支气管哮喘患者健康教育指导下规范治疗前后抑郁情绪、哮喘控制及生存质量的调查

The relationship of depression status with asthma control and quality of life in asthma patients before and after standard treatment and health care education

目的对支气管哮喘(简称哮喘)患者按全球哮喘防治创议(GINA)进行健康教育指导下的规范治疗,对治疗前后的抑郁情绪发生情况、哮喘控制测试(ACT)评分及生存质量进行调查分析。方法对入选调查的59例门诊哮喘患者要求同时填写CES-D量表、ACT量表和生存质量量表,在健康教育指导下规范治疗后复诊并再次填写上述量表,对前后两次所得量表的数据以CES-D评分按有否抑郁情绪排序进行统计学处理。结果(1)有抑郁情绪的哮喘患者规范治疗前占40.7%(24/59),经规范治疗后降低为13.6%(8/59),配对χ2检验显示差异有统计学意义(P=0.00)。(2)有无抑郁情绪两组组间比较可见,规范治疗前生存质量及其5个构成因素中,除活动受限和对自身健康的关心外的3个因素差异均有统计学意义(P<0.05),规范治疗后生存质量及其5个构成因素中除活动受限和心理因素外的3个因素差异均有统计学意义(P<0.05)。ACT评分规范治疗前组间比较未见明显差异(P>0.05),规范治疗后组间比较差异有统计学意义(P<0.05)。(3)相关分析显示,规范治疗前哮喘患者的抑郁情绪与生存质量及构成生存质量5因素中的哮喘症状、心理状况和对刺激原的反应呈明显的负相关(P<0.05),与ACT评分及构成生存质量其他2个因素则未见明显相关(P>0.05),规范治疗后生存质量及其5个构成因素中除活动受限和心理因素外的3个因素皆呈显著差异(P<0.05),且与ACT评分也呈明显的负相关(P<0.05)。结论哮喘症状和对刺激原的反应是影响哮喘人群抑郁情绪最具共性的因素,心理因素和对自身健康的关心也影响哮喘人群抑郁情绪值得引起重视;健康教育对哮喘患者配合规范治疗、控制症状和减轻抑郁情绪至关重要。

Objective To investigate the depression status, asthma control level and quality of life in asthma patients before and after health care education according to Global Initiative for Asthma guidelines. Methods 59 enrolled outpatients with asthma were asked to self-administer the center for epidemiologic studies- depression （CES-D） scale, asthma controll test （ACT） scale and the quality of life （QOL） questionnaire, respectively. All the patients were educated and treated by health care professionals under the guidance of GINA 2004.After average of 2.5 months ± 15 days, the patients were asked to self-administer all the scales and questionnaire once again on return visit. The data was collected and analyzed statistically based on whether or not the patient bad depression according to the CES-D score. The data before and after education was compared statistically. Results A. 40.7% （24/59） of the patients bad depression emotion before guided treatment, and after that the percentage significantly decreased to 13.6% （8/59） （P 〈 0.05）. B. Compared the depressive group to non-depressive group, there were significant differences in 3 of 5 domains in QOL excluding limitation of activity and self concern about health （ P 〈 0.05） before guided treatment.There was no significant difference in ACT score before guided treatment, while vise versa after that （ P 〈 0.05）. C. Before guided treatment the depression status was inversely correlated with 3 in 5 domains of QOL （ symptoms of asthma, psychologic status and response to irritant） ,as well as QOL as a whole （ P 〈 0.05）, but not with the other two domains of QOL scale and ACT score. After guided treatment, the depression status had inverse correlation with QOL and 3 in 5 domains of QOL scale （ excluding limitation of activity and psychologic status） （ P 〈 0.05） as well as ACT score （ P 〈 0.05）. Conclusions The symptoms of asthma and response to irritants are common factors that influence the depressive emotion in asthma population. Psychologic status and self concern about health are both important factors which should not be overlooked. Health care education is beneficial to asthma patients in therapy adherence and relief of depression emotion.