脑卒中患者总体幸福感影响因素分析及心理干预疗效的1年随访

One-year follow-up study of affecting factors and psychological intervention of general well-being feeling in stroke patients

目的:探讨应用心理干预后脑卒中患者总体幸福感评分的变化情况及其影响因素。方法:本调查于1997-09/2000-12完成。选择在聊城市第四人民医院神经科、菏泽市第三人民医院神经科、济南市第一人民医院神经科及齐鲁医院神经科就诊的脑卒中患者206例,均自愿参加调查。根据随机原则 1:1配对分为2组,干预组和对照组各103例。①干预组在病后1个月末开始干预,干预措施采用以心理干预为主,必要时辅以药物干预的原则。20-30min/次,1次／周,连续五六周即结束干预。②对照组不进行干预。采用总体幸福感量表(共有33项,得分越高,幸福度越高。国内测试样本采用本量表前18项平均得分,男性为75分,在女性为71分。本调查仅使用前18项)对两组患者进行总体幸福感评定,评定时间分别在发病后1个月内、第3个月末、第6个月末、1年末,共进行4次,并进行两组患者总体幸福感评分的比较分析。结果:干预组和对照组各103例脑卒中患者,全部进入结果分析,无脱落。①两组患者总体幸福感量表评分比较:干预组患者干预后3次评定总体幸福感量表评分均明显高于对照组[77.7±12．8,80．0±13.2,82．7±14．0; 72.3±14．2,71．9±13．3,71.4±16．1(t=2．86-5.37,P<0．01)],且干预组心理干预后3次评定量表得分均明显高于干预前(68．7±14．5)(t=-7．01-4．71, P<0．01)。②影响脑卒中后患者总体幸福感量表评分的多因素分析:脑卒中后患者的总体幸福感受病情、多种社会心理因素及人口学资料因素的影响。结论:脑卒中后患者的总体幸福感与病情、多种社会心理因素及人口学资料因素有关。积极开展心理干预能有效提高脑卒中后患者的总体幸福感,改善其生活质量。

AIM： To investigate the changes and factors influencing general well-being feeling in patients with stroke after psychological intervention. METHODS： The investigation was conducted between September 1997 and December 2000. 206 patients with stroke, who were treated at Department of Neurology, Liaocheng Municipal Fourth People＇s Hospital, Department of Neurology, Heze Municipal Third People＇s Hospital, Department of Neurology, Jinan Municipal First People＇s Hospital and Department of Neurology, Qilu Hospital, were selected. They all ag＇reed to join the investigation. They were assigned into 2 groups at random with 1 to 1 pairing： intervention group and control group with 103 in each .group. ①The patients in the intervention group were intervened after onset at the end of the first month, mainly using psychological intervention. When needed, the drug was used, once 20-30 minutes, once a week, totally 5 or 6 weeks continuously. ②The patients in the control group were not intervened. General well-being were evaluated with general well-being schedule （GWB） in patients from the two groups （totally 33 items, the higher the score, the higher the well-being was. The domestic test sample used the mean score of former 18 items of this schedule, 75 points in males, and 71 points in females. This investigation only used the former 18 items.）. Time of evaluation was within 1 month, the end of the 3^rd month, the end of the 6^th month and the end of one year after onset, respectively. The comparative analysis of general well-being score in patients from the two groups was performed. RESULTS： 103 stroke patients in the intervention and 103 in the control group were all involved in the result analysis, without drop. ① Comparison of general well-being score in patients of the two groups： Well-being scores of GWB in the patients from intervention group in the 1^st, 2^rd and 3^rd after intervention were all higher significantly than those in the control group [77.7±12.8,80.0±13.2,82.7±14.0;72.3±14.2,71.9±13.3,71.4±16.1（t =2.86-5.37, P〈0.01）], and it was higher in the intervention group after psychological intervention in the 1^st, 2^rd and 3^rd than those before intervention （68.7±14.5） （t=-7.01 to -4.71, P〈0.01）. ② Multiple factor analysis of score of GWB in stroke patients： After stroke the general well-being was affected by patient＇s condition, various social psychic factor and data factor of demography. CONCLUSION： General well-being feeling of stroke patients is related to patient＇s condition, various social psychic factor and data factor of demography. Active psychological intervention can enhance effectively general wellbeing in stroke patients, improve their quality of life.