意义疗法对改善维持性血液透析患者不良情绪及生活质量的临床观察

The effect of Frank therapy on quality of life in maintenance hemodialysis patients

【目的】探讨意义疗法对改善维持性血液透析(maintained hemodialysis,MHD)患者不良情绪及生活质量的临床价值。方法选择在本透析中心行MHD治疗的患者156例(男70例,女86例,年龄22~75岁)随机分为对照组和研究组,每组各78例。对照组采用常规心理护理,研究组在常规心理护理基础上使用意义疗法进行干预。利用焦虑量表、抑郁量表、生存质量量表和匹兹堡睡眠质量指数量表分别对2组患者入组前和入组后第3、6、12个月的相关指标进行评估分析,同时观察记录患者的血压情况。结果与对照组比较,研究组患者第6月焦虑评分(t=-2.704,P=0.022)、抑郁评分(t=-2.684,P=0.022)、睡眠质量指数(t=1.945,P=0.035)和12个月焦虑评分(t=-3.411,P=0.003)、抑郁评分(t=-2.757,P=0.031)、睡眠质量指数(t=-2.786,P=0.002)显著降低,具有统计学意义。研究组患者第3个月(χ~2=0.475,P=0.661),第6月(χ~2=11.952,P=0.001),第12月(χ~2=21.501,P=0.002)血压控制达标率显著高于对照组。研究组患者第12个月生活质量评分中的躯体功能(t=1.931,P<0.001)、躯体问题所造成的角色限制(t=-2.112,P<0.001)、躯体不适(t=0.533,P=0.012)、健康总体自评(t=1.931,P=0.031)、活力(t=1.324,P=0.013)、情感角色(t=2.180,P=0.011)分值均显著高于对照组。结论意义疗法能够改善MHD患者的不良情绪、睡眠质量和生存质量,能够提高血压控制达标率。

Objective To investigate the clinical value of Frank＇s meaningful therapy for improving the quality of life in maintenance hemodialysis （MHD） patients. Methods A total of 156 MHD patients （70 males and 86 females with the age of 22-75 years old） were enrolled in this study. They were randomly divided into control group （n=78） and study group （n=78）. Patients in the control group were treated with routine psychological nursing, while those in the study group were treated with Frank therapy. The patients were assessed before the therapy and after the therapy for 3, 6 and 12 months. Anxiety scale, depression scale and SF-36 scale were used to evaluate the quality of life. Results The study group had lower anxiety score （t=-2.704, P=0.022）, depression score （t=-2.684, P=0.022） and sleep quality index （t=1.945, P=0.035） at 6th month of the therapy as compared those in the control group. The compliance rate of blood pressure control was significantly higher in the study group than in the control group at 3rd month （χ2=0.475, P=0.661）, 6th month （χ2=11.952, P=0.001） and 12th month （χ2=21.501, P=0.002） after the therapy. PF （t=1.931, P〈0.001）, RP （t=-2.112, P〈0.001）, BP （t=0.533, P=0.012）, GHP （t=1.931, P=0.031）, VT （t=1.324, P=0.013） and REP （t=2.180, P=0.011） scores of the quality of life scales were significantly higher in the study group than in the control group. Conclusion Frank＇s meaningful therapy can significantly improve mood, sleep quality, quality of life, and the compliance rate of blood pressure control in MHD patients.