叙事治疗联合自我管理行为支持在D型人格老年急性心肌梗死患者中的应用

Application of narrative therapy combined with self-management behavioral support in elderly patients with type D personality with acute myocardial infarction

目的探讨叙事治疗联合自我管理行为支持对D型人格老年急性心肌梗死经皮冠状动脉介入治疗(PCI)术后患者心理健康、自我管理行为能力、健康促进生活方式的影响。方法选择某院110例接受PCI治疗的D型人格老年急性心肌梗死(acute myocardial infarction,AMI)患者为研究对象,按收治的顺序,分为对照组和观察组,每组各55例。对照组患者术后常规干预。观察组在对照组基础上增加个性化叙事治疗联合自我管理行为支持。记录出院后急性心脏事件发生情况。采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评估患者心理健康情况。采用冠心病自我管理行为量表(CSMS)评价患者自我管理疾病能力。采用健康促进生活方式量表测评健康促进生活方式水平。采用WHOQOL-100简表评价生存质量。结果干预后,观察组HAMA、HAMD评分分别为(13.60±2.10)分、(12.30±2.22)分均显著低于对照组(20.10±2.40)分、(21.20±3.05)分;观察组健康促进生活方式总分(105.10±7.75)分明显高于对照组(93.30±7.40)分;观察组自我管理能力总分、生存质量得分均明显高于对照组(均P<0.05)。出院后6个月,观察组急性心脏事件发生率(3.64%)低于对照组(16.36%),差异有统计学意义(P<0.05)。结论对D型人格老年AMI患者PCI术后实施个性化叙事疗法联合自我管理行为支持,能逐步缓解患者悲伤、抑郁等负性情绪,促使患者主动形成健康促进生活方式,增强自我管理行为水平,重建自我价值,继而全面改善健康状况与生存质量,实现更高层次的健康与幸福。

Objective To explore the effects of narrative therapy combined with self-management behavioral support on mental health,self-management behavioral ability and health-promoting lifestyle of elderly patients with type D personality after percutaneous coronary intervention(PCI)for acute myocardial infarction.Methods A total of 110 elderly patients with type D personality and AMI who received PCI treatment in a hospital were selected as the research objects.According to the order of admission,they were divided into control group and observation group,with 55 cases in each group.The control group received routine intervention after surgery.In the observation group,personalized narrative therapy combined with self-management behavioral support was added on the basis of the control group.The incidence of acute cardiac events after discharge was recorded.HAMA scale and HAMD scale were used to evaluate patients'mental health.The CSMS scale was used to evaluate patients'ability to self-manage disease.The health promotion lifestyle scale was used to evaluate the level of health promotion lifestyle.The quality of life was evaluated by WHOQOL-100.Results After intervention,HAMA and HAMD scores of the observation group were(13.60±2.10)and(12.30±2.22)points,respectively,significantly lower than those of the control group(20.10±2.40)and(21.20±3.05)points.The total score of health promoting lifestyle in the observation group(105.10±7.75)was significantly higher than that in the control group(93.30±7.40).The scores of self-management ability and quality of life in the observation group were significantly higher than those in the control group(all P<0.05).Six months after discharge,the incidence of acute cardiac events in the observation group(3.64%)was lower than that in the control group(16.36%),P<0.05,and the difference was statistically significant.Conclusion The implementation of personalized narrative therapy combined with self-management behavioral support for elderly AMI patients with type D personality after PCI can gradually relieve the patients'negative emotions such as sadness and depression,and promote the patients to take the initiative to form a health-promoting lifestyle,so as to strengthen the level of self-management behavior,rebuild self-worth,and then improve overall health status and quality of life,to achieve a higher level of health and happiness.