团体认知行为疗法对直肠癌永久性结肠造口患者心理及自我管理效能感的影响

Impact of group cognitive behavioral therapy on the psychology and self management efficacy of colorectal cancer patients with permanent colon stoma

目的探讨对直肠癌永久性结肠造口患者进行团体认知行为疗法后对患者的心理及自我管理效能感的影响。方法选取2015年1月-2016年1月行Miles手术的低位直肠癌患者80例,按照随机分组的方法分为干预组和对照组,各40例,对照组给予常规的护理方法,干预组在对照组基础上实施团体认知行为（GCBT）干预护理,比较两组患者经不同护理后的治疗依从性、心理状态以及自我管理效能。结果两组患者护理前,SAS、SDS评分比较,差异无统计学意义（P〉0.05）;两组患者护理后的评分低于护理前,且干预组患者SAS评分为（34.52±4.16）分,SDS评分为（31.01±4.51）分,而对照组SAS评分为（48.12±5.01）分,SDS评分为（46.12±5.15）分,两组比较,差异有统计学意义（P〈0.05）;两组患者在护理干预前的各项造口相关效能感量表评分比较,无明显差异,护理后各项评分均有提高,干预组患者的造口照顾效能评分为（58.24±3.34）分,社交能力评分为（38.25±2.63）分,饮食选择评分为（4.52±0.75）分,生活信心评分为（11.56±1.11）分,总评分为（113.6±7.59）分,而对照组患者的造口照顾效能评分为（54.44±3.18）分,社交能力评分为（31.05±2.53）分,饮食选择评分为（3.56±0.72）分,生活信心评分为（9.56±1.02）分,总评分为（97.3±7.26）分,两组比较,差异有统计学意义（P〈0.05）。结论 GCBT疗法能显著提高永久性结肠造口患者的自我管理效能,改善患者焦虑、抑郁的心理,值得临床护理推广应用。

Objective To explore the impact of group cognitive behavioral therapy on the psychology and self management efficacy of colorectal cancer patients with permanent colon stoma.Methods 80 patients with low rectal cancer who conducted Miles operation from January 2015 to January 2016 were randomly divided into intervention group and control group,each group was 40 cases.Patients in control group were given routine nursing method,and patients in intervention group were given group cognitive behavioral（GCBT） intervention nursing on the basis of control group.Treatment compliance,mentality and self management efficacy in two groups were compared after different nursing.Results Before nursing, the SAS and SDS score in two groups had no obvious difference（P 0.05）;After nursing,the score decreased compared with before nursing,and the SAS and SDS score were respectively（34.52±4.16） and（31.01±4.5） in intervention group,better than that were respectively（48.12±5.01） and（46.12±5.15） in control group,and the difference was statistical significance（P〈0.05）;Before nursing intervention,various stoma related efficacy scale between two groups had no obvious difference;After different nursing,all score increased and the stoma related efficacy scale,social competence score,diet selection score,life confidence score and total score of this group in intervention group were respectively（58.24 ±3.34）,（38.25±2.63）,（4.52±0.75）,（11.56±1.11） and（113.6±7.59）,which were respectively（54.44±3.18）,（31.05±2.53）,（3.56±0.72）,（9.56±1.02） and（97.3±7.26） in control group,the data between two groups had obvious difference,and the difference was statistical significance（P〈0.05）.Conclusion GCBT therapy can effective enhance the self management efficacy of colorectal cancer patients with permanent colon stoma,improve the anxiety and depression of patients,it is worth to popularize and using in clinical nurse.