贝克认知疗法干预对呼吸机相关肺炎患者后期撤机困难及心理状态的影响

Effect of Baker cognitive therapy intervention on late weaning difficulty and mental state in patients with VAP

目的:探讨贝克认知疗法干预对呼吸机相关肺炎(Ventilator associated pneumonia,VAP)患者后期撤机困难及心理状态的影响。方法:选取2018年4月-2020年4月本院重症监护室(Intensive Care Unit,ICU)收治的VAP患者124例为研究对象,随机分为观察组和对照组,每组各62例。对照组采用常规干预,观察组在对照组基础上给予床旁一对一贝克认知疗法干预。比较两组撤机情况,干预前后焦虑自评量表(Self-Rating Anxiety Scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)评分、症状自评量表(Symptom Checklist 90,SCL-90)评分,两组患者满意度。结果:观察组在撤机次数、撤机时间及患者耐受程度方面均优于对照组,差异有统计学意义(χ^(2)=15.110,11.896,17.555;P<0.05);干预后,观察组SAS、SDS评分均低于对照组,差异有统计学意义(t=-6.287,-5.048;P<0.05);干预后,观察组抑郁、焦虑、恐怖、偏执、强迫症状、躯体化评分均低于对照组,差异有统计学意义(t=-4.747,-3.707,-4.529,-4.408,-3.901,-3.161;P<0.05);观察组总满意度高于对照组,差异有统计学意义(χ^(2)=5.035,P<0.05)。结论:贝克认知疗法干预能有效改善VAP患者后期撤机困难情况,减轻患者焦虑、抑郁程度,提高患者心理健康水平及满意度。

Objective:To explore the effect of Baker cognitive therapy on the difficulty of weaning and psychological status in patients with ventilator-associated pneumonia(VAP).Methods:From April 2018to April 2020,124patients with VAP were selected from Intensive Care Unit(ICU)of our hospital.They were randomly divided into observation group(n=62)and control group(n=62).The control group was treated with routine intervention,and the observation group was treated with bedside one-to-one Baker cognitive therapy on the basis of the control group.The weaning conditions of the two groups were compared,and the scores of self-rating anxiety scale(SAS),selfrating depression scale(SDS)and symptom checklist 90(SCL-90)were compared between the two groups before and after intervention.Results:The times of withdrawal,the time of withdrawal and the tolerance of patients in the observation group were significantly better than those in the control group(χ^(2)=15.110,11.896,17.555;P<0.05).After intervention,the scores of SAS and SDS in the observation group were lower than those in the control group,and the difference was statistically significant(t=-6.287,-5.048;P<0.05).After intervention,the scores of depression,anxiety,phobia,paranoia,obsessive-compulsive symptoms and somatization in the observation group were lower than those in the control group,and the difference was statistically significant(t=-4.747,-3.707,-4.529,-4.408,-3.901,-3.161;P<0.05).The total satisfaction of the observation group was higher than that of the control group,and the difference was statistically significant(χ^(2)=5.035,P<0.05).Conclusion:Baker cognitive therapy intervention can effectively improve the difficulty of weaning in the later stage of VAP,reduce the degree of anxiety and depression,and improve the mental health level and satisfaction of patients.