摘要
目的探讨在重症医学科(ICU)实施多元化综合心理干预措施的必要性和可行性以及对患者治疗的作用.方法选择2015年至2017年西安交通大学第二附属医院急诊ICU(EICU)住院意识清醒的成人患者,并按随机数字表法分为对照组和干预组,每组40例.对照组予以常规护理和常规诊疗;干预组在常规护理和常规诊疗的基础上,在心理医师的辅助下给予多元化综合心理干预措施(护理、医疗、家属、管理层面).干预5 d后,采用治疗依从性量表、医学应对问卷(MCMQ)和症状自评量表(SCL-90)评估患者的治疗依从性、治疗应对情况和心理健康情况,并进行组间比较.结果干预5 d后,对照组和干预组分别有3例、4例患者因病情变化等原因退出研究,最终对照组纳入37例、干预组纳入36例.两组患者性别、年龄、文化程度、所患疾病、病程、EICU住院时间和急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)等基础资料比较差异均无统计学意义.干预组治疗依从性评分显著高于对照组(分:2.89±0.67比2.32±0.91,P<0.01).与对照组比较,干预组MCMQ问卷中"面对"维度评分显著升高(分:19.75±2.08比18.62±2.65),"回避"维度和"屈服"维度评分显著降低(分:14.22±1.91比15.14±1.92,8.83±1.54比9.73±2.10),差异均有统计学意义(均P<0.05).干预组SCL-90量表中"躯体化""人际关系敏感""抑郁""焦虑"和"恐怖"5个因子分值均低于对照组(分:1.59±0.38比1.81±0.37,1.72±0.40比1.93±0.42,1.76±0.32比1.92±0.29,1.82±0.40比2.14±0.40,1.44±0.30比1.60±0.38,均P<0.05),而两组"强迫症状""敌对""偏执""精神病性"4个因子分值差异均无统计学意义(均P>0.05).结论给予ICU清醒患者多元化综合心理干预措施,可提高其治疗依从性,使患者对疾病的应对方式更加积极,并能改善其心理健康情况,具有一定的必要性和可行性.
Objective To discuss the ethical necessity and feasibility of implementing multiple comprehensive psychological intervention measures in intensive care unit(ICU),and to investigate the effect of the measures on treatment compliance.Methods The conscious adult patients hospitalized in emergency ICU(EICU)of the Second Affiliated Hospital of Xi'an Jiaotong University from 2015 to 2017 were enrolled,and divided into control group and intervention group according to random number table,with 40 patients in each group.Patients in control group were treated with routine care and routine diagnosis and treatment,and patients in intervention group were treated with the help of psychologists and with multiple comprehensive psychological intervention measures(including nursing care,medical treatment,family and management)based on routine care and routine diagnosis and treatment.After 5 days of intervention,the treatment compliance,the medical coping attitude and the mental health were assessed respectively using the Treatment Compliance Scale,the Medical Coping Modes Questionnaire(MCMQ)and the Symptom Checklist Scale(SCL-90),and then comparation were done between the two groups.Results After 5 days of intervention,3 patients in the control group and 4 patients in the intervention group withdraw the study because of the change of illness,and at last 37 patients in the control group and 36 in the intervention group were enrolled.There was no significant difference in basic data such as gender,age,education level,disease,course of disease,the length of EICU stay,and acute physiology and chronic health evaluationⅡ(APACHEⅡ)score between the two groups.The scores of treatment compliance in intervention group was significantly higher than that in control group(2.89±0.67 vs.2.32±0.91,P<0.01).Compared with the control group,the"confrontation"dimension score of the MCMQ questionnaire in intervention group was significantly increased(19.75±2.08 vs.18.62±2.65,P<0.05),while the"avoidance"and"surrender"dimensions scores were significantly decreased(14.22±1.91 vs.15.14±1.92,8.83±1.54 vs.9.73±2.10,both P<0.05).In the SCL-90 scale,the scores of the 5 factors such as"somatization","interpersonal sensitivity","depression","anxiety"and"photic anxiety"in intervention group were significantly less than those in control group(1.59±0.38 vs.1.81±0.37,1.72±0.40 vs.1.93±0.42,1.76±0.32 vs.1.92±0.29,1.82±0.40 vs.2.14±0.40,1.44±0.30 vs.1.60±0.38,all P<0.05),while there was no significantly difference in the scores of the other 4 factors as"obsessive-compulsive symptoms","hostile","bigotry"and"psychoticism"between the two groups(all P>0.05).Conclusion The multiple comprehensive psychological intervention measures used for ICU conscious patients could improve the treatment compliance,make the patients'medical coping attitude more active and improve the mental health of the patients,so it has ethical necessity and certain feasibility.
作者
潘龙飞
张欢
高彦霞
冯辉
樊媛
孙江利
陈策
李丽君
裴红红
Pan Longfei;Zhang Huan;Gao Yanxia;Feng Hui;Fan Yuan;Sun Jiangli;Chen Ce;Li Lijun;Pei Honghong(Department of Emergency,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China;Department of Psychosocial,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China;Department of Psychosocial,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shaanxi,China;Department of Cardiovascular,the Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,Shaanxi,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2019年第5期611-614,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
陕西省自然科学基金(2013JM4002)。
关键词
心理干预
重症加强治疗病房
心理健康
治疗依从性
医学应对问卷
症状自评量表
Psychological intervention
Intensive care unit
Mental health
Treatment compliance
Medical coping modes questionnaire
Symptom checklist scale
