肝移植受者等待供肝期间认知行为干预及效果评价

Mode and effect of cognitive-behavioral therapy for liver transplant recipients waiting for a liver transplant

背景:随着肝移植技术的不断发展和完善,等待供肝期和肝移植后的患者也不断增多,由于其对手术的恐惧和对移植后康复的担心等原因,其身心处于应激状态,大多存在着各种精神心理障碍,影响着患者的康复。目前对于肝移植患者心理问题的研究多集中在肝移植后,而对于等待供肝期患者的心理状态没有得到足够的评估和干预。目的:探讨适合肝移植受者等待供肝期间认知行为的干预模式,评价其改善患者身心状态的效果。方法:将12例进行移植前评估的肝移植受者随机分为实验组和对照组各6例,对照组接受常规治疗和护理,实验组除接受常规治疗和护理外还接受认知行为干预。在两组患者入院时、入院1周和3周时分别采用Zung焦虑自评量表进行评定,并测量两组生命体征的变化。结果与结论:入院1周和3周时实验组Zung焦虑自评量表得分低于对照组,随干预时间的延长,Zung焦虑自评量表得分逐渐降低;入院3周时实验组收缩压低于对照组,但两组舒张压比较和组内不同时间点比较差异无显著性意义;入院1周和3周时实验组心率值低于对照组;入院3周时实验组呼吸频率低于同期对照组。结果可见认知行为干预可降低肝移植受者等待供肝期间的焦虑恐惧程度,保持生命体征平稳,具有较好的可行性和有效性。

BACKGROUND：With the development and improvement of liver transplantation technology, patients waiting for or undergoing liver transplantation have continued to increase in number. Due to their fears and concerns about post-transplantation rehabilitation, patients are under physical and mental stress, most of whom are shown to have a variety of mental disorders that affect rehabilitation. At present, mental problems of liver transplant patients are more concentrated in post-transplantation research, while patients waiting for liver transplantation do not get enough mental assessment and intervention. OBJECTIVE：To investigate the suitable mode of cognitive-behavioral therapy for liver transplant recipients waiting for donor liver and to evaluate the effect to improve patient’s physical and mental state. METHODS：Twelve liver transplant patients who underwent pre-transplantation assessment were randomly divided into experimental group and control group, each group with six cases. The control group received conventional treatment. The experimental group received cognitive-behavioral therapy in addition to conventional treatment. Self-rating anxiety scale （SAS） and vital signs were measured in the two groups on admission, 1 week and 3 weeks after admission. RESULTS AND CONCLUSION：The SAS score of the experimental group was lower than that of the control group at 1 and 3 weeks after admission, and SAS score decreased as the intervention extended. The systolic blood pressure of the experimental group was lower than that of the control group at 3 weeks after admission, but there was no significant difference in diastolic blood pressure between two groups. The heart rate of the experimental group was lower than that of the control group at 1 and 3 weeks after admission. The respiratory rate of the experimental group was lower than that of the control group at 3 weeks after admission.Cognitive-behavioral therapy can reduce the level of anxiety and keep vital signs stable with good feasibility and effectiveness in patients waiting for liver transplantation.