难治性肠易激综合征的认知治疗

Cognitive therapy for patients with refractory irritable bowel syndrome

目的 探讨肠易激综合征 (IBS)认知治疗的程序、实施策略及其对IBS患者症状和生活质量的影响。方法 采用自身对照研究 ,2 2例符合罗马Ⅱ标准的难治性IBS患者参与认知治疗 ,疗程2～ 3个月。通过比较治疗前后患者症状、生活质量等变化以评价疗效。结果 2 2例完成第一随访单元的患者中 ,81 8%的患者症状显著改善 (P <0 0 1) ;随访 12个月时 ,72 7% (8/ 11)的患者症状完全缓解 ;第一随访单元结束时与治疗前比较 ,患者症状性焦虑各项积分以及症状严重程度指数和频率指数均显著降低 (P =0 0 0 0 ) ;生活质量明显改善 (P <0 0 5 ) ;精神症状积分如抑郁和焦虑显著降低 (P <0 0 0 1) ,积极应对积分明显提高 (P =0 0 0 0 )。结论 遵循一定治疗程序和个体化原则的认知治疗 ,对治疗难治性IBS具有针对性 ,且疗效显著。

Objective To investigate the procedure and tactics used in the cognitive therapy for patients with irritable bowel syndrome (IBS) ,and to evaluate the efficacy of cognitive therapy in the treatment of refractory IBS. Methods A self control study on the cognitive therapy for 22 patients with refractory IBS symptoms (according to Rome Ⅱ criteria) was performed. The procedure of cognitive therapy included five steps, namely health education, patients′ questioning, relaxing training, dissensitization training, and patients′ homework for enforcing the effect of former four steps. The effects of cognitive therapy for IBS were evaluated by improvement of symptom related anxiety, index of symptom, quality of life specific for IBS and coping. Results All 22 cases completed cognitive therapy and first follow up unit(FFU), at the end of FFU, clinical symptoms in all patients improved ( P <0.05), of them, 81.8% improved significantly ( P <0.001); at 12 months follow up, complete remission of clinical symptoms occurred in 72.7%(8/11) patients. Comparison of the scores of symptom related anxiety, index of symptom, quality of life specific IBS and coping at the end of 1st follow up unit with that at basal level, the scores of symptom anxiety ,indexes of severity and frequency of symptoms decreased significantly ( P <0.001,respectively); the scores of depresion and anxiety in SCL 90 also decreased significantly ( P <0.001). The scores of active coping rose significantly( P =0.000) .IBS QOL improved significantly ( P <0.05), of them, dysphoria, body image, food avoidence improved very significantly ( P <0.001, respectively).Conclusions Cognitive therapy for patients with refractory IBS is rational and effective. During cognitive therapy, we should follow the therapeutic procedure and the principle of individuation.