团体认知行为治疗对社区慢性阻塞性肺疾病患者焦虑抑郁及生存质量的干预效果

Effect of group cognitive behavioral therapy on anxiety, depression and quality of life in patients with chronic obstructive pulmonary disease in community

目的探讨团体认知行为治疗(group cognitive behavior therapy, GCBT) 对社区慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者焦虑抑郁情绪和生存质量的影响。方法 2019年8月至11月, 选取徐州市18个社区中稳定期COPD患者, 以社区为单位随机地分为干预组(n=240)和对照组(n=223), 对照组进行常规管理, 干预组在常规管理的基础上进行为期8周的团体认知行为疗法干预。干预前后分别使用肺功能检测仪检测患者FEV1%预计值、FEV1/FVC;采用医院焦虑抑郁量表(hospital anxiety and depression scale, HADS)评估患者焦虑抑郁情况;圣乔治呼吸问卷(St.George’s respiratory questionnaire, SGRQ)、慢性阻塞性肺疾病评估测试量表(COPD assessment test, CAT)、呼吸困难量表(modified medical research council dyspnea, mMRC)评估患者生存质量。采用SPSS 20.0软件进行分析处理。采用χ^(2)检验, 独立样本t检验、配对样本t检验进行统计分析。结果干预8周后, 干预组焦虑、抑郁评分低于对照组[焦虑:(8.23±4.02)分, (10.71±3.60)分;抑郁:(7.87±3.73)分, (10.20±3.72)分, t=6.415, 6.185,P<0.01]。干预后, 两组FEV1%预计值、FEV1/FVC差异均无统计学意义[(51.7±12.3)%, (52.0±12.6)%, t=-0.259, P>0.05;(57.3±10.8)%, (56.9±10.7)%, t=0.400,P>0.05]。干预后干预组mMRC、CAT、SGRQ评分均低于对照组[(1.55±0.82)分, (2.30±1.21)分;(17.35±5.78)分, (20.90±8.00)分;(41.78±21.56)分, (57.08±24.46)分;t=-7.227, -5.061, -6.580, 均P<0.01]。结论团体认知行为疗法可以改善COPD患者的焦虑、抑郁情绪, 提高患者的生存质量。

Objective To explore the effect of group cognitive behavior therapy(GCBT)on anxiety,depression and quality of life in patients with chronic obstructive pulmonary disease(COPD)in community.Methods From August to November 2019,patients with moderate COPD in 18 communities in Xuzhou City were randomly divided into the intervention group(n=240)and the control group(n=223).The control group received routine management and the intervention group received group cognitive behavioral therapy intervention for 8 weeks on the basis of routine management.Before and after the intervention,FEV1%predicted value and FEV_(1)/FVC were measured by pulmonary function tester.Hospital Anxiety and Depression Scale(HADS)was used to evaluate the anxiety and depression of patients.St.George's respiratory questionnaire(SGRQ),COPD assessment test(CAT)and modified medical research council dyspnea(mMRC)were used to evaluate the quality of life of patients.SPSS 20.0 software was used for analysis.The χ^(2) test,independent sample t-test,paired sample t-test were used for statistical analysis.Results After 8 weeks of intervention,the anxiety and depression scores of the intervention group were lower than those of the control group(anxiety:(8.23±4.02)vs(10.71±3.60);depression:(7.87±3.73)vs(10.20±3.72)(t=6.415,6.185,both P<0.01).After the intervention,there was no significant difference in FEV1%((51.7±12.3)%vs(52.0±12.6)%)predicted value and FEV1/FVC((57.3±10.8)%vs(56.9±10.7)%)between the two groups(t=-0.259,0.400,both P>0.05).The scores of CAT,mMRC and SGRQ in the intervention group were lower than those in the control group((17.35±5.78)vs(20.90±8.00),(1.55±0.82)vs(2.30±1.21),(41.78±21.56)vs(57.08±24.46))(t=-5.061,-7.227,-6.580,all P<0.01).Conclusion Group cognitive behavioral therapy can relieve the anxiety and depression and improve the quality of life of patients with COPD.