认知行为疗法对功能性便秘患者临床症状的影响

Effect of psychological behavior intervention on patients with functional constipation

目的探讨认知行为疗法对功能性便秘（FC）患者心理状态和临床症状的影响。方法对符合罗马ⅢFC诊断标准的78例患者随机分为两组，对照组（38例）给予促胃肠动力药物治疗，试验组（40例）在药物治疗的基础上给予认知行为疗法。两组疗程均为4周。于入组时、4周末采用焦虑自评量表（SAS）、抑郁自评量表（SDS）对两组患者进行心理状态评定并比较临床症状改善情况和不良反应。结果4周末试验组SAS和SDS评分比入组时均显著降低[分别为（36．25±8．61）分1：L（42．97±9．25）分，P〈0．01；（38．81±6．53）分比（43．36±7．18）分，P〈0．01]。治疗后试验组与对照组SAS和SDS评分分别为（36．25±8．61）分和（41．31±6．09）分，P〈0．01；（38．81±6．53）分和（42．33±7．64）分，P〈0．05。试验组患者的有效率为97．50％（39／40），对照组患者的有效率为84．21％（32／38），两组比较差异有统计学意义（P〈0．05）。对照组的腹痛、腹泻及停药后复发分别为23．68％、15．79％、89．47％；试验组分别为5．00％、2．50％、5．00％，两组比较差异有统计学意义（P〈0．05）。结论认知行为疗法有助于改善FC患者的心理状态，缓解便秘症状，减少不良反应的发生，优于单纯服用促胃肠动力药物治疗。

Objective To investigate the effect of the psychological behavior intervention on the mental status and clinical symptom of patients with functional constipation. Methods All of 78 patients with functional constipation diagnosed by Rome HI diagnostic code were randomly divided into study group （n = 40） and control group （n = 38）. The psychological behavior intervention was used in the study group, the caccagogue and symptomatic treatment was used in the control group. The self-rating anxiety scale （SAS）, self-rating depressive scale （SDS） was analyzed and the improving of clinical symptom, adverse effect was compared before and after 4 weeks of treatment respectively. Results The scores of SAS and SDS in the study group significandy decreased after treatment[ （36.25 ± 8.61 ）scores vs （42.97 ± 9.25）scores,P〈 0.01 ; （38.81 ± 6.53 ）scores vs （43.36± 7.18 ）scores, P 〈 0.01 ].There was significant difference between the two groups after treatment （P 〈 0.05）.The effective rate of study group was higher than that of control group （97.50% vs 84.21%,P 〈 0.05）. The rate of celiodynia, diarrhea and the recrudescence after the course of treatment in control group was 23.68%, 15.79% and 89.47% respectively, while this numerus in study group was 5.00%,2.50% and 5.00%. Conclusions Psychological behavior intervention plays an important role in the treatment of functional constipation. It can improve the mental status, clinical symptom, and decrease the adverse effect.