复情况并接受患者咨询。由经过训练的1名护士(本科学历)于干预前(术后第1天)、干预后3个月(术后3个月)发放汉密尔顿焦虑量表和积极心理量表(心理健康连续体量表简版)问卷，对患者术后焦虑情绪及积极心理(情绪幸福感、社会幸福感、心理幸福感)进行评分，并采用两独立样本t检验比较2组之间各项评分的差异，用配对t检验比较组内干预措施采取前、后各项评分的差异。

干预前，观察组与对照组焦虑评分的差异无统计学意义[(25.48±4.92)分比(26.62±4.19)分，t＝-1.377，P＝0.171]；干预后3个月，观察组和对照组焦虑评分均较干预前降低[观察组干预前、后比较：(25.48±4.92)分比(23.69±3.26)分，t＝2.437, P＝0.016；对照组干预前、后比较：(26.62±4.19)分比(24.98±3.90)分，t＝1.999, P＝0.048]；干预后3个月，观察组焦虑评分比对照组低(t＝-2.011，P＝0.047)。并且，干预前，观察组与对照组的积极心理总分以及情绪幸福感、社会幸福感、心理幸福感评分分别为(25.00±9.35)、(5.00±1.79)、(9.13±3.56)、(10.88±4.53)分和(25.90±6.35)、(5.62±1.94)、(9.03±3.56)、(11.25±4.53)分，组间比较，差异均无统计学意义(t＝-0.623、-1.84、0.143、-0.461，P＝0.535、0.068、0.886、0.646)；干预后3个月，观察组与对照组的积极心理总分以及情绪幸福感、社会幸福感、心理幸福感评分分别为(29.77±6.23)、(5.83±1.40)、(10.66±2.56)、(13.28±3.57)分和(29.72±5.19)、(6.32±1.72)、(10.40±3.07)、(13.00±3.47)分，均较干预前提高(观察组：t＝-3.394、-2.916、-2.794、-3.341，P＝0.001、0.004、0.006、0.001；对照组：t＝-3.606、-2.090、-2.252、-2.373，P＝0.001、0.039、0.026、0.019)，但2组之间比较，差异均无统计学意义(t＝-0.047、-1.739、0.506、0.444，P＝0.962、0.085、0.614、0.658)。

授权教育式"音乐氧吧"团体辅导能够有效减缓乳腺癌患者术后焦虑，促进乳腺癌患者术后积极心理的建立，值得临床研究、应用。

To explore the effect of empowerment education (music oxygen bars) on postoperative anxiety and positive psychology in breast cancer patients.

According to the inclusion and exclusion criteria, totally 124 patients who underwent modified radical mastectomy in the Department of Breast Surgery, the First Affiliated Hospital of Nanjing Medical University from April 2017 to January 2019 were enrolled for a prospective study. The patients were randomly divided into control group and observation group using random number table method. Sixty-four patients in the observation group received postoperative rehabilitation of group counseling through music oxygen bars online or in clinic under the guidance of the empowerment education theory. In the control group, 60 patients received bedside one-on-one postoperative rehabilitation guided by the trained nurses. After discharge, the recovery of both groups was monitored and rehabilitation counseling was given. The Hamilton Anxiety Scale and positive psychological questionnaires (the Mental Health Continuum-Short Form) were distributed by a trained nurse (college graduate) before intervention (on the first day after surgery) and 3 months after intervention (3 months after surgery) to evaluate postoperative anxiety and positive psychology (emotional well-being, social well-being and psychological well-being). The scores were compared between the two groups using two independent-sample t test, and the scores before and after intervention in the same group were compared using the paired t test.

Before intervention, the anxiety score showed no significant difference between the observation group and the control group (25.48±4.92 vs 26.62±4.19, t=-1.377, P=0.171). Compared with pre-intervention value, the anxiety scores of both groups were decreased significantly three months after intervention (observation group: 25.48±4.92 vs 23.69±3.26, t=2.437, P=0.016; control group: 26.62±4.19 vs 24.98±3.90, t=1.999, P=0.048), while the anxiety score of the observation group was significantly lower than that of the control group(t=-2.011, P=0.047). In addition, before intervention, the total score of positive psychology and scores of emotional well-being, social well-being and psychological well-being were 25.00±9.35, 5.00±1.79, 9.13±3.56 and 10.88±4.53 in the observation group, 25.90±6.35, 5.62±1.94, 9.03±3.56 and 11.25±4.53 in the control group, indicating no significant difference (t=-0.623, -1.84, 0.143, -0.461, P=0.535, 0.068, 0.886, 0.646). Three months after intervention, the total score of positive psychology and scores of emotional well-being, social well-being and psychological well-being were 29.77±6.23, 5.83±1.40, 10.66±2.56 and 13.28±3.57 in the observation group, 29.72±5.19, 6.32±1.72, 10.40±3.07 and 13.00±3.47 in the control group, which indicated a significant increment compared with pre-intervention values (observation group: t=-3.394, -2.916, -2.794, -3.341, P=0.001, 0.004, 0.006, 0.001; control group: t=- 3.606, -2.090, -2.252, -2.373, P=0.001, 0.039, 0.026, 0.019), but there was no statistically significant difference between the two groups (t=-0.047, -1.739, 0.506, 0.444, P=0.962, 0.085, 0.614, 0.658).

Empowerment education (music oxygen bars) and group counseling can relieve postoperative anxiety and promote positive psychology in breast cancer patients, worthy of clinical research and application.