音乐放松疗法对糖尿病视网膜病变患者生活质量的干预效应

Intervention effects of music relaxation therapy on the quality of life in patients with diabetic retinopathy

目的:应用音乐放松疗法干预糖尿病视网膜病变患者的不良心理情绪,并观察对其生活质量的影响。方法:选择2004-04/10在大连造船医院、大连市中心医院、大连市糖尿病医院门诊就诊的2型糖尿病具有Ⅱ-Ⅲ期视网膜病变的患者80例,随机分成2组,心理干预组和未干预组,每组40例。两组患者在性别、年龄、文化程度、视功能分级、体质量、身高、体质量指数、空腹血糖方面相匹配。干预组与未干预组均采用基本固定的投药治疗方法,心理干预手段采用音乐放松疗法,坚持练习2次/d,30min/次,每周2次的电话随访。疗程28d。采用糖尿病生活质量特异性量表评定糖尿病患者的生活质量。采用视功能损害眼病患者生存质量量表评定视功能损害眼病患者生活质量。采用症状自评量表评定患者心理健康状况。测试时间为首次入院时及治疗结束时。采用t检验和χ2检验比较治疗前心理状况和治疗前后两组间各指标差值的比较,采用Spearman相关分析视觉功能与糖尿病生活质量的相关性,多元逐步回归分析以治疗前后的症状自评量表总分差值为因变量,以性别、年龄、身高、体质量、体质量指数、是否干预、视功能分级、文化程度、血糖值、糖尿病特异性量表的各因子分、视功能量表的各因子分为自变量。结果:80例患者均自愿参加,并认真完成量表测试,中途无脱落。①治疗前两组心理状况的比较:两组患者治疗前在糖尿病生活质量特异性量表、视功能损害生存质量量表之间无显著差异(P>0.05);与常模比较,80例患者症状自评量表在躯体化、人际、焦虑、抑郁、恐怖和阳性分数值之间差异显著(P<0.05)。②视功能损害眼病患者生存质量量表与糖尿病生活质量特异性量表评分的相关分析:糖尿病视网膜病变患者的生活质量特异性量表的生理功能与视功能损害眼病患者生存质量量表的身体功能、社会功能和精神心理功能之间正相关(P<0.05);心理精神维度与视功能损害眼病患者生存质量量表的社会功能和精神心理功能之间正相关(P<0.05);治疗维度与视功能损害眼病患者生存质量量表的社会功能正相关(P<0.05)。③糖尿病生活质量特异性量表与症状自评量表之间的相关性:糖尿病生活质量特异性量表的生理维度与症状自评量表的强迫、抑郁、焦虑、敌对负相关(P<0.05);心理维度与强迫、抑郁、焦虑、敌对、恐怖、偏执、精神负相关(P<0.05);社会维度与强迫、人际、抑郁、焦虑负相关(P<0.05)。④多元逐步回归分析,症状自评量表的改善程度与心理干预正相关,说明心理干预可以提高心理水平,改善视功能损害眼病患者的生活质量。结论:糖尿病视网膜病变患者的心理问题严重。视网膜的病变导致的视觉功能下降,是糖尿病视网膜病变患者生活质量下降的主要原因;心理干预可提高糖尿病视网膜病变患者的生活质量;心理干预合并药物治疗改善了糖尿病视网膜病变患者的心理健康。

AIM： The music relaxation therapy was used for intervention the bad mental emotion of the patients with diabetic retinopathy, and to observe the effects on the quality of life,METHODS： We had collected 80 diabetes patients, who were all type 2 patients with Ⅱ - Ⅲ degree retinal pathological changes, from Dalian Dockyard hospital, Center hospital and Diabetes hospital as objects from April to October 2004. They were randomly divided to 2 groups： mental intervention group and un-intervention group with 40 in each group. The patients in the two groups were matched in the sex, age, education level,visual function classification, body mass, height, body mass index and blood sugar on an empty stomach. The administration treatment method fixed basically was used in the intervention group and the un-intervention group, The music relaxation method was used on the mental intervention,insisting twice a day, 30 minutes every time, and the telephone follow-up was done twice a week, for 28 days a course. We had used Diabetic Quality of Life Specific Scale （DQOL） to evaluate the quality of life of diabetic patients, Visual Quality of Life （VQOL） to evaluate the quality of life of patients with visual function lesion, and Symptom Check list （SCL-90） to evaluate the mental health condition. The time of examination was at the moment of hospitalization and the time of the end of treatment. Using t-test and χ^2 test we compared the mental condition after treatment with that before treatment, and the difference value of each index in the two groups before and after treatment was compared. The correlation of visual function and diabetic qualify of life was detected by Spearman correlative analysis,in the multi-element gradual regression analysis the difference value of total mark of SCL before and after treatment as the dependent variable,and the sex, age, height, body mass, body mass index, intervention or not,visual function classification, educational degree, blood sugar value, the every factor score of diabetic special scale and the every factor score of visual function scale as the independent variableRESULTS： All 80 patients joined in voluntarily and had accomplished seriously the study without drop. ① The comparison of the mental status in the two groups： Before the treatment, there were no significant different between the intervention and un-intervention group in DSQL, Life quality of visual function （P 〉 0.05）. Compared with norm, the difference was significant in somatization factor, interpersonal sensitivity, anxiety,depression, consternation and the positive score value of the SCL of the 80 patients （P 〈 0.05）. ② The correlation analysis of the quality of life in the ophthalmocace patients with visual functional lesion scale and diabetic specific scale： The score of body function, social function and mental function of the existence quality scale of patients with visual functional lesion and the score of diabetic specific scale were positive correlation （P〈 0.05）： The mental dimension and social function and mental function of the existence quality scale of the patients with visual functional lesion were positive correlation （P 〈 0.05）; The treatment dimension and social function of the existence quality scale of the patients with visual functional lesion were positive correlation （P 〈 0.05）. ③ The correlation of diabetic quality of life specific scale and SCL： The physical dimension of diabetic quality of life specific scale and the compulsion, depression, anxiety and rivalry of SCL were negative correlation （P 〈 0.05）; The physical dimension and the compulsion, depression, anxiety, rivalry, consternation,crankiness and spirit were negative correlation （P 〈 0.05）; The social dimension and compulsion, interpersonal sensitivity, depression and anxiety were negative correlation （P 〈 0.05）. ④ The amelioration degree of multiple stepwise regression analysis and the SCL had positive correlation with psychological intervention, which indicated that psychological intervention could enhance the level of mentality, and improve the quality of life of the patients with visual functional lesion.CONCLUSION： There are serious psychological problems in patients with diabetic retinopathy; The lesion of retina leads to the decrease of visual function, which is the main factor of the decrease of quality of life in the patients with diabetic retinopathy; The psychological intervention can enhance the quality of life of the patients with diabetic retinopathy; The psychological intervention combined with drug treatment ameliorate the psychological health of the patients with diabetic retinopathy.