重复经颅磁刺激及怜悯护理辅导对精神分裂症自我怜悯能力影响

Effects of repetitive transcranial magnetic stimulation and compassion nursing counseling on self-compassion ability of schizophrenic inpatients

目的重复经颅磁刺激(repetitive transcranial magnetic stimulation,rTMS)是精神病患者的非药物治疗手段之一,团体怜悯护理辅导近年来也逐渐应用于精神病患者护理,rTMS结合怜悯护理辅导在精神疾病的应用鲜见报道。本研究探讨rTMS结合怜悯护理辅导对精神分裂症患者自我怜悯能力的影响。方法选取2017-01-06-2017-12-30梅州市第三人民医院精神科住院的80例精神分裂症患者为研究对象,根据护理方式的不同分为研究组与对照组,各40例。研究组完成36例,在药物治疗和临床护理的基础上,给予rTMS治疗和rTMS常规护理,并进行团体怜悯护理辅导;对照组完成37例,实施单纯药物治疗和临床护理。干预前和干预6周末分别评定中文修订版自我怜悯量表(Chinese version of revised self-compassion scale,SCS-C)以及阳性和阴性症状量表(positive and negative symptom scales,PANSS),采用双因素重复测量的方差分析进行组间比较和干预前后比较。结果干预前,SCS-C自我评判、自我友善、孤立感、普遍人性感、过度沉溺、正念因子分和自我怜悯总分,两组之间比较差异无统计学意义,均P>0.05。干预6周后,研究组SCS-C总分为(86.9±12.8)分,高于干预前的(77.8±12.1)分,F=9.06,P=0.003;也高于对照组的(79.2±11.9)分,F=7.08,P=0.010。研究组SCS-C的自我评判、自我友善和普遍人性感3个因子分高于干预前,也高于对照组,差异均有统计学意义,均P<0.05。干预前,PANSS总分、阳性症状因子分和阴性症状因子分,两组间比较差异无统计学意义,均P>0.05。干预6周后,研究组PANSS总分为(26.7±11.3)分,低于干预前的(57.6±13.5)分,F=22.33,P<0.001;也低于对照组的(34.3±10.6)分,F=8.76,P=0.004。研究组阳性症状因子分为(8.6±2.6)分,低于干预前的(18.4±4.1)分,F=26.29,P<0.001;也低于对照组的(10.4±2.3)分,F=21.13,P<0.001。研究组阴性症状因子分为(9.1±2.8)分,低于干预前的(19.4±4.3)分,F=26.11,P<0.001;也低于对照组的(11.4±2.9)分,F=18.71,P<0.001。结论 rTMS结合团体怜悯护理辅导,能显著改善精神分裂症患者的病情,有效提高患者的自我怜悯水平。

OBJECTIVE Repetitive transcranial magnetic stimulation(rTMS)is one of the non-drug therapy methods for psychiatric patients.Group compassion nursing counseling has been gradually applied to psychiatric nursing in recent years.There is no special report on the application of rTMS combined with compassion nursing counseling in psychiatric department.The purpose of this study is to investigate the effect of rTMS combined with compassion care on selfcompassion ability of schizophrenic patients.METHODS From January 6to December 30 in 2017,80 schizophrenic inpatients were divided into the study group and the control group according to the different nursing methods.On the basis of drug therapy and clinical nursing,36 patients in the study group were given rTMS treatment and rTMS routine nursing care,and compassion group nursing counseling.In the control group,37 cases were treated with simple medicine and clinical nursing.The Chinese version of revised self-compassion scale(SCS-C)and the positive and negative symptom scales(PANSS)were evaluated before and after 6weeks of intervention.Then,the data were compared between the two groups before and after intervention.RESULTS Before intervention,there was no significant difference between the two groups in self-judgment of self-compassion,self-friendliness,isolation,general human nature,over-indulgence,mindfulness factor scores and total score of self-compassion(all P>0.05).After 6weeks of intervention,the total score of SCS-C in the study group was higher than that before the intervention(86.9±12.8 vs 77.8±12.1,F=9.06,P=0.003).It was also higher than that in the control group(86.9±12.8 vs 79.2±11.9,F=7.08,P=0.010).The scores of three factors such as self-evaluation,self-friendliness and general human nature of SCS-C were significantly higher in the study group than those before the intervention,and were higher than those in the control group(all P<0.05).There was no significant difference in PANSS total score,positive symptom factor score and negative symptom factor score between the two groups before intervention(all P>0.05).After 6 weeks of intervention,the total score of PANSS in the study group was(26.7±11.3)score,lower than that before the intervention[(57.6±13.5)score,F=22.33,P<0.001]and lower than that in the control group[(34.3±10.6)score,F=8.76,P=0.004].The scores of positive symptom factor in the study group after 6weeks of intervention was(8.6±2.6)score,lower than that before the intervention[(18.4±4.1)score,F=26.29,P<0.001]and that in the control group[(10.4±2.3)score,F=21.13,P<0.001].The scores of negative symptom factor in the study group after 6weeks of intervention was(9.1±2.8)score,lower than that before the intervention[(19.4±4.3)score,F=26.11,P<0.001]and that in the control group[(11.4±2.9)score,F=18.71,P<0.001].CONCLUSION rTMS combined with self-compassion nursing can significantly improve the condition of schizophrenic inpatients and improve their self-compassion level.