正念认知治疗对急性脑梗死患者病耻感、自我效能及生活质量的影响

Effect of mindfulness-based cognitive therapy on stigma,self-efficacy and quality of life in patients with acute cerebral infarction

目的:探讨正念减压疗法(MBSR)对急性脑梗死(ACI)患者病耻感、自我效能及生活质量的影响。方法:遴选90例ACI患者随机均分为对照组和观察组,对照组给予常规康复干预,观察组基于以上干预基础给予MBSR干预,观察两组干预前及干预6周后的病耻感、自我感受负担、正念水平、自我效能感及生活质量的变化。结果:干预后,观察组和对照组的关于病耻感量表中疏远因子(t=10.803,5.925;P<0.05)、刻板因子(t=10.509,5.562;P<0.05)、歧视因子(t=11.519,5.858;P<0.05)、抵抗因子(t=9.984,5.519;P<0.05)及社会退缩因子(t=9.005,4.159;P<0.05)共5项评分显著降低,观察组和对照组的自我感受负担量表(SPBS)评分(t=14.173,5.857;P<0.05)显著降低,正念注意觉知量表(MAAS)(t=-7.942,-4.904;P<0.05)及一般自我效能感量表(GSES)评分(t=-18.144,-7.994;P<0.05)显著提高,观察组和对照组的生命质量简表SF-36中生理机能(t=-7.049,-3.658;P<0.05)、生理职能(t=-5.834,-3.099;P<0.05)、躯体疼痛(t=-7.022,-4.111;P<0.05)、一般健康(t=-7.559,-3.516;P<0.05)、活力(t=-7.483,-4.438;P<0.05)、社会功能(t=-6.224,-2.854;P<0.05)、情感职能(t=-7.159,-2.667;P<0.05)及精神健康(t=-7.441,-4.125;P<0.05)显著降低,以上指标观察组变化幅度显著大于对照组(t=4.612,3.742,4.686,3.091,4.249,5.692,2.210,6.7422.404,2.194,2.459,2.701,2.051,2.528,3.115,2.965;P<0.05)。结论:MBSR法可有效减轻ACI患者的病耻感和自我感受负担,提高其正念水平和自我效能感,利于患者生活质量提高。

Objective:To explore the effects of mindfulness-based stress reduction(MBSR)on stigma,self-efficacy and quality of life in patients with acute cerebral infarction(ACI).Methods:A total of 90 patients with ACI were selected and randomly divided into control group and observation group.Control group was given routine rehabilitation intervention,and observation group was given MBSR intervention based on the basis of above intervention.The stigma,self-perceived burden,mindfulness level,self-efficacy and quality of life were observed in the two groups before intervention and after 6 w of intervention.Results:After intervention,the scores of 5 items of alienation factor(t=10.803,5.925;P<0.05),stereotype factor(t=10.509,5.562;P<0.05),discrimination factor(t=11.519,5.858;P<0.05),resistance factor(t=9.984,5.519;P<0.05)and social withdrawal factor(t=9.005,4.159;P<0.05)in observation group and control group were significantly reduced,and the score of Self-Perceived Burden Scale(SPBS)(t=14.173,5.857,P<0.05)in observation group and control group was significantly reduced,and the scores of Mindfulness Attention Awareness Scale(MAAS)(t=-7.942,-4.904;P<0.05)and General Self-Efficacy Scale(GSES)(t=-18.144,-7.994;P<0.05)were significantly improved,and the scores of physiological function(t=-7.049,-3.658;P<0.05),role physical(t=-5.834,-3.099;P<0.05),physical pain(t=-7.022,-4.111;P<0.05),general health(t=-7.559,-3.516;P<0.05),vitality(t=-7.483,-4.438;P<0.05),social function(t=-6.224,-2.854;P<0.05),emotional function(t=-7.159,-2.667;P<0.05)and mental health(t=-7.441,-4.125;P<0.05)of quality of life short-form SF-36 in observation group and control group were significantly decreased,and the changes of the above indicators were significantly greater than those in control group(t=4.612,3.742,4.686,3.091,4.249,5.692,2.210,6.742,2.404,2.194,2.459,2.701,2.051,2.528,3.115,2.965;P<0.05).Conclusion:MBSR can effectively alleviate the stigma and self-perceived burden of ACI patients,improve the mindfulness level and self-efficacy,and help to enhance the quality of life.