正念认知改善腹膜透析患者慢性失眠的效果研究

Effectiveness of Mindfulness-Based Cognitive Behavioral Therapy on Peritoneal Dialysis Pa⁃tients with Insomnia

目的:探讨以正念为基础的认知行为疗法(MBCT)对腹膜透析患者失眠症状和透析效果的影响。方法:将70例符合失眠症诊断的终末期肾病腹膜透析患者随机分为2组,各35例。对照组接受睡眠卫生教育,试验组在此基础上接受8周的MBCT治疗。在治疗前、后,采用肾脏疾病生活质量简表的睡眠分量表(SQS)评估患者睡眠质量,采用五因素正念度量表(FFMQ)评估试验组的正念情况,并检测2组的血清白蛋白(ALB)、C反应蛋白(CRP)、尿素清除率(Kt/V)。结果:治疗后,对照组的AlB和Kt/V低于同组治疗前(P<0.05),试验组的CRP低于同组治疗前和对照组(P<0.05),试验组的Kt/V高于对照组(P<0.05);试验组FFMQ量表各分量表的评分均高于治疗前(P<0.05);试验组SQS量表总分高于对照组及同组治疗前(P<0.05),且试验组的SQS量表各项评分均高于同组治疗前(P<0.05)。结论:MBCT可以有效减轻腹膜透析患者的失眠症状,并提高透析的充分性和营养状况,减轻炎症,是一种安全有效的心身治疗方法。

Objective:To investigate the effect of mindfulness-based cognitive behavioral therapy(MBCT)on peritoneal dialysis patients with insomnia.Methods:Seventy end-stage kidney disease patients receiving peritoneal dialysis who were diagnosed with insomnia were randomly divided into the control group and therapy group,with 35 patients in each.Cases in both groups received sleep hygiene education.Cases in the therapy group additionally received 8 weeks of MBCT.All patients were evaluated by the sleep quality scale(SQS)before and after intervention.The Five Facet Mindfulness Questionnaire(FFMQ)was adopted to assess mindfulness in therapy group patients.The serum albumin(Alb),C-reactive protein(CPR),and urea clearance(Kt/V)in both groups were investigated.Results:After treatment,the Alb and Kt/V in the control group were decreased compared to those before treatment(P<0.05).The CRP in the therapy group was decreased compared to that before treatment and that of the control group(P<0.05).The Kt/V in the therapy group was greater than that of the control group(P<0.05).The therapy group showed an increased score in every component of the FFMQ compared to that before treatment(P<0.05).After treatment,the total SQC score in the therapy group was increased compared to the control group and therapy group before treatment(P<0.05),and the scores of all items of the SQS were increased compared to those before treatment within the same group(P<0.05).Conclusion:MBCT may alleviate insomnia symptoms in peritoneal dialysis patients and may improve the effect of dialysis and reduced inflammation.MBCT can serve as a safe and effective means of psychosomatic therapy.