认知行为干预联合康复锻炼对腰椎间盘突出症术后腰椎功能康复和恐动程度的影响

Effect of cognitive behavior intervention combined with rehabilitation exercise on the recovery of lumbar function and the degree of phobia after operation of lumbar disc herniation

目的探讨研究认知行为干预对腰椎间盘突出症(LDH)术后恐动、疼痛度及康复结局的影响。方法收集漯河市中心医院2019年6月至2021年5月收治的128例行腰椎融合术的患者进行回顾性研究,按照不同的护理干预方案,分为常规护理组和认知行为干预组,常规护理组给予一般的护理干预和心理干预,认知行为干预组在常规护理的基础上给予认知行为干预。比较两组干预前、出院日、出院后1个月、3个月及6个月的恐动情况、腰椎功能康复及疼痛程度。结果恐动症TSK评分量表(TSK)、日本骨科协会评估治疗分数(JOA)、疼痛数字评分表(NRS)评分的比较:两组患者的TSK、JOA、NRS评分在组间效应、时间效应和交互作用上,差异有高度统计学意义(P<0.01)。各时间点分数的比较:在实施干预前两组患者TSK评分、JOA评分、NRS评分相比,差异均无统计学意义(P>0.05);在出院当天及出院后1个月,两组患者TSK评分和NRS评分差异均无统计学意义(P>0.05),而JOA评分差异有统计学意义(P<0.05);出院后3个月和6个月时,认知行为干预组患者的TSK评分、NRS评分明显低于常规护理组,JOA评分明显高于常规护理组,其差异均有高度统计学意义(P<0.01)。结论认知行为干预方案能够显著降低LDH术后患者的恐动程度,有效促进患者的腰椎功能恢复,显著缓解患者的术后疼痛程度。

Objective To explore the effect of cognitive behavior intervention on postoperative phobia,pain and rehabilitation outcome of lumbar disc herniation(LDH).Methods A retrospective study was conducted on 128 patients who underwent lumbar fusion surgery in Luohe Central Hospital from June 2019 to may 2021.According to different nursing intervention schemes,they were divided into conventional nursing group and cognitive behavior intervention group.The conventional nursing group was given general nursing intervention and psychological intervention,and the cognitive behavior intervention group was given cognitive behavior intervention on the basis of conventional nursing.The phobia,recovery of lumbar function and pain of the two groups were compared before intervention,on the day of discharge,1 month,3 months and 6 months after discharge.Results Comparison of TSK scores,JOA scores and NRS scores of the Japanese Orthopaedic Association:the difference of TSK,JOA and NRS scores between the two groups was statistically significant in the inter group effect,time effect and interaction(P<0.01).Comparison of scores at each time point:before the intervention,there was no significant difference in the TSK score,JOA score and NRS score between the two groups(P>0.05);On the day of discharge and one month after discharge,there was no significant difference in TSK score and NRS score between the two groups(P>0.05),but there was significant difference in JOA score(P<0.05);At 3 and 6 months after discharge,the TSK score and NRS score of the patients in the cognitive behavior intervention group were significantly lower than those in the conventional nursing group,and the JOA score was significantly higher than that in the conventional nursing group.The difference was highly statistically significant(P<0.01).Conclusion Cognitive behavior intervention program can significantly reduce the degree of phobia of patients after LDH,effectively promote the recovery of lumbar function,and significantly alleviate the postoperative pain of patients.