正念认知疗法在抑郁症患者日常护理中的应用

Application of mindfulness-based cognitive therapy on daily nursing in depression patients

目的探讨正念认知疗法在抑郁症患者日常护理中的应用价值。方法将2013年8月-2015年8月在四川大学华西医院接受治疗的90例抑郁症患者按照随机数表法分为观察组及对照组，各45例。，对照组患者接受常规护理，观察组患者接受常规护理联合正念认知疗法干预，均持续8周。采用抑郁自评量表（SDS）、汉密尔顿抑郁量表（HAMD）评价患者的抑郁情绪，心境状态量表（POMS）评价患者的整体心境，总体幸福感量表（GWB）评价患者的主观幸福感受，采用免疫荧光法测定血清下丘脑-肾上腺-垂体轴激素含量，采用健康状况问卷（SF-36）评价患者的生活质量。结果治疗后8周，观察组患者SDS[（42．81±5．09）分]、HAMD[（15．42±1．93）分]、POMS中消极心境[（61．28±6．84）分]评分低于对照组[（54．72±5．89）、（24．17±3．02）、（73．56±8．12）分]，POMS中积极心境[（29．37±3．41）分]、GWB[（112．84±15．76）分]评分高于对照组[（21．05±2．46）、（85．92±9．14）分]，差异有统计学意义（P〈0．05）。观察组患者血清促肾上腺皮质激素释放激素[（17．68±1．95）pg/mL]、促肾上腺皮质激素[（38．94±4．71）pg／mL]、皮质酮[（157．28±19．72）pg／mL]、皮质醇[（74．82±8．11）pg／mL]含量低于对照组[（20．91±2．64）、（51．46±5．97）、（213．63±24．95）、（115．73±14．92）pg／mL]，差异有统计学意义（P〈0．05）。观察组患者生活质量评分中生理功能[（68．39±7．12）分]、社会功能[（70．38±8．25）分]、生理职能[（67．28±7．11）分]、躯体疼痛[（67．19±7．05）分]、精神健康[（75．38±8．13）分]、情感职能[（73．28±8．15）分]、活力[（68．84±7．01）分]、总体健康[（75．36±8．52）分]评分高于对照组[（54．93±6．02）、（61．16±6．95）、（58．53±6．09）、（60．26±6．85）、（64．79±7．15）、（65．42±7．09）、（57．93±6．24）、（64．73±7．02）分]，差异有统计学意义（P〈0．05）。结论正念认知疗法在治疗抑郁症方面效果确切，可优化患者情绪状态及生活质量，平衡下丘脑-肾上腺-垂体轴激素分泌。

Objective To study the application value of mindfulness-based cognitive therapy on daily nursing in de- pression patients. Methods 90 patients with depression in West China Hospital of Sichuan University during August 2013 to August 2015 were divided into observation group （n=45） and control group （n=45） according tn the random number table method. The patients in control group were treated with routine nursing care and those in observation group received mindfulness-based cognitive therapy plus routine nursing care, both lasted for eight weeks. Two group patients depression mood was assayed by self rating depression scale （SDS）, Hamilton depression scale （HAMD）, profile of mood states （POMS）; subjective well being was tested according to general well-being seale （GWB）; serum hypotha- lamic pituitary axis hormones were detected by i mmunofluoreseence; quality of life was assessed by short form 36 health survey questionnaire （SF-36）. Results After treatment of eight weeks, scores of SDS [（42.81±5.09） points], HAMD [（15.42±1.93） points], negative state of POMS [（61.28±6.84） points] in observation group were lower than those in control group [（54.72±5.89）, （24.17±3.02）, （73.56±8.12） points], positive state of POMS [（29.37±3.41） points], GWB [（112.84±15.76） points] scores in observation group were higher than those in control group [（21.05±2.46）, （85.92±9.14） points], the differences were statistically significant （P 〈 0.05）. Serum contents of CRH [（17.68±1.95） pg/mL], ACTH [（38.94±4.71） pg/mL], CORT[（157.28±19.72） pg/mL], Cor[（115.73±14.92） pg/mL] in observation group were lower than those in control group [（20.91±2.64）, （51.46±5.97）, （213.63±24.95）, （115.73±14.92） pg/mL], the differences were staffs-tieally significant （P〈0.05）. Scores of physiological function [（68.39±7.12） points], social function [（70.38±8.25） points], physiological function [（67.28±7.11） points], body pain [（67.19±7.05） points], mental health [（75.38±8.13） points], emo- tional function [（73.28±8.15） points], vitality [（68.84±7.01） points], general health [（75.36±8.52） points] in observation group were higher than those in control group [（54.93±6.02）, （61.16±6.95）, （58.53±6.09）, （60.26±6.85）, （64.79±7.15）, （65.42±7.09）, （57.93±6.24）, （64.73±7,02） points],the differences were statistically significant （P 〈 0.05）. Conclusion Mindfulness-based cognitive therapy has exactly effect in depression, can effectively optimizate patients＇ emotion, qual- ity of life, balance hypothalamie pituitary axis hormones secretion.