阶梯疗法对中青年早期腹膜透析患者疾病适应能力及应对方式的影响

Effects of stepped-care intervention on disease adaptation and medical coping among young and middle-aged patients undergoing early stage of peritoneal dialysis

目的探讨阶梯疗法对中青年早期腹膜透析患者疾病适应能力和应对方式的影响。方法选择2018年1月至2019年12月桂林医学院附属医院肾内科治疗的中青年早期腹膜透析患者72例为研究对象。按照抽签法分为试验组和对照组,每组36例。对照组给予常规干预,试验组在此基础上实施6次基于阶梯疗法的综合适应方案。干预前和干预6周后,采用疾病心理社会适应量表(PAIS-SR)和医学应对方式问卷(MCMQ)评价干预效果。结果干预后,试验组PAIS-SR量表中卫生保健、工作能力、家庭关系、交流情况、娱乐情况、心理状态等维度得分及总分分别为(7.88±1.53)、(9.12±1.30)、(6.62±1.10)、(6.74±1.31)、(6.44±1.80)、(8.29±1.83)、(50.35±4.26)分,明显低于对照组的(8.70±1.33)、(10.06±1.90)、(7.61±1.66)、(7.73±1.86)、(7.48±2.15)、(9.45±1.60)、(56.58±5.04)分,2组比较差异有统计学意义(t值为2.317~5.464,P<0.01或0.05)。试验组MCMQ量表中面对分量表得分为(12.97±2.44)分,明显高于对照组的(11.58±2.33)分;回避、屈服分量表得分为(16.41±1.46)、(13.44±1.83)分,明显低于对照组的(17.76±1.52)、(14.73±2.36)分,2组比较差异有统计学意义(t值为2.389、3.696、2.496,P<0.05)。结论阶梯疗法能提高中青年早期腹膜透析患者疾病适应能力,提高其积极医学应对方式。

Objective To explore the effects of stepped-care intervention on disease adaptation and medical coping among young and middle-aged patients undergoing early stage of peritoneal dialysis.Methods Totally,72 young and middle-aged patients undergoing early stage of peritoneal dialysis from January 2018 to December 2019 in the Affiliated Hospital of Guilin Medical College were divided into experimental group and control group according to drawing lots methods,each group contained 36 cases.The control group received routine nursing,while patients in the experimental group were given stepped-care intervention for 6 times.Before and after intervention,the effects was assessed by Self-report Pychosocial Adjustment to Illness Scale(PAIS-SR)and Medical Coping Modes Questionnaire(MCMQ),respectively.Results After intervention,the health care scores,ability to work scores,family relationship scores,communication scores,entertainment scores,psychological condition scores and total PAIS-SR scores were 7.88±1.53,9.12±1.30,6.62±1.10,6.74±1.31,6.44±1.80,8.29±1.83,50.35±4.26 in the experimental group,significantly lower than those in the control group 8.70±1.33,10.06±1.90,7.61±1.66,7.73±1.86,7.48±2.15,9.45±1.60,56.58±5.04(t values were 2.317-5.464,P<0.01 or 0.05).the MCMQ scores in facing were 12.97±2.44 in the experimental group,significantly higher than that in the control group 11.58±2.33;the avoidance and yielding scores were 16.41±1.46,13.44±1.83 in the experimental group,significantly lower than those in the control group(17.76±1.52,14.73±2.36),the differences were statistically significant(t values were 2.389,3.696,2.496,P<0.05).Conclusions Stepped-care intervention can improve the ability of disease adaptation and promote the positive transformation of young and middle-aged patients undergoing early stage of peritoneal dialysis.