血管性痴呆患者实施需要引导行为妥协模式为理论框架的行为干预

Implement of behavioral intervention taking need-driven dementia-compromised behavior pattern as theory frame in patients with vascular dementia

目的:探讨改善血管性痴呆患者生活质量的有效行为干预模式。方法:选择2003-03/2005-11泰山医学院附属医院神经内科,泰安市中医院和深圳市人民医院老年病科住院的76例血管性痴呆患者,随机分为研究组36例和对照组40例,两组患者均使用常规治疗护理措施,并进行健康教育。对研究组增加以需要引导痴呆行为妥协模式为指导的个体化行为干预:针对患者不同的兴趣爱好和疾病的严重程度,调整适合患者技能水平及兴趣的娱乐性活动,用塑造、惩罚、激励及榜样等措施来矫正血管性痴患者的各种不良行为,依患者痴呆程度差异而进行不同程度的个别护理,使患者全身心参与,体验正向情感,减少负向情感。2次/d,连续4周,20min/次。干预3个月和6个月后,采用简易智力状态量表、日常生活能力量表、长谷川痴呆患者量表进行测评,并将测评结果加以比较。结果:纳入患者76例,均进入结果分析。①在个体化行为干预前两组简易智力状态量表量表、日常生活能力量表、长谷川痴呆患者量表评分相比,差异无显著性(P>0.05)。②实施干预3月后,对照组与研究组患者简易智力状态量表评分、长谷川痴呆患者量表评分相比差异有显著性(20.82±3.36,23.78±3.71,t=3.6501,P<0.05;21.48±2.82,23.37±3.80,t=2.4782,P<0.05),日常生活能力量表评分差异无显著性(35.76±8.20,36.02±8.12,t=0.1387,P>0.05)。③实施干预6月后,对照组与研究组患者简易智力状态量表、日常生活能力量表、长谷川痴呆患者量表评分相比差异均有显著性(21.26±3.52,24.02±4.11;35.85±8.14,40.28±6.45;21.55±3.19,23.45±4.12,P均<0.05)。结论:需要引导痴呆行为妥协模式为指导的个体化行为干预能有效改善血管性痴呆患者认知功能,提高生活质量。

AIM： To explore the effective behavioral interventional pattern for improving the quality of life （QOL） in patients with vascular dementia. METHODS： Seventy-six patients with vascular dementia, who were hospitalized in the Department of Neurology, Affiliated Hospital of Taishan Medical College, Taian Hospital of Traditional Chinese Medicine, Department of Gerontology, Shenzhen People＇s Hospital between March 2003 and November 2005, were randomly divided into study group （n=36） and control group （n=40）. Patients in beth groups were given conventional nursing and health education, besides, those in the study group patients received individualized behavioral intervention guided by need-driven dementia-compromised behavior （NDB） pattern： According to the different interests and severity of disease in the patients, the recreational activities fit for the skill level and interests of the patients were adjusted, and their various adverse behaviors of the patients with vascular dementia were corrected through the measures of modeling, punishment, encouragement and example, individual nursing care was given according to the different severity of dementia, so as to make the patients fully participate in the activities for experiencing positive emotion and reducing negative one; 20 minutes for each time, twice a day for 4 continuous weeks. At 3 and 6 months after intervention, the patients were measured with mini-mental state examination （MMSE）, activity of daily scale （ADL） and Hasegawa dementia scale （HDS）, and the results were compared. RESULTS： All the 76 patients were involved in the analysis of results. ① The scores of MMSE, ADL and HDS had no significant differences before the individualized behavioral intervention between the two groups （P 〉 0.05） ② At 3 months after intervention, there were significant differences in the scores of MMSE and HDS between the control group and study group （20.82±3.36, 23.78±3.71, t=3.650 1, P 〈 0.05; 21.48±2.82, 23.37±3.80, t=2.478 2, P 〈 0.05）, but the score of ADL had no significant difference （35.76±8.20, 36.02±8.12, t=0.138 7, P 〉 0.05）.③ At 6 months after intervention, there were significant differences in the scores of MMSE, ADL and HDS between the control group and study group （21.26±3.52, 24.02±4.11; 35.85±8.14, 40.28±6.45; 21.55±3.19, 23.45±4.12, P 〈 0.05）. CONCLUSION： Individualized behavioral intervention guided by NDB pattern can effectively improve the cognitive function and QOL of patients with vascular dementia.