集束化认知行为干预在Stanford A型主动脉夹层患者术前焦虑抑郁中的应用
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摘要
目的探索集束化认知行为干预对Stanford A型主动脉夹层患者术前焦虑抑郁状态中的应用效果。方法选取2016年1月-2017年12月住院诊断为急性Stanford A型主动脉夹层患者102例,其中男68例,女34例,年龄(51.01±10.8)岁。按入院顺序,随机分为对照组和干预组,每组各43例,对照组采用传统的护理措施,干预组在传统护理的基础上进行集束化的认知行为干预,2组患者分别于入院当天、入院后第3d及术前1d采用Zung焦虑自评量表(SAS)和Zung抑郁自评量表(SDS)进行评分。2组患者的焦虑量表(SAS)值和抑郁量表(SDS)值等指标进行比较。结果干预组患者的SAS值及SDS值明显低于对照组(P<0.05),差异具有统计学意义。结论集束化认知行为干预可以减轻Stanford A型主动脉夹层患者术前焦虑、抑郁等负性情绪,提高患者对该病的认知水平与遵医行为,增进护患之间的情感交流与配合,使夹层破裂发生率显著降低,有助于减少围术期并发症的发生,适合在心脏大血管病房推广示范。
Objective To explore the effectiveness of bundled cognitive-behavioral intervention applied in preoperative anxiety and depression for patients with Stanford type A aortic dissection. Methods 102 cases of acute Stanford type A aortic dissection who were admitted during January 2016 and December 2017 were selected, including 68 male cases and 34 female cases. The age range was(51.01±10.8). The targets were randomly divided into control group and intervention group where there were 43 cases in each group respectively. The traditional nursing approach was given to the control group while the bundled cognitive-behavioral intervention was delivered to the intervention group on top of the traditional measures. Zung SAS and Zung SDS were adopted to assess these two groups of patients on the day of admission, the third day of admission and the day before operation. The indicators listed in the SAS and SDS were compared between two groups. Results The value of SAS and SDS in the intervention group was obviously lower than that in the control group(P<0.05) and the difference was statistically significant. Conclusion The bundled cognitive-behavioral intervention can reduce patients' negative emotion like anxiety and depression, improving patients' cognition about diseases and treatment compliance and enhance the emotional communication and cooperation between nurses and patients. This will reduce the incidence rate of aortic dissection rupture, helping to decrease the incidence of perioperative complications and increase patient's survival rate while reducing the mortality.
Objective To explore the effectiveness of bundled cognitive-behavioral intervention applied in preoperative anxiety and depression for patients with Stanford type A aortic dissection. Methods 102 cases of acute Stanford type A aortic dissection who were admitted during January 2016 and December 2017 were selected, including 68 male cases and 34 female cases. The age range was(51.01±10.8). The targets were randomly divided into control group and intervention group where there were 43 cases in each group respectively. The traditional nursing approach was given to the control group while the bundled cognitive-behavioral intervention was delivered to the intervention group on top of the traditional measures. Zung SAS and Zung SDS were adopted to assess these two groups of patients on the day of admission, the third day of admission and the day before operation. The indicators listed in the SAS and SDS were compared between two groups. Results The value of SAS and SDS in the intervention group was obviously lower than that in the control group(P<0.05) and the difference was statistically significant. Conclusion The bundled cognitive-behavioral intervention can reduce patients' negative emotion like anxiety and depression, improving patients' cognition about diseases and treatment compliance and enhance the emotional communication and cooperation between nurses and patients. This will reduce the incidence rate of aortic dissection rupture, helping to decrease the incidence of perioperative complications and increase patient's survival rate while reducing the mortality.
引文
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[2]Cheryl Crocker,Willian Kinnear.Weaning from ventilation:Does a care bundle approach work[J].Intensive and Critical Care Nursing,2008,24:180-186.
[3]陈灏珠.实用内科学[M].北京:人民卫生出版社,2007:1593-1594.
[4]Sellke.Sabiston&Spencer surgery of the chest[M].7thed.Philadelphi Pennsylvania:Elsevier Saunders,2005:1195-1235.
[5]Galla BM,Wood JJ,Chin AW,et al.One year follow-up to modular cognitive behavioral therapy for the treatment of pediatrio anxiety disorders in an elementary school setting[J].Child Psychiatry&Human Development,2012,43(2):219-226.
[6]Lopez C,Antoni M,Penedo F,et al.A pilot study of cognitive behavioral stress management effects on stree,quality of life,and symptoms in persons with chronic fatigue syndrome[J].Journal of Psychosomatic Research,2011,70(4):328-334.
[7]Greer JA,Traeger L,Bemis H,et al.A Pilot randomized controlled trial of brief cognitive-behavioral therapy for anxiety in patients with terminal canceer[J].Journal of Psychosomatic Reseach,2012,17(10):1337-1345.
[8]汪向东,王希林,马弘,等.心理卫生评定量表手册[M].北京:中国心理卫生杂志社,1999:194-196,235-237.
[9]张玲,潘润德.认知行为和抗焦虑药物治疗焦虑障碍的随机对照研究[J].中国神经精神疾病杂志,2007,33(12):755-760.
[10]Crandallm,Lammersc,Sendersc,et al.Initial ralidation of a numeric zero to ten scale to measure children's state anxiety[J].Anesth Analg,2007,105(5):1250-1253.
[11]Hopkinson NS,Englebretsen C,Cooley N,et al.Designing and implementing a COPD discharge care bundle[J].Thorax,2012,67(1):90-92.
[12]Crunden EI,Boyce C,Woodman H,et al.An evaluation of the impact of the ventilator care bundle[J].Nurs Crit Care,2005,10(5):242-246.
[13]唐朝晖,罗冬芳,张慧君.主动脉夹层患者急性期负性心理分析及护理[J].现代医药卫生,2009,25(18):88-89.
[14]Anna Letterstal,Ann Catrine Eldh,Parolofesson,et al.Patients'experience of open repair of abdominal aorticaneurysm-preoperative information,hospital care and recovery[J].J Clin Nurs,2010,19(21-22):3112-3122.
[15]Bertero C,Carlsson P,Lundgren F.Screening for abdominal aortic aneurysm,a one-year followup:An interview study[J].J Vasc Nurs,2010,28:97-101.