心理干预对飞秒激光联合准分子激光原位角膜磨镶术治疗近视患者的效果

Effect of the psychological intervention on the physical and mental health of patients with myopia undergoing Femtosecond Laser and Excimer Laser in Situ Keratomil＇eusis

目的了解近视患者的心身健康，为患者的心理护理提供依据，探讨心理干预对近视患者心身健康的影响。方法对141例（251眼）患者在飞秒激光联合准分子激光原位角膜磨镶术（FL—LASIK）手术前的初诊时、手术后的半年复诊时采用康耐尔心身健康问卷（comell medical index，CMI）进行调查，对近视患者术前、术中和术后采取有针对性的心理护理措施，并将调查结果的全项目（A～R项）、心理项目（M～R项）、A—R项18项因子的均分进行比较。结果患者复诊时全项目（A～R项）和心理项目（M—R项）心身症状的发生频度均比初诊时下降，均分比较差异有统计学意义[A～R：（19．82±7．43）比（25．06±10．08），t=4．969，P〈0．01；M—R：（6．32±2．75）比（7．73±2．94），t=4．159，P〈0．01]。患者初诊和复诊时A～R项18项因子中的A项（眼与耳）、G项（神经系统）、L项（习惯）、0项（焦虑）、P项（敏感）比较差异有统计学意义[A：（6．62±6．03）比（2．14±1．86），t=8．430，P〈0．01；G：（0．49±0．50）比（0．29±0．13），t=4．597，P〈0．01；L：（1．21±0．42）比（0．96±0．08），t=6．943，P〈0．01；O：（1．25±1．03）比（0．62±0．70），t=6．007，P〈0．01；P：（1．63±0．92）比（0．59±1．01），t=9．039，P〈0．01]。结论术前初诊时不同患者的心理素质各异，应对手术的一系列心理防御机制不佳。提示要加强初诊、术前、术中、术后及各阶段复诊时的心理护理，给予患者心身健康更多的关注。心理干预对FL—LASIK治疗近视患者的心身健康有一定影响，提高了近视患者的生活质量。

Objective To study the physical and mental health status of patients with myopia so as to provide evidence for psychological care and explore the effect of psychological intervention on the patients with myopia. Methods Totals of 141 patients （251 eyes ）, before diagnosed, six months after surgery, were investigated with Cornell Medical Index （CMI）. Myopic patients received targeted psychological care before, during and after surgery. The findings of all items （A-R items）, psychological items （M -R key items）, A-R 18 items were compared. Results The frequency of psychosomatic symptoms of patients in all items （ A - R items） and psychological items （M-R items） of return visit was significantly lower than that of the first visit [A-R：（19.82±7.43） vs （25.06±10.08）; M-R：（6.32 ±2.75） vs （7.73±2.94）;P〈0. O1].Among A -R 18 items, item A （eyes and ears）, G （nervous system）, L （used to）, O （anxiety）, P （sensitive） of first visit was higher than that of the return visit, and the difference was statistically significant [ A ： （6.62 ± 6.03） vs （2.14±1.86）,G：（0.49±0.50） vs （0.29±0.13）,L：（1.21 ±0.42） vs （0.96±0.08）, 0：（1.25±1.03） vs （0.62±0.70）,P：（1.63±0.92） vs （0.59±1.01）;P〈0.001].Condusions Patients show different preoperative psychological quality in their first visit and have poor psychological defense mechanisms. So, the psychological care should be strengthened in first visit, preoperative, during operative and postoperative period and more attention should be paid to their physical and mental health. Psychological intervention can improve the life quality of myopia patients with FL - LASIK treatment.