认知行为疗法结合生物反馈训练对冠状动脉搭桥患者术后认知、应激反应的影响

Effects of Cognitive Behavioral Therapy Combined with Biofeedback Training on Postoperative Cognitive and Stress Responses in Patients Undergoing Coronary Artery Bypass Grafting

目的:探讨认知行为疗法(cognitive and behavior therapy,CBT)结合生物反馈训练对冠状动脉搭桥患者术后认知、应激反应的影响。方法:选取2017年5月—2021年4月驻马店市中心医院收治的126例进行冠状动脉搭桥术的患者作为研究对象,根据围术期应用的护理方案将患者分为对照组(n=63,常规护理干预)及试验组(n=63,CBT结合生物反馈训练护理干预)。术后随访6个月,监测并比较两组患者术后心率变异性指标、情绪、认知、应激反应相关指标。结果:对各项心率变异性检测指标比较可见,术后3个月两组患者全部窦性心搏RR间期(简称NN间期)的标准差(standard diviation of NN intervals,SDNN)、相邻正常心动周期差值的均方根(root mean square of the successive differences rMSSD)均较术前升高,且术后3个月试验组心率变异性指标改善情况均优于对照组,差异有统计学意义(t=6.805、8.064,P<0.05);干预后焦虑自评量表(Self-Rating Anxiety Scale,SAS)与抑郁自评量表(Self-rating depression scale,SDS)评分比较可见,两组患者均较干预前降低,且试验组较对照组降低,差异有统计学意义(t=19.400、10.214,P<0.05);术后简易智力状态检查量表(mini-mental state examination,MMSE)评分比较可见,术后3 d、7 d、14 d试验组均显著高于对照组,差异有统计学意义(t=2.378、3.190、6.610,P<0.05);两组患者术后心率、舒张压比较,试验组低于对照组,差异有统计学意义(t=15.913、10.734,P<0.05)。结论:与常规护理干预相比,进行冠状动脉旁路移植术的患者应用CBT结合生物反馈训练干预可更有效地改善心率变异性,改善患者抑郁情绪,提升患者的术后认知能力,降低其生理应激反应。

Objective:To investigate the effects of cognitive and behavior therapy(CBT)combined with biofeedback training on the cognitive and stress responses of postoperative coronary artery bypass graft patients.Methods:126 patients admitted to the hospital for coronary artery bypass grafting from May 2017 to April 2021 were selected as study subjects,and the patients were divided into a control group(63 cases,conventional nursing intervention)and a pilot group(63 cases,CBT combined with biofeedback training nursing intervention)according to the perioperative applied nursing protocol.Patients were followed up for 6 months after surgery,and postoperative heart rate variability indexes,mood,cognition,and stress response-related indexes were monitored and compared between the two groups.Results:At 3 months after surgery,the standard diviation of NN intervals(SDNN),root mean square of the successive differences rMSSD,and the standard diviation of NN intervals(SDNN)of all sinus beats in both groups were higher than those before surgery,and the improvement of heart rate variability indexes in the test group was better than that in the control group at 3 months after surgery,and the difference was statistically significant(t=6.805,8.064,P<0.05).After the intervention,the scores of Self-Rating Anxiety Scale(SAS)and Self-rating depression scale(SDS)decreased in both groups compared with those before the intervention,and the test group was lower than the control group,and the difference was statistically significant(t=19.400,10.214,P<0.05).At 3 d,7 d,and 14 d postoperatively,the postoperative simple mental state examination scale(MMSE)scores were higher in the test group than in the control group,with statistically significant differences(t=2.378,3.190,6.610,P<0.05).The postoperative heart rate and diastolic blood pressure in the test group were lower than those in the control group,the differences were statistically significant(t=15.913,10.734,P<0.05).Conclusion:Compared with conventional nursing interventions,CBT combined with biofeedback training intervention in patients undergoing coronary artery bypass grafting was more effective in improving heart rate variability,improving patients’depression,enhancing their postoperative cognitive abilities,and reducing physiological stress responses.