认知行为疗法联合肺康复治疗尘肺病患者效果

Effect on the treatment of patients with pneumoconiosis using cognitive behavior therapy combined with pulmonary rehabilitation

目的观察认知行为疗法(CBT)联合肺康复治疗尘肺病的临床疗效。方法采用方便抽样方法,选择108例尘肺病患者为研究对象;随机分为对照组和CBT组,每组各54例。对照组患者予常规对症治疗和肺康复治疗12周,CBT组患者在对照组治疗的基础上予CBT治疗,分析治疗效果。结果治疗前,2组患者《蒙特利尔认知评估量表》(MoCA)得分、第1秒用力呼气容积占预计值的百分比(FEV_(1)%)、1秒率、《改良版呼吸困难量表》(mMRC)得分、6 min步行试验距离(6MWD),《医院焦虑抑郁量表》(HADS)的《焦虑分量表》(HADS-A)和《抑郁分量表》(HADS-D)、《慢性阻塞性肺疾病评估测试》(CAT)、《圣乔治呼吸问卷》(SGRQ)的得分,以及血清瘦素、白细胞介素-6(IL-6)、C-反应蛋白(CRP)的水平分别比较,差异均无统计学意义(P值均>0.05)。治疗后,与对照组比较,CBT组患者MoCA得分、FEV_(1)%、1秒率和6MWD均升高(P值均<0.05),mMRC、HADS-A、HADS-D、CAT和SGRQ的得分均下降(P值均<0.05),血清瘦素、IL-6和CRP的水平均下降(P值均<0.05)。结论CBT联合肺康复治疗可更好地改善尘肺病患者的认知能力、呼吸功能、运动功能、负性情绪和生活质量,并可减轻炎症反应,具有一定的临床应用价值。

Objective To observe the clinical effects of cognitive behavioral therapy(CBT)combined with pulmonary rehabilitation on the treatment of patients with pneumoconiosis.Methods A total of 108 patients with pneumoconiosis were selected as the research subject using convenient sampling method.They were randomly divided into control group and CBT group,with 54 cases in each group.Patients in the control group were treated with conventional symptomatic treatment and pulmonary rehabilitation treatment for 12 weeks.While patients in the CBT group were treated with CBT treatment in addition to treatments of the control group.The therapeutic effect was analyzed.Results Before treatment,there was no statistical difference on score of Montreal Cognitive Assessment(MoCA),percentage of forced expiratory volume in one second to the predicted value(FEV_(1)%),forced expiratory volume in one second to force vital capacity ratio(FEV_(1)/FVC%),score of the Modified Medical Research Council Dyspnea Scale(mMRC),six minute walk distance(6MWD),Hospital Anxiety and Depression Scale(HADS)subscale scores of anxiety(HADS-A)and depression(HADS-D),and scores of Chronic Obstructive Pulmonary Disease Assessment Test(CAT),St.George's Respiratory Questionnaire(SGRQ),and serum levels of leptin,interleukin-6(IL-6)and C-reactive protein(CRP)between the two groups(all P>0.05).After treatment,the score of MoCA,FEV_(1)%,FEV_(1)/FVC%and 6MWD increased(all P<0.05),while the scores of mMRC,HDS-A,HDS-D,CAT and SGRQ decreased(all P<0.05),and the levels of serum leptin,IL-6 and CRP decreased(all P<0.05)in the CBT group compared with the control group.Conclusion The combined treatment of CBT and pulmonary rehabilitation can better improve the cognitive ability,respiratory function,motor function,negative emotion and quality of life,and alleviate inflammatory response in patients with pneumoconiosis.It is of certain clinical application value.