理性情绪疗法对维持性血液透析患者睡眠质量的影响

Effect of rational-emotive therapy on sleep quality in maintenance hemodialysis patients

目的探讨理性情绪疗法对维持性血液透析(maintenance hemodialysis,MHD)患者睡眠质量的改善作用。方法以32例MHD患者为研究对象,疗程1年。应用理性情绪疗法干预患者,记录患者一般临床资料、常规血生化指标和各种遵医行为;采用匹茨堡睡眠质量指数量表(PSQI)评定MHD患者睡眠质量。比较心理干预前后患者睡眠状况变化并分析其影响因素。结果与心理干预前比较,MHD患者PSQI总分显著下降,(8.04±6.11)分vs(9.53±5.06)分(P<0.05);主观睡眠质量、睡眠持续性、睡眠紊乱和白天功能紊乱明显改善。随干预时间延长,患者遵医行为明显改善,透析后血清钙(Ca2+)水平逐渐升高,血清钾(K+)、磷(PO34-)、超滤量和体质量增长与干体质量比值(IWGR%)稳定下降,血压逐渐改善,血红蛋白上升(P<0.05)。睡眠质量因子得分与血清Ca2+和血红蛋白负相关,与血清K+、PO34-、超滤量、IWGR(%)和收缩压正相关(P<0.01)。结论理性情绪疗法能够明显改善MHD患者的睡眠质量,其改善作用可能与患者治疗依从性增加有关。

Objective To explore the effect of rational-emotive therapy on sleep quality in maintenance hemodialysis（MHD） patients.Methods Thirty-two MHD patients were applied by rational-emotive therapy for one year.Clinical data and serum parameters and therapy compliance were recorded;and the sleep quality was evaluated by Pittsburgh Sleep Quality Index（PSQI） during the observation period.The changes of sleep state and influencing factors were assessed before and after the mental intervention.Results After the mental intervention,the PSQI score of MHD patients decreased obviously,（8.04±6.11） marks vs（9.53±5.06） marks（P0.05）,and the subjective sleep quality,sleep continuity,sleep disorder and day sleep disorder increased significantly（P0.05）.As time extended,the therapy compliance improved significantly,the level of serum calcium and hemoglobin improved obviously,kalium,phosphor,and ultrafiltration quantity as well as the rate of interdialytic weight gain to dry weight（IWGR%） decreased significantly（P0.05）.PSQI score was positively correlated with kalium,phosphor,ultrafiltration quantity,IWGR%,but negatively correlated with serum calcium and hemoglobin（P0.01）.Conclusion The rational-emotive therapy can obviously improve the sleep quality of MHD patients.Therapy compliance improvement may be the possible mechanism.