叙事性健康干预在类风湿关节炎中的应用效果

Application effect of narrative health intervention in rheumatoid arthritis

目的:探讨基于针对性管理的叙事性健康干预对类风湿关节炎(RA)患者负性心理、正念思维和生活质量的影响。方法:选择2020年1月至2021年12月在某院就诊的134例RA患者作为研究对象,采用随机数字表法将患者分为对照组和观察组各67例。对照组给予常规性健康干预,观察组给予基于针对性管理的叙事性健康干预。干预前(入组时)、干预后(出院时)采用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估患者负性心理状态,采用正念注意觉知量表(MAAS)评估患者的正念水平,采用心理弹性量表(CD-RISC)评估患者的心理弹性,采用简易应对方式问卷(SCSQ)评估患者的应对方式,采用类风湿性关节炎患者生活质量量表(QLICD-RA)评估患者的生活质量。结果:干预后两组患者SAS评分、SDS指数、消极应对均较干预前显著降低(t=4.774,5.116,9.449,9.370,4.679,12.056;P<0.05),且观察组上述指标均较同期对照组显著降低(t=4.723,4.783,6.531;P<0.05)。干预后两组患者MAAS评分、CD-RISC评分(坚韧、乐观、自强和CD-RISC总分)、SCSQ积极应对、SCSQ应对倾向、QLICD-RA评分(躯体功能、心理功能、社会功能、特异模块及QLICD-RA总分)均较干预前显著升高(t=6.648,12.532,8.769,12.757,5.045,8.866,14.906,16.994,11.745,13.909,5.045,21.224,9.786,24.865,7.758,7.137,2.370,10.492,6.104,11.963,14.716,8.830,15.288,11.501;P<0.05),且观察组上述指标均高于同期对照组(t=6.802,5.076,6.006,5.113,5.464,4.211,17.290,3.813,7.093,5.553,3.803,5.617;P<0.05)。结论:基于针对性管理的叙事性健康干预可减少RA患者的负面情绪,提高患者正念水平,改善其心理弹性和应对方式,提高患者的生活质量。

Objective:To explore the effect of narrative health intervention based on targeted management on negative psychology,mindfulness and quality of life of patients with rheumatoid arthritis.Methods:A total of 134 patients with RA treated in our hospital from January 2020 to December 2021 were selected as the research object.Patients were randomly divided into control group and observation group,with 67 cases in each group.The control group was given routine health intervention,and the observation group was given narrative health intervention based on targeted management.Before the intervention(at the time of enrollment)and after the intervention(at the time of discharge),the negative psychological state of patients was assessed by self rating Anxiety Scale(SAS)and self rating Depression Scale(SDS),the mindfulness level of patients was assessed by mindfulness attention Awareness Scale(MAAS),the psychological elasticity of patients was assessed by Psychological Resilience Scale(CD-RISC),the coping style of patients was assessed by simple coping style questionnaire(SCSQ),and the quality of life of patients with rheumatoid arthritis(QLICD-RA)was evaluated.Results:After the intervention,the SAS score,SDS index and negative coping in the two groups were significantly lower than those before the intervention(t=4.774,5.116,9.449,9.370,4.679,12.056;P<0.05),and the above indexes in the observation group were significantly lower than those in the control group in the same period(t=4.723,4.783,6.531;P<0.05).After the intervention,MAAS score,CD-RISC score(tenacity,optimism,self-improvement and total score of CD-RISC),SCSQ positive coping,SCSQ coping tendency and QLICD-RA score(physical function,psychological function,social function,specific module and total score of QLICD-RA)in the two groups were significantly higher than those before the interventio n(t=6.648,12.532,8.769,12.757,5.045,8.866,14.906,16.994,11.745,13.909,5.045,21.224,9.786,24.865,7.758,7.137,2.370,10.492,6.104,11.963,14.716,8.830,15.288,11.501;P<0.05),and the above indexes in the observation group were higher than those in the control group in the same period(t=6.802,5.076,6.006,5.113,5.464,4.211,17.290,3.813,7.093,5.553,3.803,5.617;P<0.05).Conclusion:Narrative health intervention based on targeted management can reduce the negative emotions of RA patients,improve their mindfulness level,improve their psychological resilience and coping style,and improve their quality of life.