正念行为训练对脑梗死后肩手综合征患者疾病不确定感和应对方式的影响

Effects of mindfulness behavior training on coping style and illness uncertainty in patients of shoulder hand syndrome after ischemic stroke

目的研究正念行为训练对脑梗死后肩手综合征患者疾病不确定感和应对方式的影响。方法65例脑梗死后肩手综合征患者按照随机数字表法分为对照组（n=32）和实验组（n=33），对照组给予手法康复，实验组在此基础上给予正念行为训练。治疗前后采用巴式指数（BI）、疾病不确定感量表（IUS）、医学应对方式量表（MCSQ）和正念注意觉知量表（MAAS）评测两组患者自理能力、应对方式、疾病不确定感和正念水平。结果治疗前，两组患者Barthel、MCSQ、IUS及MAAS评分差异无统计学意义（P〉0．05）；治疗后，实验组Barthel评分[（72．4±11．6）分]显著高于对照组[（62．9±10．1）分]、IUS评分变化[（69．3±9．3）分]优于对照组[（86．9±7．2）分]；MCSQ及MAAS各维度评分高于对照组，差异有统计学意义（P〈0．05）。治疗后，对照组Barthel评分〉60分17例，实验组Barthel评分〉60分26例，两组比较差异有统计学意义（χ2=6．415，P〈0．05）。结论正念行为训练可减轻脑梗死后肩手综合征患者疾病不确定感，促使采取积极的应对方式、促进功能康复。

Objective To study the effects of mindfulness behavior training on coping style and illness uncertainty in patients of shoulder hand syndrome （ SHS ） after ischemic stroke. Methods 65 cases with SHS were randomly divided into two groups by digit method： the control group （ n= 32） and experimental group （ n= 33 ）. Patients in control group only received routine rehabilitation, while patients in experimental group also received mindfulness behavior training. The daily life, medical coping style, illness uncertainty and mindfulness were evaluated respectively by Barthel Index （ BI ） , Medical Coping Style Questionnaire （ MCMQ ）, Illness Uncertainty Scale （IUS） and Mindful Attention Awareness Scale （MAAS）. Results Before training, there were no significant difference in BI,MCMQ,IUS and MAAS （P〉0.05）.After treatment, scores in BI improved significantly in the ex- perimental group than that in the control group（ 72.4±11.6 vs 62.9± 10.1 ）, scores in IUS improved significantly in the experimental group than that in the control group（ 69.3±9.3 vs 86.9±7.2） and scores in MCMQ and MAAS improved significantly in the experimental group than that in the control group（P〈0.05 ）.26 cases whose Barthel index was more than 60 points in experimental group after treatment were found while 17 cases whose Barthel index was more than 60 points in control group were done after treatment （ χ2 = 6.415, P〈0.05）. Conclusion Mindfulness behavior train- ing can regulate the patient coping style and weaken illness uncertainty, and improve functions rehabilitation.