饮食指导联合心理干预对治疗肠易激综合征作用的研究

Diet guidance combined psychological intervention on patients of irritable bowel syndrome

目的探讨肠易激综合征(IBS)伴抑郁症状患者通过饮食指导联合心理干预治疗能否更好地改善IBS相关症状。方法将临床诊断为IBS患者采用症状自评量表(SCL-90)总分超过160分,或任一因子分超过2分;抑郁自评量表SDS标准分≥50;焦虑自评量表SAS标准分≥53为伴抑郁症状的患者213例,采用随机数字表取样本106例,随机分成药物抗抑郁治疗组35例(对照组)、心理干预组(药物抗抑郁治疗基础上加心理干预)35例和联合饮食组(心理干预组治疗基础上加饮食指导)36例,疗程6周。治疗期间记录症状改善情况及心理症状自评量表(SCL-90)、抑郁自评量表评分以及焦虑自评量表,并追踪其疗效。结果联合饮食组在治疗第4周末和第6周末的总有效率分别为75.00%和94.44%,均明显高于对照组的48.57%和62.86%。与心理干预组相比,联合饮食组的总有效率也较高,从心身健康的改善来看,联合饮食组和心理干预组随着治疗时间的延长、压力的减轻以及饮食的调整,抑郁情绪明显缓解,患者的躯体化、人际关系、抑郁、焦虑和临床症状评分等变化显著,与对照组相比有显著性差异(P<0.01,P<0.05),结束治疗后第12周随访,联合饮食组的复发率仅有5.56%。结论饮食指导联合心理干预对治疗肠易激综合征起着协同作用,可有效提高IBS伴抑郁症状患者治疗效果并减少复发。

Objective To research the effects of diet guidance and psychological intervention on patients of irritable bowel syndrome （IBS） complicated with depression. Methods The patients with IBS were assessed with SCL-90 Scores. Among them, 213 patients were selected as their total scores reached 160 or single factor score reached 2, sel-fassessment of depression scores （SDS） I〉50 and self-assessment of anxiety scores （SAS） t〉53. The patients were diagnosed as compression. A random number table was used to select samples （ 106 cases） , which were randomized into medication on compression group with 35 cases （control group） and psychological intervention group with 35 cases （medication ＋ psychological intervention） and combination treatment group with 36 cases （medication ＋ psychological intervention ＋ diet guidance） with a period of 6 weeks. The symptom improvement, SCL-90 scores, SAS scores and SDS scores were recorded during treatment and the efficacy was followed up. Results At the end of 4th and 6th weeks, the general effective rates in combination treatment group were 75.00% and 94.44% respectively against 48.57% and 62.86% in control group, which was also better than those of psychological intervention group. As for mental health improvement, with time passed; depression and diet behavior were significantly improved in combination treatment group and the patients＇ physical changes, inter-personal relations, depression, anxiety, clinical symptom scores were much better than those of medication on control group （ P 〈 0.01, P 〈 0.05 ）. Follow-up after treatment in the 12th week, the recurrence rate in combination group was only 5.56%. Conclusion Diet guidance combined psychological intervention are effective in improving the efficacy in treating IBS complicated with depression and reduce the recurrence.