团体积极心理治疗联合认知干预对慢性心力衰竭患者抑郁、心理弹性及认知功能的影响

Effects of group positive psychotherapy combined with cognitive intervention on depression, psychological elasticity and cognitive function in patients with chronic heart failure

目的探讨团体积极心理治疗联合认知干预对慢性心力衰竭（CHF）患者抑郁、心理弹性及认知功能的影响。方法采用方便抽样法，选取南京医科大学附属无锡第二医院2016年8月-2017年8月的CHF患者86例，按照随机数字表法分为对照组与干预组，每组各43例。对照组给予常规治疗及护理，干预组在此基础上接受6周团体积极心理治疗联合认知干预，在干预前、干预3周后、干预后第6个月、干预后第12个月采用返院评估、随访或电话调查等方法，利用汉密顿抑郁量表（HAMD）、心理弹性量表（CD—RISC）、蒙特利尔认知评估量表（MoCA）及自我护理能力实施量表（ESCA）评估两组患者的抑郁情绪、心理弹性、认知水平及自我管理能力。记录并比较两组患者干预前后心力衰竭发作次数。结果干预组患者在干预3周后HAMD、CD—RISC均分分别为为（16．32±1，404）分和（63．91±2．644）分，其抑郁情绪改善程度优于对照组（P〈0．05）。干预后第6个月和第12个月干预组MoCA得分分别为（26．65±1．850）分和（26．19±1．906）分，其下降水平低于对照组，差异均有统计学意义（P〈0．05）。干预组患者干预后自我管理能力优于对照组，且心力衰竭力次数少于对照组，差异均有统计学意义（P〈0．05）。结论团体积极心理治疗联合认知干预能够有效改善CHF患者抑郁情绪，提升心理弹性水平和认知功能，提高自我健康照护管理能力，减少心力衰竭力发作次数，并有一定远期效果。

Objective To explore the effect of group positive psychotherapy combined with cognitive intervention on depression, resilience and cognitive function in patients with chronic heart failure （CHF）. Methods A total of 86 patients with CHF who were undertaking treatment in the Wuxi NO.2 People＇s Hospital from August 2016 to August 2017 were selected by convenience sampling method, and divided into control group and intervention group by random number table method, with 43 cases in each group. The patients in the control group were given routine treatment and nursing, while the patients in the intervention group received 6 weeks of group positive psychotherapy combined with cognitive intervention. Hamilton Depression Scale （HAMD）, Psychological Resilience Scale （CD-RISC）, Montreal Cognitive Assessment Scale （MoCA） and Self-Care Ability Implementing Scale （ESCA） were used to investigate the patients before intervention, 3 weeks after intervention, 6 months after intervention and 12 months after intervention to assess patients＇ depression, resilience, cognitive level and self-management ability. The number of heart failure episodes before and after intervention was recorded and compared between the two groups. Results The average scores of HAMD and CD-RISC in intervention group were （16.32 ±1.404） and （63.91 ±2.644） respectively after 3 weeks of intervention. The improvement of depression was better than that of control group （P 〈 0.05）. The scores of MoCA in intervention group at 6 and 12 months after intervention were （26.65 ± 1.850） and （26.19 ±1.906） respectively. The decrease level was lower than that in control group, and the difference was statistically significant （P 〈 0.05）. The self-management ability of the intervention group was better than that of the control group, and the times of heart failure was less than that of the control group, with statistical significance （P 〈 0.05）. Conclusions Group positive psychotherapy combined with cognitive intervention can effectively improve the depressive mood of CHF patients, enhance the level of psychological resilience and cognitive function, improve the abihty of self-health care and management, reduce the number of heart failure attacks, and has a certain long-term effect.